Carpal Tunnel Syndrome

 

What is it?

Carpal tunnel syndrome (CTS) is a set of signs and symptoms brought about by entrapment of the median nerve between the carpal bones of the wrist and the transverse carpal ligament that holds down the flexor tendons. The median nerve supplies the thumb, forfinger, middle finger, and half of the ring finger. If it is caught or squeezed in any way, it creates symptoms in the part of the hand the nerve supplies.

 

How is it recognized?

CTS can cause pain, tingling, numbness, and weakness in the part of the hand supplied by the median nerve.

What happens?

The source of the pain associated with CTS is debatable. While some experts claim that pressure directly on the nerve causes pain, other suggest that pressure impedes  blood flow to the nerve, and that is the source of the problem.

Whether the damage is the nerve itself or to it blood supply, pressure within the carpal tunnel may arise from several sources. To develop a treatment strategy and to assess the appropriateness of massage, the aggravating factors must be determined.

Like Edema: Fluid retention, which is common for overweight people as well as menopausal and pregnant woman, creates extra pressure in an area with no room to spare.

Or Subluxation: Sometimes the carpal bones, especially the capitate bone in the center of the distal row of carpal bones, subluxate toward the palmar side. This can put mechanical pressure on the median nerve that is not relieved by diuretics, anti-inflammatories, or any other drugs.

Fibrotic buildup: This is the most common variety of carpal tunnel syndrome. In an attempt to keep up with demands, the body tends to hypertrophy, or grow bigger and thicker wherever we use it most. This is true of muscles and bones, and it also happens with the synovial sheaths at the wrist. When they thicken because of overuse, they press on anything else that has to travel through the tiny tunnel formed by the carpal bones and the transverse carpal ligament-namely, the median nerve. The ligament may also swell with chronic irritation, adding to the pressure on the median nerve.

Signs and Symptoms

Depending on the source and severity of the problem, CTS can manifest as tingling: pins and needles: burning, shooting pains: intermittent numbness: and weakness as innervations to the hand muscle is interrupted. The thenar pad may flatten out as the thumb muscle atrophy from lack of nerve stimulation. It is often worse at night, when people may sleep on their arm or turn their wrist into awkward positions. It can be painful enough to wake someone out of a deep sleep. If pressure is taken off the nerve promptly, symptoms tend to disappear. But the worst-case scenario is permanent damage to the median nerve resulting in some loss of muscle function and sensation in the hand.

Is massage indicated or contraindicated?

Depending on the underlying factors, some CTS cases respond well to massage. Work on or around the wrist must stop immediately if any symptoms are elicited. It is necessary to get a medical diagnosis in order to know which type of CTS is present.

The appropriateness of massage depends on which kind of CTS the client has, and that determination is not a massage therapist’s job. The most responsible choice then, is to work conservatively, check with the client’s health care team, and monitor results. Edematous CTS responds well to massage that focuses on draining the forearm. Fibrotic CTS may or may not improve with massage, depending on how thick and where the fibrosis is. CTS due to a subluxation may respond to massage and traction, but wrist adjustments are not in the scope of practice of massage. If work on or around the wrist creates symptoms, stop immediately!

Deep tissue massage: Contraindicated while acute: otherwise indicated. Work whole arm, shoulder girdle, neck. Use active movements of wrist and hand to assist release.

Lymphatic drainage: Supportive, especially after a focused standard massage treatment.

Swedish massage: Indicated if massage does not elicit symptoms: Stay within pain tolerance.

PNF/MET/ stretching: Indicated in all stages.

Shiatsu: Indicated. Treat all meridians and extension in forearm, especially yin side. Hold carpal tunnel lightly: Make sure carpals don’t separate.