The classic representation of carpal tunnel syndrome (CTS), is pain and numbness/tingling in the palmar aspect of the thumb, index finger and middle finger. The symptoms are worse at night and the patient typically complains of clumsiness with precision gripping. Is surgery required?
This is caused by compression on the median nerve as it enters the carpal tunnel, ( created by the Transverse Carpal ligament and the Carpal bones). The most common reason for developing CTS is from repetitive motion or prolonged wrist use in full flexion or full extension.
People tend to complain more at night, because as we sleep we tend to curl up and place our wrist in extreme flexion. This increases pressure inside the tunnel. Use of a carpal tunnel brace helps alleviate the symptoms during sleep.
Carpal tunnel treatment should be approached with non-invasive procedures. Begin by bracing, the use of ergonomic devices regarding hand and wrist positions, such as split keyboards and ergonomic mouse, routinely perform carpal tunnel stretches ( I will make a video blog of some stretches). Surgery should be the last resort, as it is often unsuccessful. The reason for this, is that during surgery the Transverse Carpal ligament is cut to open up the tunnel. Unfortunately, in time the ligament will grow back and heal with scar tissue, which makes the tunnel even smaller. Another reason why surgery or bracing might be unsuccessful is because your CTS symptoms might not be caused by the the carpal tunnel itself. The median nerve might be compressed further up the arm. It could be compressed as it travels underneath the Flexor Digitorum Superficialis muscle, as it pierces the Pronator Teres muscle, at the Ligament of Struthers above the elbow, at the Coracopectoral tunnel in the chest area, or at the Scalene muscles in the neck.
With Active Release Techniques we are able to examine these impingement sites and pinpoint exactly where the impingement of the median nerve is located. Often times, there is more than one impingement site. If your symptoms include any other part of the hand or arm it is likely that the problem is elsewhere than the carpal tunnel itself. Impingement of the median nerve at the carpal tunnel will cause problems only in the thumb and first two fingers, if the symptoms involve the whole hand and/or any other part of the arm the impingement is further up, compressed by one of the above mentioned structures.