I wrote a research paper on Carpal Tunnel Syndrome (CTS) for massage school and am posting an abbreviated version of my findings.

CTS is a progressive peripheral entrapment of the median nerve by the transverse carpal ligament, causing sharp, shocking pain and/or numbing. Common symptoms include:

• Tingling or numbness in the thumb, 1st, 2nd, 3rd and occasionally the 4th finger.
• Pain radiating or extending from the wrist up the arm to the shoulder or down into the palm or fingers, especially after forceful or repetitive use.
• A sense of weakness in the hands and a tendency to drop objects.

Causes

• It is often difficult to identify a single cause of CTS. The Mayo Clinic (2011) reported that a combination of risk factors generally appear to contribute to the development of the condition. While these factors alone do not cause carpal tunnel syndrome, they may increase the chances of developing or aggravating the condition. These factors include:
• Anatomic factors. Wrist fracture or dislocation can alter the space within the carpal tunnel and create pressure on the median nerve. Also, it is more common in women, possibly because the carpal tunnel area is relatively smaller than in men.
• Nerve-damaging conditions. Certain chronic illnesses, such as diabetes and alcoholism, increase the risk of nerve damage, including damage to the median nerve.
• Inflammatory conditions. Illnesses that are characterized by inflammation, such as rheumatoid arthritis or an infection, can affect the tendons in the wrist and create pressure on the median nerve.
• Alterations in the balance of body fluids. Certain conditions such as pregnancy, menopause, obesity, thyroid disorders and kidney failure can affect the level of fluids in the body. Fluid retention may increase pressure within the carpal tunnel, irritating the median nerve.
• Workplace factors. Working with vibrating tools or in an assembly-line type of setting which requires prolonged or repetitive flexing of the wrist may create harmful pressure on the median nerve, or worsen existing nerve damage. The Department of Rehabilitation Staff from The Brigham & Women’s Hospital (Brigham & Women’s Hospital, 2007) points out that scientific evidence is conflicting and that workplace factors haven’t been established as direct causes of CTS. There is little evidence to support extensive computer use as a risk factor for carpal tunnel syndrome, although it may cause a different form of hand pain.

Treatment

Western medicine suggests mild symptoms may be improved with frequent breaks from repetitive motion and localized cold treatment therapy, while non-surgical therapy for more severe and persistent symptoms include nocturnal wrist splinting/immobilization, Nonsteroidal anti-inflammatory drugs or corticosteroid injections to decrease swelling. When non-surgical therapy fails to relive the symptoms or when symptoms persist for more than ten months, surgery is often prescribed in order to relieve pressure on the median nerve by cutting the ligament pressing it. After surgery, the ligament tissues gradually grow back together while allowing more room for the nerve than existed before.

It is beneficial for sufferers of CTS to avoid heavy lifting or other activities which place excessive stress on the hand and wrist, including direct pressure along the median nerve.

Researchers have concluded (Wong, 2013) that many forms of natural – or alternative medicine – therapy can be as effective as conventional care for CTS. Acupuncture and acupressure therapy along the meridians of wrist, hand and forearm can relieve pressure and decrease inflammation around the carpal tunnel, thus reducing nerve entrapment. Nutritional supplementation such as Vitamin B12, bromelain and Arnica have been found to decrease swelling and increase recovery in people suffering from carpal tunnel syndrome in several blind tests. Some have reported that chiropractic adjustments, yoga, and massage also reduce symptoms.

Massage sessions generally begin with moderate to deep tissue work on the soft tissues around the forearm and wrist, avoiding deep or direct pressure on the median nerve. Broadening manipulation of the pronator quadratus muscle to separate the muscle away from the meridian nerve can also be effective. Due to the nature of carpal tunnel syndrome, a massage practitioner should consider continue working up the arm and shoulder to relieve tension and include stretching movements such as wrist extensions to stretch the flexors. However, it is imperative to immediately cease the massage therapy if symptoms are exacerbated by the treatment.

Summary

Carpal Tunnel syndrome is one of the most common disorders of the upper extremity. There are no proven strategies to prevent carpal tunnel syndrome, though it appears that avoiding undue and repetitive stress on the wrist may help avoid it.

I am surprised to find no reliable sources claiming to have determined the actual cause of the syndrome. In fact, the more I researched carpal tunnel syndrome, the less confident I became in western medicine’s suggested treatments. If I were to be diagnosed with carpal tunnel syndrome, I would certainly utilize natural remedies such as massage and nutritional supplementation rather than trust western medicine’s all-too-common prescription of drugs and evasive surgery.

EnzoFrazier, November 2013

Sources

1. Mayo Clinic Staff (February 22, 2011) Carpal tunnel syndrome, Mayo Clinic. Retrieved on October 31, 2013 from http://www.mayoclinic.com/health/carpal-tunnel-syndrome/DS00326/TAB=indepth
2. Department of Rehabilitation staff (2007), Standard Care of Carpal Tunnel Syndrome, Brigham & Women’s Hospital. Retrieved on November 1, 2013 from http://healthlibrary.brighamandwomens.org/Search/85,P00048#
3. Neuromuscular staff (November 5, 2011) Meridian Nerve, Neuromuscular. Retrieved on October 31, 2013 from http://neuromuscular.wustl.edu/nanatomy/median.htm
4. Cathy Wong (July 23, 2013), Carpal Tunnel Syndrome Remedies, Alternative Medicine. Retrieved on November 2, 2013 from http://altmedicine.about.com/od/carpaltunnelsyndrome/a/carpal_tunnel_2.htm
5. CarpalTunnelRelief (December 11, 2007), Carpal Tunnel Explained, YouTube. Retrieved on October 31, 2013 from https://www.youtube.com/watch?v=S7Jkoks2lt4