Carpal Tunnel Syndrome: Are You Sure?

Carpal Tunnel Syndrome

Note: This post is courtesy of a collaborative effort between Dan and his current PT student, Trent Salo, out of the University of St. Augustine in Florida.  Way to go Trent! 
The physical therapists at SSOR are skilled at evaluation of orthopedic and sports diagnoses that come through our doors.  It’s not uncommon for us to have a condition misdiagnosed or not diagnosed with the whole picture in place for the patient.   Nothing frustrates us more than seeing people who have unnecessary tests, injections, or surgeries.  One condition that is sometimes misdiagnosed is carpal tunnel syndrome.  Some patients have surgery, sometimes in both hands, only to have persistent symptoms.  So now what?  Well, somewhere along the way, no one evaluated their neck to see if it was the culprit or a contributing factor.   People look at us funny, but all kidding aside – carpal tunnel syndrome can have a major contribution from your neck.  Studies have supported this premise here, here, here, and here.

What is carpal tunnel syndrome?

Carpal Tunnel Syndrome (CTS) is a condition involving the wrist and hand typically occurring in individuals continually using their fingers in extreme wrist positions, or those involved in activities requiring use of hand tools and prolonged gripping.  CTS is what is known as a “cumulative trauma disorder” because it’s not something you get acutely and it tends to evolve over time with repetitive positions, movements, and postures.  The carpal tunnel is located on the palm side of the wrist and contains and protects the tendons that flex the fingers, as well as the median nerve. CTS symptoms typically begin gradually; numbness and tingling in the hand, most noticeably at night. Occasional numbness and tingling can eventually lead to a constant numbness, and even loss of grip strength of the affected hand. Treatment wise, CTS is typically treated conservatively with posture education, stretching, and strength exercises for the wrist and hand. In severe cases, surgery may be indicated to reduce the pressure from the carpal tunnel on the median nerve.

The Link Between the Neck and Carpal Tunnel Syndrome

In the human body, there are over 45 miles of nerves which intertwine throughout the tissues. These nerves originate from the spinal cord and travel into the periphery of the body (arms and legs), innervating muscles and skin along the way. The median nerve, for example, exits the spine at the C5-T1 spinal nerve level and travels down the arm crossing the elbow, traveling through the carpal tunnel all the way into the hand.

Well, if you sit at a computer all day or find yourself hunched over a desk working with small items (i.e a tailor), the nerves at the neck can get “squeezed” from poor posture and the resulting lack of mobility.  If the nerve is encroached from the roots coming off the spine, it can create symptoms down the arm and into the hand.  An analogy may help illustrate our point:
Imagine your drive to work in the morning- you’re cruising on Interstate-435 in Overland Park headed to Kansas City and you come up to the Quivira exit and traffic is at a standstill.  You crawl at a snail’s pace for miles and eventually pass a car accident at Wornall.  The accident at Wornall caused a backup all the way to Quivira, yet nothing was wrong at Quivira.  In this analogy, I-435 is your nerve coming out of the neck.  All of the areas it “stops” to innervate are the “exits” on I-435.  If there is an “accident” at one exit, the ripple effect will occur at places far from the site of origin.  So, any “accident” at the neck may cause trouble “miles away” from the source.

So is it my neck or is it just carpal tunnel syndrome?

While we don’t recommend patients self-diagnose (or worse yet, use “Dr. Google” to diagnose!), certain factors can provide a hunch that the numbness and tingling in the hands isn’t necessarily coming from the hands. Probably the most important factor to consider is the impact posture can have on symptoms. Although there is no such thing as “perfect posture,” if changing the position of the neck or shoulder reproduces or relieve symptoms in the hand, it’s a good indication the problem is the neck and not the hand. Additionally, the feeling of numbness, tingling, discomfort, or muscle weakness felt further up the arm is also a solid indication the problem isn’t only at the wrist.  There are a series of other tests and measures a physical therapist can have you do to determine if the neck has something to do with it.
How to Treat Carpal Tunnel Syndrome
Physical therapists are experts in anatomy and can have a pretty good idea of where the problem may be coming from by just listening to you describe your areas of complaint.  Treatment typically starts with postural education and workplace ergonomics.  You may be a candidate for splints as well to keep you out of provocative positions.  Basic stretches of the wrist and hand are also common interventions.  Additionally, physical therapists are equipped with the skills and training to perform techniques to “free up” nerve areas which may have gotten a little “sticky” and are causing problems.  Mobilization and manual therapy to the neck and shoulder, specific “nerve flossing” exercises to the arm typically lead to a quick reduction in symptoms without even touching the area experiencing discomfort.  Cervical traction as well as thoracic spine mobilizations to help with your posture are also indicated.  Finally, breathing exercises may also help – sometimes people become “chest breathers” and this can further “squeeze” the nerves in the neck.  Sounds crazy, we know, but trust us – we see it all the time!  Next time you experience these symptoms, don’t assume the problem is coming from you hand; schedule an appointment with a physical therapist at SSOR to determine what’s going on.  Before rushing into surgery, make sure it’s actually indicated.
It would be a privilege to serve you and partner with you in your care.  We are experts at evaluation of musculoskeletal problems and are confident that we can get to the true cause of your condition.  Carpal tunnel syndrome can be painful and debilitating – just make sure it’s actually from your wrist!