This is a post that may interest any person who has had an office job and has had to type for hours on end. However, these are not the only people who should be interested. Anybody who does work with their hands, physical therapists, masseuses, garment industry workers, musicians, construction workers etc. will have some sort of pain in the hand, wrist complex. Many after years of suffering have carpal tunnel syndrome surgery. Let me say this with clarity: ONLY A SMALL NUMBER OF SURGERIES AND REPORTED CASES ARE TRUE CARPAL TUNNEL SYNDROME.
Unfortunately this is another case of misunderstanding anatomy function and cause of dysfunction. Now I am not saying that all carpal tunnel surgeries are ineffectual, quite the opposite, they are very impactful when a true case of carpal tunnel syndrome. But I think that there is no doubt in my mind or that of my colleagues that this was an over prescribed surgery in the last 20 years. I have met a number of patients who say the same thing. It helped for a period of time after the surgery, but the pain reappeared with a vengeance. So what is CTS?
True CTS happens when for whatever reason the nerve that supplies most of the energy to close the hand gets cut off by swelling in the wrist area. You see the nerve and arteries of this particular nerve are covered by an fibrous band called the Flexor Retinaculum. The theory of CTS is that repetitive finger typing cause chronic irritation of the median nerve causing swelling which causes the contents underneath the flexor retinaculum to become compressed leading to symptoms of numbness and tingling in the palm. Severe cases see the hand in a strange tiger claw resting position. This is because the nerve output is so low to the hand that Radial and Ulnar nerve overpower the median nerve.
Have you ever shook hands with someone and noticed that they could not grasp your hand, just hold it as if tey wanted you to shake their palm? I’ve seen real cases like these from bass guitarists from the the very technical strumming patterns they use.
I will tell you the real reason that cutting the flexor retinaculum is not the end all be all. The nerves are all covered by myelinating cells that help to increase the conductivity of the nerve charge. Furthermore all nerves also have a sheath (some more o r less ligamentous elastic or collagen based) that acts as an insulator to keep the conductivity focused. In the hand and wrist these sheaths become individual “socks” for the nerves. If you bought and wore a sock or stocking that was 3 sizes too big the sock would curl and bunch up and cause irritation. This is kind of what happens to the nerves of the hand. So the Flexor Retinaculum is not the only compression factor for those nerves. Also compression is not the word I like, how about irritation or inflammation.
CTS proponents say that repetitive typing causes compression and swelling of the nerve. HOGWASH. Repetitive movements irritate the nerves and muscles causing them to strain and affect adjacent muscles. Here’s the secret, FOREARM FLEXORS and FOREARM EXTENDORS. These are the muscle controlling hand and wrist motion and when we hold our wrists at one position too long the theses are the muscle groups that are affected, become strained and relay this strain to their ligaments which all coalesce at the wrist and hand juncture. So many of these “CTS” cases are just under attended forearm muscles! If you ask me cutting anything off the body is a fallacious argument of the medical profession unless that structure is infected, cancerous, or the last resort. I am a strong proponent for surgery when certain structures are involved, but you can’t make me believe that the appendicitis is not a working organ or has no use (in fact it does have a use and a later post will explain).
Now back to the point, when you cut the retinaculum and then don’t treat or change the offending action you are bound to get the symptoms again. Will ergonimcs help, yes. Will stretching the forearm muscles before you get to typing help, yes. Will taking short breaks often to rest those muscles help, yes. Many of us go to the masseuse for their back, but probably all of us should g o for a forearm session yet not many of us do.
Some may say that this is too simplistic an idea, how can massaging your forearm help carpal tunnel syndrome as it is a compression problem and not a muscular one? Remember now that most cases are not really CTS and that is just one diagnosis of a many and an umbrella term at that. No many of these diagnosis should be changed to neuritis (inflammation of the nerve) due to sprain/strain of the forearm musculature. Feel you forearm now, does it feel like mushy meat and no pain? good. If yours are like mine you may find tight bands of muscle that feel like rope, if you do I can bet you experience occasional hand and wrist pain.
1) Find a spot on the forearm that is painful when you press deep. I find that the closer you are to the elbow the more of these trigger points you’ll find.
2) Press down slowly and gradually deeper until the pain is noticeable
3) Move the wrist in an up and down and/or circular motion
4) Change the “point of attack” or area of massage as the pain subsides and repeat.
The point of the exercise is to self massage some of the forearm trigger points while providing circulation to the wrist and hand in the form of movement. Try not to bruise yourself, be intuitive with your touch especially when doing this on someone else, and drink lots of water to provide lubrication and to wash out the toxins that accumulate as a result of inflammation. If you are scheduled to get CTS surgery, please get several surgical opinions and/or see a chiropractor.