Conservative Therapy Best for Carpal Tunnel Patients

Carpal tunnel syndrome is a nerve entrapment disorder that is associated with considerable pain and functional impairment of the fingers and hand. It is also quite common for this condition to refer pain up the median nerve pathway into the elbow, shoulder, upper back and neck.

Caused by an imbalance of the muscles that open, close, deviate and rotate the hand, results in biomechanical dysfunction and a joint imbalance, affecting the median nerve at the wrist junction.  Severe cases of carpal tunnel syndrome can lead to muscle atrophy and deterioration of the median nerve when left untreated. It is the cause of significant disability worldwide and a subject of growing research in the medical and physical therapy communities.  With costs to treat this disorder surpassing 60 billion annually, a common sense treatment approach is being sought by both private and federal communities. 

There are many pathways to muscle imbalance in the hand, and considerable research has examined the pressure system surrounding the carpal canal. This work has shown that people with carpal tunnel syndrome have markedly increased pressure in the carpal canal in the hand following minor movement in the wrist that involve repetitive and/or static wrist and finger flexion.  The longer these types of activities are performed, the greater the muscle imbalance develops and the more severe the symptoms become.  As the finger and wrist flexor muscles that close the hand become more developed than their opposing extensor muscles that open the hand, the stronger muscles cause the bones to shift in the direction due to the “pulling” action of the stronger muscles and results in the impingement of the structures between.  In this case, the median nerve is impinged.  As the median nerve and flexor tendons now have to glide past each other as the fingers and wrist flex and extend while being in a state of impingement, there is increased friction which irritates the tendons and nerve and causes inflammation and swelling of these tissues. The result of this pressure and secondary swelling is a further increase in edema inside the median nerve.  (Swelling is often thought of as the “cause” of carpal tunnel, when in fact it is the “result” of being irritated due to its state of being impinged between the flexor tendons inside the carpal tunnel which has also been reduced in size due to the collapse / shifting of the carpal bones.)

This entrapment produces a variety of painful symptoms. Indeed, carpal tunnel syndrome is characterized by paresthesia (also known as a pins and needles), numbness, tingling and a lack of coordination of the fingers along with muscle degeneration if left untreated, but it may also include pain, stiffness, tenderness, and swelling, and many people with the condition notice themselves assuming a ginger stance at the computer keyboard or workstation. As symptoms progress and worsen over time, carpal tunnel syndrome generally includes muscle wasting, diminished strength, and a serious loss of overall dexterity and coordination.

Although the disorder is significantly debilitating, effective treatments do exist. Those with the most scientific support target symptoms by restoring muscle balance in the hand. Most often a combination of strengthening and lengthening exercises combined with supportive equipment is enough to improve symptoms dramatically.

By addressing carpal tunnel with conservative modes of treatment (Flextend, Restore, etc.), people can usually avoid the high failure rates associated with treatments like cortisone injections and surgery.  Always be sure to consult with your physician and be sure that you have a received an accurate diagnosis of your condition, but if you do not agree with your doctor, seek a second or third opinion.