Carpal Tunnel is a nasty condition affecting one nerve in the wrist. So let's take a look at what it is, and where it came from.
What is Carpal Tunnel?
True Carpal Tunnel is when the median nerve is compressed as it travels through the wrist at the carpal tunnel. The bones of the wrist and the flexor retinaculum form the tunnel through which the flexor tendons of the hand and the median nerve runs.
This can happen due to inflammation, usually from overwork tasks, such as lots of computer use, or the use of vibrating power tools. In addition inflammatory arthritis, diabetes and obesity are all risk factors.
However, not all presentations of carpal tunnel are what they seem. 🤔 It is very easy to blame any wrist numbness on carpal tunnel, but more often than not, this is not the cause of the numbness.
How you you know if it is true Carpal Tunnel?
In true carpal tunnel, only the median nerve will be affected. Only the median nerve runs through this tunnel so, if your client complains that the whole hand goes numb, it is unlikely to be Carpal Tunnel Syndrome. Take a look at the picture on the right, you can clearly see that only one nerve goes through the "Carpal tunnel"
But the question we really need to be asking ourselves is where did this come from? To answer that, we need to look away from the wrist.
The nerves of the arm exit the spine at the cervical level and run under the Clavicle. Hang on a minute, did I just mention the Clavicle!
What has the Clavicle to do with Carpal Tunnel Syndrome?
Well, take a look at the picture on the left. Now imagine your client, along with the symptoms of carpal tunnel also has a protracted shoulder. When the shoulder protracts, the clavicle depresses and lessens the space available for the nerves to run under it. Now imagine that your client also has a forward head posture. The nerve line runs between the anterior and mid scalenes and this can shorten in a forward head posture, often causing dysfunction to the nerves.
So, if you only treat the carpal tunnel at the wrist, you will never get rid of the source of the problem. Next time you see a client with symptoms indicative of Carpal Tunnel, take a look at their upper body posture, alongside localised treatment. Make sure you address any upper crossed syndrome you may see, retract the head and shoulders by strengthening the muscles of the posterior shoulders and mid back, and loosen the pecs, biceps and wrist flexors to treat the entire line.
Remember this is often an overuse injury, so you will need to assess you client for strength issues. Unless it is a medical issue, it will often be their job causing the issue. So watch them, or get them to make a video of themselves working, so you can see how they are adapting. If the hand is weak, the muscles of the upper arm will try to assist and this leads to them overworking, hence the protracted shoulder position occurs as the issue runs up the line. So think about what you can do to strengthen them for the job they need to do. If all you do is to treat the wrist, your client will, most likely, be back within a year with the problem flared up again.😉
If you are using this for CPD, have a go at the following question.
Think about the entire line of the upper limb, from the fingers to the head, refresh your knowledge of the structures that run throughout this line paying particular attention to any muscles causing the shoulder, neck, upper arm and wrist to flex. Don't forget the fascial lines and the nerve lines.
Now follow the nerve line through these structures and work out what you need to strengthen and what you need to loosen to offload this nerve.
Then write it all up in your CPD logbook. For your FREE Reinge Education logbook, click here and sign up to our newsletter.
Reinge Education provide CPD courses for therapists and trainers across the country, these are in both an online format and in face to face workshops. Our unique combination of knowledge allows us to provide a fresh approach, looking at how anatomy affects function within the body, merging therapy and sports science to give a unique perspective.