Carpal tunnel syndrome is an entrapment syndrome of the median nerve at the wrist level and can result from many disease conditions. If you have been diagnosed as having carpal tunnel syndrome it is important to exclude other conditions that can cause problems of the peripheral nerves specifically metabolic conditions such as diabetes. The common mechanical cause for initiating the symptoms is repetitive stress injury to the wrist.
When there is carpal tunnel syndrome, the patient usually has symptoms of pain, tingling and or numbness in the thumb, index finger, middle finger and half of the ring finger closer to the middle finger. Many patients however complain of numbness in all the fingers. If the patient has numbness also in the little finger and the ring finger this is an indication that the ulnar nerve is also involved. When there are symptoms in all the fingers, the involvement is not only localized to the median nerve.
The local pressure on the median nerve is usually from thickened and swollen flexor tendons that pass through the carpal tunnel under the ligament of the wrist called the flexor retinaculum. Inflammation of these flexor tendons makes the carpal tunnel tight allowing the tendons to press on the nerve. If the goal of the treatment is to decongest the carpal tunnel using local injections or surgery, the patient's symptoms may not be alleviated. Many patients continue to have symptoms with treatments that are directed only to the median nerve at the wrist level.
To avoid having surgery as the first line of choice, treatments must involve the flexor tendons that pass through the wrist putting pressure on the median nerve. Using the see-saw principle you will now understand that if the flexor tendons are the problem, their actions have been chronically unopposed by the presence of weak or lengthened extensor muscles on the back of the forearm.
Patients with carpal tunnel syndrome especially those who have symptoms also in the last 2 digits have associated spinal nerve root aging at multiple levels. When spinal nerve roots age or are subjected to sudden or insidious trauma, the muscles that they supply become shortened and tight. The most commonly injured nerve roots are C6 and C7 spinal nerve roots. Of all the muscles that these nerves supply, the muscles that will become weakened first are the muscles that are frequently subjected to lengthening contractions.
In the upper limb, the muscles that will weakened first are the posterior deltoid, latissimus dorsi and the triceps muscles. Since these large and powerful muscles are the first ones to be used in prolonging contractions in order to stabilize joints in most activities of daily living, when they become weaker, the smaller muscles of the forearm are used to stabilize the joints. The forearm extensor muscles arise from above the elbow joint and in the presence of weakness of the triceps, will be called into play to help the triceps in motions that require straightening the elbow.
The forearm extensor muscles are primarily used for lifting the wrist upward. When they become weak, the flexor muscles in the front of the forearm become tight and shortened due to the unopposed pull and will initiate not only the development of carpal tunnel syndrome but in maintaining the symptoms by continued pressure on the median nerve at the wrist level .
Therefore, conservative treatment of carpal tunnel syndrome treatment is more complicated than one might think of. To return optimal function to the posterior deltoid, triceps and latissimus dorsi muscles, the tightness and spasm in these muscles have to be released. To allow the strongest and largest muscle provided by the C6 and C7 roots, sometimes the latissimus dorsi, to function better release of muscle spasm and shortening within this muscle must be addressed. In addition, for this muscle to perform optimally, non-invasive electrical stimulation of the motor points with eToims, must involve the entire paraspinal muscles from neck to the lower back, scapular and upper limb muscles as well as muscles of the hip and pelvic girdle .
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