Amazing that this hasn’t been thought of before now! How could years of research, millions of dollars spent on testing, and thousands of physicians and therapists overlook the answer to carpal tunnel syndrome? Simple, look at the symptom and not the cause! Physicians aren’t taught to look at muscles as a cause of joint pain. This information changed my entire medical practice – it will change your life!”
Zev M. Cohen, MD
Excerpt from “Carpal Tunnel Syndrome – What You Don’t Know CAN Hurt You“
While carpal tunnel syndrome (CTS) and trigger finger are separate conditions and cause totally different symptoms, both of them are the result of spasms in muscles that affect the wrist and hand.
The symptoms for carpal tunnel syndrome are burning pain, numbness, and tingling in the wrist, thumb, and first two fingers. The symptom for trigger finger is the inability to smoothly bend or open the fingers. It’s interesting to see that the same forearm muscles that cause CTS wrist pain are the same muscles that are also the cause of trigger finger.
First let’s look at carpal tunnel syndrome. Notice that two muscle groups (the flexors and extensors) not only cause CTS symptoms, but are also responsible for the clicking and stiffness that are symptoms of trigger finger.
The carpal tunnel is a narrow opening in the wrist that guides the eight flexor tendons, and the median nerve, from the forearm to the hand. Carpal tunnel syndrome is pressure on the median nerve within the carpal tunnel, causing numbness and tingling in the thumb and first two fingers.
As many as 400,000 carpal tunnel release surgeries are performed every year. Statistics have surmised that approximately 35% of the adults living in the United States have reported pain in their hand and wrist, or numbness in their fingers. People are suffering from pain and numbness, losing their careers, and being forced to change their lifestyle to accommodate for their inability to do even simple everyday tasks.
Seven Facts About Carpal Tunnel Syndrome That Can Change Your Life:
- The key word in the definition of carpal tunnel syndrome is within the carpal tunnel. Only 5% of the median nerve is actually passing through the carpal tunnel. The median nerve begins in your neck, travels across your shoulder, down your arm, through the carpal tunnel, and into your hand.
- Pressure on the median nerve anywhere along its pathway will cause numbness in your fingers! This is called referred pain, although technically it’s called the gate theory. The phenomenon of referred pain has been proven in hundreds of medical research studies and compiled by Drs. Travell & Simon in their groundbreaking book Myofascial Pain and Dysfunction: The Trigger Point Manual. (Lippincott Williams & Wilkins).
- The vast majority of medical treatments focus on pressure within the carpal tunnel of the wrist, ignoring 95% of the median nerve and the well-known implication of referred pain. Frequently medical practitioners prescribe braces to prevent your wrist from bending and pressing on the median nerve, and focus their attention on this small section of the nerve. Often surgery is deemed the only treatment, opening up the carpal tunnel to remove pressure from the median nerve. Reports have shown that surgery is frequently unsuccessful at providing permanent relief from symptoms as scar tissue created by the surgery can grow around the median nerve, causing more complications than before. Surgery can also have serious side effects if the median nerve is accidentally damaged or severed, causing permanent paralysis of the hand. Surgery should always be the very last choice of treatment since it is irreversible.
- Anti-inflammatory medications, as demonstrated by the recent Vioxx® exposé, can cause serious conditions such as stomach bleeding and heart attack. Strong drugs must be used with discretion, avoided when possible, and always monitored closely by your physician.
- Drs. Travell and Simon, leading experts in the field of repetitive disorders have demonstrated that repetitively straining muscles will cause the fibers to slowly tie up into tiny knots, which are called “spasms,” or the words they coined “trigger points.” Trigger points in the muscles that cross over the median nerve, and also in the muscles that insert into the wrist and hand, will cause both pain and numbness. The symptoms of these trigger points mimic those of carpal tunnel syndrome! At Julstro Muscular Therapy Center we have proven that releasing the tension in these trigger points will immediately give relief to the symptoms of carpal tunnel syndrome.
- A standard test for carpal tunnel syndrome is an Electromyography (EMG) which is a painful nerve conduction test that involves putting needles into the median nerve above and below the carpal tunnel, and then sending electricity through the nerve to monitor how long it takes for the impulse to hit the second needle. The following muscles are involved in referred pain and numbness to the hand and wrist, and are frequently the cause of a false-positive EMG reading within the carpal tunnel. You can see graphics for each muscle by going to the anatomy lesson on www.aboutCTS.com
- The scalene muscles are located in the neck and pass directly in front of a large bundle of nerves that innervate parts of your chest, upper back, shoulders, down your arm, and into your hand. As the muscle forms trigger points it presses into the bundle of nerves, causing a burning, tingling sensation, as well as numbness, over a wide area from your shoulders all the way down to your fingers.
- The median nerve passes directly under the tendon for the pectoralis minor which is a muscle located in your chest. When the pectoralis minor contracts (shortens) it pulls your shoulders forward so your arms can reach in front of you. However, when the muscle is held in the contracted position for an extended period of time, pressure is forced down on the median nerve, and your hands will tingle or go numb. This muscle is also involved in raising your arms up so you can sleep on your bent arm. Waking up with your fingers tingling, is a sure sign that you sleep with your arm tucked under your head. If you are working with your arms up and experiencing numbness in your hand, you will also be advised that this is a sign for carpal tunnel syndrome. Called the “Flick Sign”, it is actually relieved by just putting your arm down, and is not a signal that surgery is imminent.
- The extensor muscles are located on the top of your forearm. These muscles insert into the carpal bones at the back of your hand and also on your fingertips. They are responsible for bending your hand back at the wrist, and for opening your hand from a closed position. Trigger points in the extensor muscles will pull the carpal bones out of alignment and therefore change the dimensions of the carpal tunnel. This can easily trap the median nerve within the carpal tunnel, and cause you to have a false-positive reading on the EMG test for nerve conduction within the tunnel.The extensor muscles are involved in both carpal tunnel syndrome and trigger finger. The extensors must fully stretch in order for you to curl your fingers into a fist. If one or more of the muscles are held taut because of spasms, you will not be able to bend your fingers, and you´ll experience stiffness in your finger joints.
- The flexor muscles are located on the underside of your forearm. The tendons of the flexor muscles go through the carpal tunnel and insert into your palm and your fingertips. When the muscles contract you will curl your fingers into your fist, and also bend your wrist down. When the flexor muscles are shortened by trigger points the tendons will become taut, and impinge on the median nerve as it goes through the tunnel. This will also cause you to have a false-positive result from an EMG nerve conduction test.The flexor muscles are also involved in both carpal tunnel syndrome and trigger finger. The flexors must fully stretch in order for you to flatten your hand and fingers. If one or more of the muscles are held taut because of spasms, you will not be able to straighten your fingers, and you´ll hear and feel the familiar “click” that is a symptom of trigger finger. One of the extensor muscles also controls your thumb joint and enables you to bend your thumb in the middle. If this muscle is in spasm your thumb won´t be able to open up straight.
- The opponens pollicis is the thick muscle at the base of your thumb. Its function is to draw your thumb into the center of your palm. This muscle originates on the bridge to the carpal tunnel, at the center of your wrist. When the muscle is shortened by trigger points, it pulls on the bridge to the tunnel, putting pressure directly down on the median nerve. This again causes a false-positive EMG reading.When this muscle is in spasm your thumb will be held toward your palm and you may think you have arthritis while all you have is a tight muscle.
In each case, simply eliminating the trigger points will ease the tension on the median nerve, and take the pressure off the insertion points at the wrist and hand. A simple, yet logical, solution to a complex problem.
I suggest you get regular deep muscle massage or learn how to self treat each of the muscles. A qualified massage therapist knows how to release the trigger points in each of the muscles indicated. Not only will releasing the trigger points eliminate the pain and numbness, but will encourage better circulation to your arms and hands, healing any micro-tears caused by the repetitive strain to the fibers. However, repetitive strain on a muscle will cause the trigger points to reoccur in short order. Treatments need to be done frequently at first, even several times a day for several days in a row. It´s a matter of re-training your muscles to be longer, so they won´t be pressing down on the nerve, or pulling on the insertion points. Self treatment is easy, and highly effective. You can treat your muscles at the end of a busy day, allowing them to heal during the night. YOU are your own best therapist!
Carpal tunnel syndrome and trigger point don´t need to be a part of your life, and certainly shouldn´t have anything to do with ending your career!