Carpal Tunnel Syndrome (CTS) is a painful condition of your arm that is mainly characterized by a variety of symptoms in your hand, including numbness, tingling, loss of grip strength, and pain at night. The “carpals” are the bones in your hand and they form an arch or tunnel that houses many structures, including the median nerve. It is believed that the median nerve is “compressed” within this tunnel, resulting in the aforementioned signs and symptoms. Common treatment includes local stretching and nerve glide exercises directed mainly at the carpal region and, if that is unsuccessful, then a surgical “release” of the retinaculum is performed with variable success.
As a manual structural therapist, I have always had a different take on carpal tunnel syndrome. First, let’s talk about the make up of the median nerve: the median nerve is made up of nerve roots that exit the spinal column at the levels of C5-T1 that pass just under the clavicle and then travel down the arm (see picture below, courtesy of Grant’s Anatomy). You can see the thick, canvas like tissue at the wrist. This is what is “released” in surgery.
Since the median nerve roots come out of the middle and lower neck, it makes good sense to first look at the mobility of the cervical spine to determine if there is any segmental vertebral joint restrictions that may be playing a role in the arm symptoms. I just read a research article from some Physiotherapists in Spain that give this treatment approach some scientific credibility. To summarize the article:
71 women with diagnosed CTS had their cervical (neck) range of motion tested to see if they also demonstrated restrictions proximally (the area that the median nerve is formed from).
Conclusion: Women with mild to severe CTS all exhibited less cervical spine range of motion compared to women of the same age without CTS.
My take home message is this: if you have CTS and are being treated, make sure your practitioner is also addressing your cervical spine, clavicle, and explaining the role of the neck in your hand symptoms. Good luck!
Ed Deboo, Physical Therapist