Resolving Carpal Tunnel Syndrome
Just in North America alone, over 260,000 Carpal Tunnel Release operations are performed each year, and over 47% of these cases are reported as being work-related!
The costs due to CTS are substantial – both for the patient and for the employer.
When does Carpal Tunnel Syndrome occur?
The increased use of computers, and their accompanying flat, light-touch keyboards that allow for high-speed typing, have resulted in an epidemic of injuries to the hands, arms, shoulders, and neck. The increased use of pointing devices like the computer mouse and trackball (which require repeated subtle movements) add to these injuries.
The thousands of repeated keystrokes and long periods of clutching and dragging with the mouse causes chronic irritation to soft-tissue (nerves, muscles, ligaments, fascia, and tendons). This irritation creates friction and pressure, which eventually leads to small tears within the soft-tissue. These in turn cause inflammation, decreased circulation, and swelling (edema).
CTS injuries are aggravated by:
- Poor posture and body positions.
- Poor ergonomics (positioning of the chair, mouse, monitor, keyboard, assembly line, and so on).
- Decreased strength due to poor conditioning or injury.
- Insufficient relaxation/rest time away from the stresses that cause the problem.
- Excessive force that is required to perform an action.
- Muscle imbalances.
All these factors place unnecessary, repeated stress upon all the soft-tissues of the neck, shoulders, arms, wrists, and hands.
The classical medical definition of Carpal Tunnel Syndrome (CTS) says:
‘The impairment of motor and/or sensory function of the Median Nerve as it traverses through
the Carpal Tunnel.’
Research is now showing that this traditional emphasis upon the Carpal Tunnel area is not only inaccurate, but that it also ignores the bigger picture, where the Median Nerve is often entrapped along other areas from the wrist to the neck, rather than at just the carpal tunnel.
So, Carpal Tunnel Syndrome can occur anytime the median nerve is entrapped or restricted anywhere along its entire length along your arm.
Other nerve entrapment sites:
From an Active Release Techniques (ART) perspective, CTS is often caused by entrapment of the Median Nerve at several other common entrapment sites:
- Median Nerve at the Thenar Muscles.
- Median Nerve at the Carpal Tunnel.
- Median nerve at the Pronator Teres and Flexor Digitorum Superficialis.
- Median Nerve at the Ligament of Struthers.
- Median Tract at the Coracopectoral Tunnel.
- Median Nerve at the Scalenes.
Although these are common entrapment sites, it is important to note that the entrapment of the Median Nerve can occur anywhere along the length of the nerve.
It therefore becomes critical that treatment methods be able to identify and release entrapments along the entire length of the Median Nerve. This requires a great amount of tactile sensitivity from the practitioner.
For a practitioner to achieve long term, positive results, he or she must consider these other areas of possible entrapment, rather that focusing exclusively on the Carpal Tunnel area.
To be successful at treating CTS, the practitioner must do several things, including:
- Locate the restrictive adhesions that have formed, as well as the direction in which these adhesions are aligned.
- Identify both the primary, and the antagonistic, muscles that are causing the injury.
- Determine which other soft-tissue structures along the kinetic chain are affected by these adhesions.
- Use a hands-on approach, such as Active Release Techniques, to release the restrictions that are the cause of the problem.
Active Release Technique (ART) is a hands-on touch and case-management system that allows the practitioner to diagnose and treat soft-tissue injuries, such as Carpal Tunnel Syndrome.
By using ART, our doctors are able to release the restrictive adhesions blocking the carpal tunnel, and other restricted sites along the Median nerve. Our dynamic, integrated program restores function to the Median nerve, decreases swelling, releases restrictions, and rehabilitates your hand, wrist, and arm to its normal function and strength.
One of the most significant advances in treating Carpal Tunnel Syndrome (CTS) is a new procedure in Active Release Techniques® (ART) called “Peripheral Long Tract Nerve Release.”
In contrast to the basic ART procedures, the primary focus of this new technique is to move the nerve through the tissue. In these procedures, the practitioner tensions the soft tissue structure involved, and then performs procedures that enable the nerve to be pulled though the soft-tissue structure, thereby releasing the nerve from surrounding adhesions.
The true power of this procedure is that it enables the practitioner to pull the nerve through any site of entrapment, alleviating even significant amounts of nerve compression.
There are many things you can do to help yourself prevent CTS.
For example, you can change the ergonomics of your workstation, as shown in this video, or you can perform some regular and simple exercises as shown in the following two sections.
So be proactive… and help yourself!
During the early stages of nerve entrapment, some simple exercises can often help you to release the nerve, and thereby prevent the occurrence of CTS.
Try the following nerve flossing exercise, which actually moves, or slides, the Median Nerve through the surrounding tissue layers, and helps to keep it from becoming entrapped.
- Stand in a relaxed posture with the affected arm extended parallel to the floor, with your palm facing up.
- Bend the elbow so that the forearm extends perpendicular to the arm, and bend your wrist to stretch the fingers of your hand away from the body at a right angle.
- Keep the upper arm parallel to the shoulder.
- Keep your other shoulder relaxed.
- Bend your head towards the affected side – ear to shoulder with no rotation.
- Hold for a count of eight.
- Bring your arm down to your side, rotate your arm in with your palm facing up. This position is like a waiter waiting for his tip.
- Bend your head towards the opposite side – ear to shoulder with no rotation.
- Hold for a count of eight.
- Repeat parts A and B four to six times.
We believe that effective, focused exercises play an important role in the healing and regeneration of damaged tissues. Every patient at our clinic receives appropriate exercises. Our exercise programs are based on four basic principles:
- Cardiovascular function.
See Kinetic Health’s Shoulder and Arm Exercise Videos for a sample of some the exercises we prescribe to our Carpal Tunnel patients.