Carpal tunnel syndrome
is a painful condition, with symptoms ranging from
numbness, tingling and paresthesia (pins and needles)
in the thumb, index and middle fingers. Not all of
the listed symptoms have to occur simultaneously
and can vary from week to week. Severe cases of carpal
tunnel are characterized by wrist inflammation and
swelling and muscle wasting in the hand, especially
the base of the thumb (Thenar eminence).
Carpal tunnel syndrome in most cases is caused by
a muscle imbalance between the flexors, extensors,
radial and ulnar deviators and supinator and pronator
muscles in the hand and forearm that ultimately leads
to median nerve entrapment at the wrist junction.
The entrapment occurs as both weak and strong muscles
pull at the bones in a tug-of-war fashion, causing
the bones to shift towards the stronger muscle side
and resulting in the shifting and misalignment of
the bones, which in turn compress the median nerve
and other surrounding soft tissues and blood vessels.
It is simply that the weaker stabilizing muscles
can no longer do their job and lose the battle as
the stronger muscles tighten down further and further
and compress underlying structures. The condition
can be exceedingly painful, and it is often associated
with decreased strength and coordination in the hand.
Although numerous treatments exist, such as cortisone
injections and surgery, the most effective are those
that address the underlying muscle imbalance that
drives the condition.
During an initial doctor visit, patients may be
prescribed non-steroidal anti-inflammatory drugs
(NSAIDS) to reduce swelling and ease pain. They may
also be advised to refrain from movements that place
undue pressure on the affected area or wear a brace,
which is fine but at nighttime only as daytime use
increases the existing muscle imbalance by reducing
stimulation and activity to the already weak and
imbalanced extensor muscles. However, these are generally
short-term treatments intended to provide relief
of acute symptoms.
Effective relief and long-term treatment
for carpal tunnel syndrome often comes in the form of hand and
forearm exercises and stretches that promote muscle
balance around the median nerve. These exercises
are designed to promote greater equality in muscle
strength and length in the wrist and to bolster trapped
nerves and tendons. Many occupational and physical
therapists used nerve and tendon "gliding" exercises
in the early stages of the illness, but fail to take
it the next step, which is to create overall balance
between all of the agonist and antagonist muscle
groups in the hand and forearm, the key to fast,
effective relief.
Research supports the use of exercises that involve
strengthening the extensor muscles and stretching
the flexor muscles and tendons in the hand and forearm.
The goal is to provide overall balance and stability
to the muscles, which in turn provides increased
joint integrity and the reduction of median nerve
compression.
By eliminating the causative factors of median nerve
compression through effective stretch and exercise
therapy, the injury simply goes away!
Be sure to consult with your physician prior to
beginning an exercise or therapy program.
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