Several million Americans are affected by this disorder. Lindy Loya MA, an Occupational Therapist and a Certified Hand Specialist assured me Carpal Tunnel can usually be cured. That's good to hear.
First let's examine the carpal tunnel.
The hand is supplied by three nerves which originate in the spinal cord and extend down through the arm and into the hand. They are called the median, radial and ulnar nerves. The median nerve wires or innervates the muscles that bend and open the thumb away from the hand and bend the first three fingers; the thumb, the index and the middle finger.
The Carpal Tunnel
The carpal tunnel is formed by the 8 carpal bones that include the hamate, trapezium, triquetrum pisiform, trapezoid, capitate, scaphoid, lunate and a ligament which spans the front of the wrist called the transverse carpal ligament. Imagine the heel of your hand when it is supinated.
Nine tendons and the median nerve pass through this tunnel. So as you can imagine, it could get a little crowded in there.
During wrist and finger movement these tendons and the median nerve must slide across each other.
Signs of Carpal Tunnel
In carpal tunnel syndrome, the median nerve gets compressed inside this tunnel. The first signs are loss of sensation in the areas the median nerve innervates, after a specific activity or at night. A therapist will use a Phalen's test or Tinel's sign to help diagnose CTS.
There are three levels of injury to the nerve:
- Neurapraxiais when the nerve is squashed a little. Not unlike having a rubber band tied around your wrist.
- Axonotmesisis a volarian (referring to the palm of the hand) degeneration or necrosis of the axon.
- Neurotmesis is when the nerve has actually degenerated and must be surgically repaired
Depending on the level of injury to the nerve, will determine on the type of treatment.
CTS occurs in women more than men. It seems women generally have smaller wrists but not smaller tendons. This makes them more susceptible to this condition. There is also an increased prevalence during pregnancy when more fluids are retained, increasing pressure in the blood vessels that travel through the carpal tunnel impinging the median nerve even more.
Causes of Carpal Tunnel Syndrome
The most common cause of CTS is a cumulative trauma disorder caused by overuse or repetitive activities. However two other potential causes of CTS have been identified:
- changes in anatomical structures or
- underlying systemic or physiological disorders such as diabetes, rheumatoid arthritis or metabolic disorders.
The increase incidence of CTS in younger people involved in computer work or repetitive manual labor may be because of the increased awareness of this condition. CTS normally occurring bilaterally, (bothsides) could indicate some kind of systemic or physiological disorder.
If you suspect someone has CTS, do not diagnose and refer them to a doctor or a hand specialist.
If you live in Southern California, look Linda up.
Positions to avoid
Lindy told me that extreme wrist flexion can cause twice the amount of pressure against the median nerve while extreme extension can cause up to three times the amount of pressure!
Generally, avoid extreme flexion and extension. Do not apply force directly to the tunnel. Pushups or benching with a false grip would be out of the question. Unless of course, the pushups were performed on your fists.
Gripping or pinching forcefully with a fist or the first three fingers can sometimes aggravate the nerve and cause pain.
If a doctor has diagnosed you or your client with CTS make sure to obtain a second opinion from a Certified Hand Specialist such as Lindy. As she warned me,
"tendinitis can often be misdiagnosed as CTS and the nerve may be impinged in many different areas as it travels down the arm."
How to exercise.
Having CTS doesn't mean you can't train. You just have to understand the condition and be a little creative.
It's kind of difficult to train you upper body without gripping forcefully, so why not by - pass the whole joint?
Once the condition stabilizes and/or you or
they 've been given the permission to exercise, here are some suggestions:
Buy some padded ankle cuffs that close with a ring instead of a belt buckle. Then go to Home Depot and buy two 24 inch pieces of seat belt material or safety cord. Attach these two pieces together in the middle with another large ring and place another ring on each of the two remaining loose ends. You'll have what looks like a big V, with a large ring in the middle and two smaller rings at each end.
In order to perform a seated lat pulldown without using your wrists, attach the two ankle cuffs to your biceps or just above the elbow, then attach the large middle ring from your V- strap to the hook on the pulldown cable (where the bar used to be) and the other ends of the straps to the left arm and the right arm. Now you can perform the pulldown without any strain on your wrists! Don't go up too far though, or the straps will start to roll up your arm.
To perform straight arm pulldowns, just stand up and keep everything where it is. Pull your arms from about shoulder height in front of you, down pass your sides. Again, don't let your arms go too high or the cuffs will roll off your arms.
To perform flat, incline dumbbell press or flyes, move an adjustable bench in between the cable columns. Keep the ankle cuffs at the elbow or a little above the elbow. Grab the cables from above or below and attach them to the corresponding ankle cuffs. Remember, the good thing, is the pectoralis major or the latissimus dorsi attach don't attach to the wrist.
For lateral raises you might be able to move the cuffs a little towards the forearm instead of the biceps. Just attach the bottom cable from the cable column and line up the specific fibers of the shoulder you want to work on. For front raises, stand with your back to the cable column and raise your arm in front of you. For middle delts, stand with the cable stack to the side, bend at the waist, stabilize the spine and abduct the humerus letting the cable pass in front of you. For rear delts, stand with the cable stack at your side an attach the upper cable to the cuff around your elbow or a little above and horizontally abduct the cable as it passes right in front of you.
For biceps, attach the V- straps to the low cable and perform preacher curls facing the cable stack. The ankle cuff will have to go around your forearm and you won't be able to extend your arm all the way. The ROM will be shortened but at least the force of the weight won't be crossing your wrist.
If you can find some Power Block dumbbells to curl with, you'll be able to spread the force of the dumbbell over the forearm instead of just across the wrist.
For triceps, lie down on a bench parallel to the cable column, attach the V- strap to the bottom cable and the ends to the ankle cuffs on your forearm and perform elbow extension.
By now, I think you'll get the idea. I'm sure you'll be able to come up with some other ideas. Since Carpal Tunnel Syndrome is at the wrist, the goal is to
not involve the wrist.
Don't forget to include some stretches in your program. Here are some of the stretches Lindy suggested:
- Hold both hands in front of you and place the wrist in neutral as if you were a director looking through a TV screen. Then bend your 4 fingers from the first knuckle towards the center. Remember to keep your fingers straight the whole time.
- With the hands in the same position, just curl the fingers.
- After curling the fingers; make a fist.
- With the hands in the TV position try and stretch your thumb over your palm and touch the base of your little finger.
- Supinate and gently bend your thumb backward. In typing or computer work, the thenar muscle ( that big chunk of flesh below your thumb) becomes shortened. This stretch will help with that.
Remember if there is pain, stop the exercise. If the pain, continues refer them to a doctor or a Hand Specialist.
I hope these exercises will be helpful to you or your clients with CTS
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