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
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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), 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.
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