Carpal tunnel syndrome is a common diagnosis for people that complain of numbness, tingling, and/or pain in the hands and forearm region. Sometimes it is true carpal tunnel syndrome as described below), but often it is a combination of factors. If you have these symptoms, read on and let’s see if some of this applies to your situation.
True carpal tunnel syndrome
I’ve seen a number of people over the years that have been told they have carpal tunnel syndrome (CTS). However, many of these people had symptoms that were similar, but not quite CTS.
According to National Institute of Neurological Disorders, “Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist. The median nerve controls sensations to the palm side of the thumb and fingers (although not the little finger), as well as impulses to some small muscles in the hand that allow the fingers and thumb to move. The carpal tunnel – a narrow, rigid passageway of ligament and bones at the base of the hand – houses the median nerve and tendons.”
In short, what that means is that the median nerve is compressed at the wrist (palm side) and causes symptoms into the thumb, index, middle, and (sometimes) ringer finger (palm side). If you have pain elsewhere, by definition it is not carpal tunnel syndrome.
Carpal tunnel syndrome or not?
When it comes to numbness, tingling, and pain in the extremities, I’m less worried about giving it a specific name and more worried about what is causing it. As described above, nerve entrapment at the carpal tunnel region (the wrist) causes symptoms at the thumb and fingers and can be named carpal tunnel syndrome. If there are symptoms elsewhere or in addition to the thumb and fingers on the palm side, it’s not (only) carpal tunnel syndrome, but it is still most likely caused by nerve entrapment (we will discuss that below). Same issue, but the nerve is being caught somewhere else other than the carpal tunnel region.
Nerve entrapment syndrome
I prefer to call these issues nerve entrapment syndrome. That simply means that the nerve is being compressed or caught (adhered to) somewhere between where the nerve originates at the spine and where it ends up at the nerve endings. This could be the carpal tunnel region, but it could be a number of other places as well.
Let’s take a look at the median nerve as an example. In the picture below, you will the median nerve as it passes from the shoulder down to the hand. There are several areas where it can become entrapped, such as the neck, the shoulder, the biceps, the forearm, and finally the carpal tunnel region. Treatment approaches that fail to check and treat these other potential sources of entrapment may not be effective.
Other than the median nerve, there can be entrapment of the ulnar and radial nerves, as well as the nerve roots. Issues with these nerves leads to diagnoses such as thoracic outlet syndrome, radiculopathy, “pinched nerve” due to disc bulges or a slipped disc, etc. These are all just specific names for the same thing, nerve entrapment. The difference in naming it is what is causing the nerve entrapment. In most cases, the treatment approach will remain the same, just applied to a different area of the body.
Diagnosis and treatment options
The first step when someone comes to see me for this type of problem is to perform a history and examination and diagnose the issue. Most of the time it is due to nerve entrapment somewhere along the nerve. However, other issues that cause similar symptoms must be ruled out such as thyroid problems, diabetes, circulatory problems, etc. Once these are ruled out, then we can get to work on identifying where the nerve is entrapped.
It’s common to have multiple entrapment sites. Even though there may be a primary area of entrapment, as the issue is there longer and longer, it irritates the nerve and causes other muscles to tighten and entrap the nerve elsewhere. So, by the time someone comes in for treatment, several areas must be addressed.
I use what’s called nerve tension tests. These tests put the extremity in various positions that test how well the nerve does or doesn’t glide or slide within the muscles. If there are no areas of entrapment, the stretch can be done without feeling any pain. If there are areas of entrapment, the stretch is difficult and the person feels discomfort throughout the arm.
Here’s a photo of someone performing a nerve tension test.
Once it is determined the nerve is entrapped, the common areas of entrapment are addressed one by one. This is done by using a muscle therapy technique that helped to reduce muscle tension and break up adhesions between the nerve and muscle tissue. You can learn more about this specific technique by CLICKING HERE.
After each area of entrapment is treated, then we recheck the tension test. If it has improved, we know we’re treating the right area. If it doesn’t, or if it doesn’t cause the test to return to normal, then other areas are addressed. This process occurs several times within the visit until we have a normal tension test or progress stops. This is repeated over several visits as the patient reports that their symptoms are improving. If things do not improve over the course of 4-6 visits, then it’s usually necessary to order more testing to determine other causes of the symptoms.
The above approach is recommended prior to undergoing more invasive procedures such as injections and surgery. Even if surgery is ultimately required, the patient is better off having gone through the type of treatment I provide since it helps address multiple areas of entrapment in addition to the primary reason for the issue.
My experience with nerve entrapment syndromes
I see people with this type of problem on a regular basis. The nice thing about this is that the nerve tension tests can be done in the office, treatment provided, followed by a retest. This allows me to pinpoint the areas of entrapment and treat them. Most of the time if we can address all of these areas and end up with a normal test by the end of the visit, the person’s symptoms are much improved after that first visit and usually the issue is resolved within 4-6 visits. The test – treat – retest approach makes it easy for both myself and the patient to see that what we are doing is effective.
I see the best results for people that have mild symptoms and have had it for a few months or less. The worse the symptoms are and the longer it’s there, the more difficult it is to treat. That’s not to say it can’t be treated using this approach, but it will take longer. I’ve seen people suffering from these symptoms for several years and having quite severe constant numbness and tingling. It takes some work, but things do eventually improve. In a handful of cases, usually where people do not give it enough time or if they have a job that requires heavy use of their hands or use of power tools on a regular basis, surgery was required. Surgery or injections are also often required for people with more severe disc herniations or spine instability. These cases are usually obvious and we refer to a spine surgeon for further evaluation.
The bottom line
If you are experiencing numbness, tingling, or pain in the extremities, take the first step to a address the problem and call to get in for an evaluation. With nerve related conditions such as this, it is recommended to seek care sooner than later as long term nerve entrapment can lead to permanent nerve damage.
If you have any questions about the above, click here to send me an email.
Thanks for reading,
Buddy Touchinsky, D.C.