Carpal Tunnel syndrome or not - causes and treatment options
True Carpal Tunnel Syndrome (CTS) is a common condition that affects the hand and wrist. It occurs when the median nerve becomes compressed by a narrowing of the Carpal Tunnel which is located in the wrist (the carpal tunnel is a narrow passageway on the palm side of the wrist, surrounded by ligaments and bones). This compression can cause pain, numbness, and tingling in the affected hand.
The Median Nerve arises from the brachial plexus and travels down the arm into the hand through sometimes quite narrow passages.
There are several causes that can result in a narrowing of the Carpal Tunnel resulting in CTS, including repetitive hand motions, such as typing or using a computer mouse, and certain medical conditions, such as arthritis or diabetes.
Symptoms of true Carpal Tunnel include burning pain, tingling and numbness in the hand and wrist. The pain might momentarily ease off when shaking the hand.
Although this is a real presentation there are a group of other soft tissue related presentations that share very similar symptoms with CTS and that get often, for this reason, misdiagnosed with CTS.
Most common causes of Carpal Tunnel Syndrome Symptoms that are not true CTS
Here is a list of presentations with very similar symptoms than Carpal Tunnel Syndrome, all of the following can cause in higher or lower degree the following symptoms:
- Pain down the arm
- Pain in the forearm
- Pain in the hand
- Pain in the wrist
- Tingling or numbness sensation in arm, hand and wrist
- Loss of strength in the arm and hand
To make things easier let’s divide these presentations in two groups.
Group 1 – Presentations in this group are directly involved with the Median Nerve.
What sets them apart from true CTS is that in the last one compression of the nerve happens at wrist level (”pressure on a nerve in your wrist”, as extracted from nhs.co.uk), while in these presentations the compression or irritation of the nerve happens higher up, either forearm, arm, chest or neck.
The cause is usually irritation, myofascial restrictions or Trigger Points in the muscles and fascial that surround the Median nerve on its way down to the hand.
The prognosis is usually better that true Carpal Tunnel Syndrome where there’s a problem at the Carpal Tunnel itself.
Some of the most common presentations in this group are as follow:
- 1.1- Compression of the Brachial Plexus nerve group at the neck/scalens.
Scalene are a group of three pairs of muscles in the lateral neck: scalenus anterior, scalenus medius and scalenus posterior.
Irritation of the scalenes is associated with a number of upper body and thoracic musculoskeletal imbalances and presentations that will need to be addressed during treatment in order to relief the symptoms. Scalens are also accessory muscles in breathing and they can get irritated as a result of inadequate breathing patterns.
Treatment plan consists on releasing the scalens group.
Since this group of muscles are usually irritated as a result of a variety of musculoskeletal imbalances and breathing imbalances, these will need to be addressed too during the course of the treatment.
These might involve correcting postural imbalances through strength based exercises.
- 1.2- Compression of the Brachial Plexus nerve group at the Pectoralis Minor.
Pectoralis Minor is the deepest of the Pectoralis muscles located in the upper lateral area of the chest. It attaches to the costal cartilages of 3rd to 5th rib and coracoid process of the scapula.
The brachial plexus nerve group passes right underneath Pectoralis minor. Inflammation in the area can cause irritation of the median Nerve.
Pectoralis minor muscle can be considered an accessory muscle of breathing, as it helps raise the ribs during inspiration and assists in expanding the thoracic cavity. Stress and shallow breathing make it propense to irritation.
When shortened can play a major role in the common “shoulder forward” postural pattern and can contribute to nerve irritation around the neck, chest or shoulder joint.
Treatment plan consists on releasing the Pectoralis minor as well as correcting other structural imbalances if present, which is usually the case.
The treatment at our clinic consists of a combination of Trigger Point and Myofascial Release work together with corrective strength based exercises
- 1.3- Irritation of the Median nerve as it leaves the shoulder blade, under the armpit by Trigger Points or irritation of subscapularis, coracobrachialis, teres major or Latissimus dorsae.
The median passes by very close to these muscles.
These muscles are also very much related with shoulder positioning and affected by a kyphotic postural patterns (very common rounded shoulder and rounded mid back).
Effective treatment would involve not only releasing these muscles but also correcting the imbalances that are contributing to the presentation.
About the author
Rocio Santiago
MA in Nursing, Dip. Soft Tissue Therapy
Ro initially began her career as a nurse. Following this and after a difficult time in her life that resulted in a career change, Ro went on to train at one of the leading soft tissue therapy schools in Europe, completing a 3 year degree level course and specialising in effective soft tissue manipulation for the treatment of musculoskeletal pain.
The treatment method Ro uses consists of a combined approach using different specialised techniques, myofascial release and trigger point work among others, with the intention and focus on providing effective results in the least possible amount of time.
Combining her training, science background and life experience, her treatment method is based in science and built using a whole body approach, where mind and body are addressed as one.
Ro has been seeing clients as a soft tissue therapist for 8 years, successfully treating a wide range of conditions.