Carpal Tunnel Syndrome - Or is it?
Patients talk to me all the time about numbness and tingling in their hands or fingers. And they usually ask the same question: “Is it carpal tunnel syndrome?” Sometimes the answer is “yes,” but even more often the answer is something else.
Numbness and tingling in the hands and/or fingers is usually caused by an issue with the nerves or the blood vessels that serve the area. Along the path from the brain to the fingers, our nerves travel through many places where things can get pinched or irritated. When our hands “go numb” or get that creepy crawly feeling, something is preventing the nerve signals from getting through to the numb area. Here is a list (although not exhaustive) of many of the places the nerves to our hands can get squished.
#1 - At the neck
All of our nerves start at our brain and have to pass through our spinal column to get to their end destination. If your neck is misaligned, or you have a disc that is protruding, these can cause our nerves in our hands to feel numb.
#2 - At the “thoracic outlet”
The “thoracic outlet” is the area where your first two ribs and your collar bone meet your neck. There is a small triangular shaped area that houses all of the nerves, arteries, and veins that supply your whole arm. This is probably the most common place for the impingement to happen.
#3 - At the bicep and upper arm
The strong, large muscles of our upper arm can also be a place where nerves can be squeezed. Especially if we have had any injury to the area, knots or scar tissue may develop which can make the issue worse.
#4 - At the elbow
There are several places around the bones of our elbow and in the muscles on the front side of the elbow that can be a tight squeeze for nerves.
#5 - At the forearm
This is also a common place to have nerves impinged that serve our hands. The forearm is jam packed with lots of muscles that make our fingers, hands, and wrists move with dexterity. This is also a common place to injure our muscles with repetitive motion including ways that we grip or grab things with our hands.
#6 - At the wrist
There are a ton of tiny little joints at the wrist, and a lot of tendons, nerves, and blood vessels that have to pass from a large area into a small area. This bottle neck is a common place for impingement.
Nerve Impingement Locations. Adapted from https://body-disease.com/wp-content/uploads/2013/01/A-The-cutaneous-distribution-and-B-course-of-the-median-nerve.jpg
#7 - At the carpal tunnel
The Carpal Tunnel is on the palm side of your wrist and is a narrow space that is created by the bones of the wrist (your carpals) and the piece of ligament that closes off this area (transverse carpal ligament). If you have true “Carpal Tunnel Syndrome” (aka CTS), only one nerve will be affected: the median nerve. This is the only nerve that passes through this tight little spot. CTS symptoms are specific to the palm surface of the thumb, index, and middle fingers as well as a small portion of the ring finger.
#8 - In the palm
As crazy as it sounds, nerves can even get pinched off because of scar tissue or “adhesions” in the muscles and connective tissue of the palm. There are layers upon layers here that all need to move independent from their very tightly packed neighboring tissues.
As you can see, there are so many places where things can get pinched that aren’t just the physical location called the “carpal tunnel.” When you are working with a physician, it is their job to ensure that the nerves are getting information from their source, and there aren’t any obstacles causing problems along the way.
At Beyond, we perform a specific kind of muscle therapy that is focused on finding changes to tissue texture and tone. What this means is that we’re looking for “knots” or places where each layer (of muscle, nerves, and connective tissue) is moving independently and hasn’t gotten stuck to a different layer. When we can correctly identify the location of impingement, we can have a lot of success in decreasing or even eliminating numbness and tingling symptoms.
In most cases, there are also some lifestyle factors that need to be addressed. This usually includes some direction from Dr. Katie regarding posture changes (from workplace ergonomics, to standing, sitting, and sleeping). We also discuss how dietary changes can help decrease inflammation that increases the pain and irritation of nerves. Finally, stretching and strengthening can also help and must be catered to each individual case.
TL;DR - Many cases of supposed “carpal tunnel syndrome” are actually nerves that are stuck in other places than the carpal tunnel. For the best answers, see a good chiropractic physician to have them assess where things are impinged and to have those areas addressed with an adjustment and/or muscle work.
