Symptoms of Carpal Tunnel Syndrome

NUMBNESS IN THE HAND can vary from severe constant numbness and tingling to occasional numbness and tingling during daily activities. The severe constant numbness is indicative of fully developed nerve entrapment such as carpal tunnel, and needs to be addressed before it becomes incapacitating or requires surgical intervention. The sporadic or occasional numbness indicates a developing problem that will probably become more acute in time without treatment. These symptoms are normally intensified when the client is under any kind of stress. The first manifestation of these symptoms often occurs when the client is awakened from sleep experiencing numbness in a hand or arm.

PAIN IN THE WRIST AND FOREAR is a symptom that should not be ignored. Clients having this symptom usually are developing carpal tunnel or nerve entrapment syndromes. The pain can be occasional occurring only at night, situational occurring minutes or hours after a specific activity such as typing on a computer, or constant.

SLEEP INTERRUPTED BY PAIN is a sign that treatment is necessary now. Clients will almost always pay attention to this symptom.

PAIN RADIATING DOWN THE ARM can start in the neck, chest, shoulder, upper arm, or elbow. It can be sharp, somewhat stabbing, or mild. Clients seldom fail to report sharp stabbing pain as it grabs their attention immediately, but occasional dull pain is often overlooked and not mentioned. However, to avoid even the dull pain, people will often limit the use of the involved hand or arm indicating that there is a developing problem that needs to be evaluated and addressed.

FINGER NUMBNESS can include the thumb and all four fingers or different combinations. The most common combinations are the thumb and index finger, the last three fingers, the thumb and first two fingers, or just the thumb. Numbness in any of those fingers or thumb is caused by entrapment or compression along the nerve pathways leading to them. The intensity can vary from complete numbness to mild, and the duration can be momentary, or lasting for days, months, or even years.

WEAKNESS/CLUMSINESS OF THE HAND RESULTING IN PROBLEMS GRASPING becomes apparent when clients aren’t able to open a jar, pick up a water bottle, give a firm handshake, or turn a doorknob. This is often accompanied by pain and stiffness, but is generally ignored until a limitation of function is experienced or the pain is severe.

HARDNESS OF THE HANDS is often a result of nerve entrapment in the arm or carpal tunnel. When a client’s hands feel like cement there is usually a significant amount of atrophy in the hands and forearms with extensive adhesions both between and within the muscle tissues. The tightened atrophied tissue and adhesions are a primary cause of nerve entrapment within the carpal tunnel and/or around the bony prominences resulting in nerve entrapment producing pain or tingling or numbness or any combination of these symptoms.

LIMITED RANGE OF MOTION OF WRIST OR FINGERS is easily observed in flexion and extension. The tendons of the wrist flexors pass through the carpal tunnel (flexor retinaculum), and the tendons of the extensors run through the posterior forearm to the wrist and fingers passing through the extensor retinaculum. Tightness, swelling, adhesions or restricted myofascial holding patterns in any of these muscles, tendons and related fascia greatly restricts the movement of the wrists or fingers and entraps or compresses the nerves.

SWELLING OF FOREARMS, HANDS, OR FINGERS is commonly found in carpal tunnel and nerve entrapment. Repetitive motion and nerve compression cause a build up of waste products (ischemia). Also, strain patterns within the muscles and soft tissue often lead to the development of micro tears from repetitive use causing fluid build up and swelling. This ischemia and swelling put pressure on the nerve pathways which creates the pain and inflammation.

PROGRESSIVE IMMOBILITY IN THE FINGERS, HANDS, WRIST, FOREARMS, OR ELBOWS is an important indicator of nerve entrapment, and is found in almost every case of nerve entrapment syndrome of the arm including carpal tunnel.

INFLAMMATION AROUND THE JOINTS OF THE ELBOWS, HANDS, WRISTS, OR FINGERS is evident in most carpal tunnel/nerve entrapment syndromes. Clients often report that they experience burning and swelling around any or all of these joints which indicates inflammation within the soft tissue that needs to be addressed.

ADHESION BUILD UP IN THE ARM is normally a significant problem in carpal tunnel and nerve entrapment cases. The body will weave collagen fibers in multiple layers of fascia creating the adhesions to mend or support a weakened area when it is subjected to stress, injury, or strain patterns. This causes a shortening of the muscle resulting in limited range of motion, stiffness and pain and is definitely aggravated by repetitive motion activities.

TREATMENT GOALS

It is extremely important to establish clear treatment goals when working with clients. This is vital when working on conditions such as nerve entrapment and carpal tunnel. Many massage therapists skip this important step. When clear and attainable treatment goals are established prior to treatment, both the massage therapist and the client will be able to measure the success and track the progress. I have found the following three levels of goals work well: 1) primary long term goals; 2) intermediate goals that will achieve the primary long term goals; 3) specific goals for an area that will achieve the intermediate goals. Let’s clarify these further.

1. Primary long term goals: The client can participate in normal life activities pain free! Example: If Jenny, a computer operator, comes in with pain and nerve entrapment symptoms such as carpal tunnel, she will be able to return pain free to her normal life activities as a computer operator following treatment. This goal is what every step of treatment is aiming to achieve. This goal is all-inclusive and is only limited by circumstances where a client is doing activities that are self-injurious and should be stopped because of the inherent injury.

2. Intermediate goals that will achieve the primary long term goals: Reduce pain, release the strain pattern, restore full range of motion, regain strength, regain coordination, and soften hardened tissues. With the accomplishment of each intermediate goal, the client is that much closer to pain free participation in normal everyday activities. When all these intermediate goals are met, the primary long term goal is achieved.

3. Specific goals for an area that will achieve the intermediate goals: Release the internal rotation of the shoulder and arm, release the compression on the brachial plexus, release the adhesions that affect the median, radial or ulnar nerve, reduce ischemia, reduce swelling and inflammation, deactivate trigger points, release myofascial holding patterns, normalize scar tissue, separate bunched groups of muscle fibers. These goals are all specific to the results we want from the actual work of our hands. As these goals are met, we will achieve the intermediate goals, and ultimately the primary goal.

- Don McCann, MA, LMT, LMHC – founder Structural Energetic Therapy, Inc.