Carpal Tunnel

click to enlarge images

In these drawings, red signifies the location of the ache. The crosses are the the tense muscle areas (triggerpoints). These are painful at touch. By releasing these tense muscle areas (Triggerpoint Treatment) , the ache stops.

This is only an example of a few muscles. You have many more muscles like that.

What Physical Sense can do for you.

To treat CTS we have to lengthen and relax the involved muscles. We do this with help of massage techniques (which include trigger point deactivation) and lengthening exercises.

This will stop the pull, thus eliminating the reason for the painful inflammation reaction of the tendons, which will stop the production of fluid so the pressure in the Carpal Tunnel will decrease. Once the pressure is of the Median Nerve the tingling sensations and numbness will cease.

This treatment, together with some techniques on the Tunnel it self, to help fluid absorption, is very successful if the problem is not too chronic (i.e.> 6 months) and when there is indeed causal over use of the fore arm muscles.

The above treatment is not successful if the fluid production in the wrist is of hormonal origin (this happens especially to women after giving birth and in menopause). Or if the fluid has been present in the Carpal Tunnel for so long that it has changed from a fluid stage to a fibrous stage.

We will also look at the cause. We need to know why the muscle(s) did not cope with the load. (i.e. Work technique? posture? Stress levels? Workstation? Etc.) So this means that we may have to do a worksite assessment, or give you posture education or educate you in stress management (which often also involves breathing education) etc.

About Carpel Tunnel Syndrome

The department of Labour states;” OOS (Occupational Overuse Syndrome) is caused by muscles being held tense or tight for too long.”

That may seem a simplified statement, but for most over use type problems, like Carpal Tunnel Syndrome the cause is indeed that simple.

The shorter and tenser the muscle the harder it pulls on the places it is attached to (i.e., the wrist). When this happens in the fore arm the pull at those attachment areas and tendons causes irritation and inflammation.

In case of CTS the muscles that work your fingers and wrist are in your fore arm and go over in tendons which come together in the wrist area. So if you are over using your wrist or finger these muscles go very tense and with that short, which makes them pull HARD at the tendons. This creates irritation and inflammation of the tendons, which in turn creates fluid. The problem in the wrist is that these irritated fluid producing tendons, then have to go through the Carpal Tunnel together with your Median Nerve. And as it is indeed a tunnel, the fluid created by the inflammation reaction has nowhere to go. This results in high pressure in the Carpal Tunnel. High pressure on the tendons, but also and more importantly high pressure on the Median Nerve. The Median Nerve can not cope very well with high pressure, and will become painful and will produce tingling sensations and numbness in your hand.

Sometimes the fluid retention in the wrist is of hormonal origin (this happens especially to women after giving birth and in menopause). It is also possible that the fluid has been present in the Carpal Tunnel for so long that it has changed from a fluid stage to a fibrous stage. In both cases physiotherapy will be of limited use.