Carpal tunnel syndrome (CTS) affects approximately 10 percent of the United States population according to the American Academy of Osteopathic Surgeons. Second only to lower back pain as the most disabling and costly health problem in the country, up to one million surgeries for CTS are performed every year. As with lower back pain, massage therapists can help their clients who have Carpal Tunnel Syndrome.
Carpal tunnel syndrome is a common work-related, repetitive-motion injury that occurs more often in women than in men who work on factory assembly lines, with computers or in other jobs that require repetitive movements. Other professionals at high risk for CTS are massage therapists, bakers, cooks, string musicians, and check-out clerks. As the physical demands of many occupations have changed, many jobs have become more specialized resulting in performing repetitive movements. A person with numbness or tingling in his or her hands, fingers, or forearms may immediately think he/she has CTS because the syndrome is so well known.
The syndrome is present when the median nerve is compromised and compressed at the carpal tunnel due to mechanical or chemical means. By looking at the anatomy of the wrist one can see why CTS is so prevalent. Through the carpal tunnel – the area at the base of the anterior wrist between the carpal bones – nine flexor tendons and the median nerve pass. If any tenosynovial proliferation (hypertrophy of the tendon-synovial complex, which is made up of the tendons and joint-synovial tissues located in the carpal tunnel), joint abnormality, tumor, or muscular anomaly exists, there is a likelihood that CTS may result.
An acute injury may damage the tendons placing pressure on the median nerve. If untreated, the tension puts the patient into a cumulative injury cycle where isometric contraction, prolonged poor posture and decreased circulation resulting in hypoxia causes fibroblastic activity and subsequent adhesion formation. Repetitive motion causes increased tissue tension and decreased circulation to the area resulting in hypoxia and adhesion or fibrosis, with subsequent entrapment of the median nerve.
The earlier the diagnosis is made, the more carpal tunnel treatment will be successful. Numbness, weakness and pain contribute to a diagnosis of CTS. Clients who complain of numbness, burning, shooting pains, tingling, and pins and needles in their thumb, index and middle fingers and the radial half of the ring finger, weakness in their hand, and pain in their hand, forearm, elbow and shoulder may have CTS. Another sign a person may have CTS is wrist pain that wakes him/her up from a sound sleep.
To test for CTS have your client perform one of the following:
- Phalen’s test — In the Phalen’s test the client presses the backside of his/her hands together and holds them for about 60 seconds. If neurological symptoms are reproduced along the median-nerve distribution, there is a good indication the client has CTS.
- Tethered median-nerve stress test — In this test, the wrist is held in extension or partial hyperextension and the index finger is pulled into hyperextension as far as the client’s range of motion will allow. If this movement reproduces the client’s pain or neurological symptoms, it is considered a positive indication of CTS.
- Carpal-compression test — Carpal tunnel syndrome may also be diagnosed by applying direct pressure over the carpal tunnel to reproduce symptoms.
- Tinel test — In this test, tap the wrist while the hand is extended. If there is pain it may be due to CTS.
Once CTS is diagnosed, there are several treatments a massage therapist can use to help his/her client reduce pain and numbness. The January-February 2004 issue of Massage Magazineoutlined several methods therapists can use to lessen their client’s pain, including:
- Myofascial stretching — In cases where nerve compression is not severe, myofascial stretching applied over the flexor retinaculum has proven helpful in reducing the aggravating symptoms of CTS. Flex the client’s wrist and with your thumbs stretch the transverse carpal ligament.
- Flexor work — Working on the wrist and finger flexor muscles is also helpful. If the condition is severe, the therapist should be gentle at first. More significant pressure may be used if the condition is not severe or during later stages of therapy.
- Stripping & compression — Deep longitudinal stripping and compression-broadening methods can be used on the forearm flexors to regain optimum tone in those tissues. To work the finger flexor muscle, use a thumb and strip the thumb up the forearm. To work the wrist flexor, place static pressure on the muscle while the client flexes his/her wrist.
In some cases the median nerve is entrapped in another location such as the pronator teres muscle. In the video, Heal Your Wrist Pain Naturally with Sean Riehl, Riehl explains various techniques a therapist could show his/her client to use at home, at the office in between visits, or techniques the therapist can do on him/herself. This includes massaging the pronator teres muscle. To do this, have your client apply static pressure to the pronator teres muscle with his/her thumb as he/she twists (turns) the wrist.
The video also shows techniques one can perform on the finger, thumb and wrist extensors and flexors, supinator and pronator muscles to further alleviate wrist pain by applying static pressure. For alleviating CTS pain Riehl suggests working the finger flexor muscles. Place static thumb pressure on these muscles while flexing the fingers.
If at any time during massage, your client experiences pain, stop, and try a different technique.
In addition to massage, educate your clients about an integrative approach. Tell clients to rest their wrists, or if they have to continue working to wear splints. Encourage your clients to consider taking vitamin B6, as a deficiency in this nutrient has been linked to CTS.
Carpal tunnel syndrome is a complex condition. However, once therapists know how to test for the syndrome they can help their clients by using the techniques listed above. Massage therapists can also use the abovementioned techniques on themselves if they are afflicted with CTS.
Editor’s note: For more information about Heal Your Wrist Pain Naturally with Sean Riehl, click here.