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This column is about my experience as an alternative health care provider within the modern medical system. Although I now live in Morro Bay, I still manage a health care clinic in the San Diego area, as I have done for the past 25 years and where I still work 10 days out of each month.
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A New Perspective on Carpal Tunnel Syndrome
by Brian Dorfman
A natural follow up to our recent discussion of thumb arthritis and thumb pain is a presentation of Carpal Tunnel Syndrome (CTS). Thumb arthritis is closely related to CTS as they both involve the same misalignment in hand positioning detailed in previous articles.
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There are various symptoms of CTS (sometimes knows as Repetitive Motion Injury or RMI) including numbing and tingling in the hands, loss of hand strength, and pain in the hands and wrists. As these symptoms progress, pain and weakness can become debilitating. Standard treatment options include wrist guards, hand splints, medications, and surgery. Although alternative treatments are not given much credibility in the modern medical environment, Yoga is one option that the National Institutes of Health endorses as having proven results. Changing the ergonomic set-up for computers is another beneficial adjustment for those who spend a lot of time typing and doing other computer related work. But, in the long run, the best treatment (and prevention) is simply creating the correct alignment in the palm and wrist as it relates to the central carpal area.
Let me explain.
The carpal tunnel is a narrow passageway located on the palm side of your wrist. This small tunnel houses
the median nerve of your hand as well as the nine tendons that bend your fingers. In addition to the nerve and tendons, veins, arteries, and bursa fluid also travel through this narrow opening at the wrist. It is compression of the median nerve that produces the numbness, pain, and hand weakness that make up carpal tunnel symptoms.
I have worked with about 200 CT cases in my career and the common factor in nearly all of them was incorrect positioning of the hand characterized by a closing in of the sides of the hand. It is this side-to-side compression that is highly problematic for the carpal area. Check out this short video for a visual explanation of correct and incorrect hand positioning as it relates to the wrist.
Common medical information suggests that the CTS is a nerve problem, but in my opinion it is a swelling problem which results in compression on the nerve. The risk for CTS increases with pregnancy, which makes perfect sense. Pregnant women often experience edema, or swelling, and swelling in the carpal area is a prime ingredient for CTS. Resolve the swelling and you resolve the pressure on the nerve. As there’s very little space in the carpal area, even a little bit of swelling will aggravate the nerve. The Mayo Clinic states that "anything that crowds, irritates or compresses the median nerve in the carpal tunnel space can lead to carpal tunnel syndrome," yet somehow they fail to include problematic hand positioning as a possible cause of the compression.
As I wrote in the article on thumb arthritis, the correct and incorrect alignment of the hand is not in dispute. It is accepted anatomy across all medical and healing fields. This is one area where the AMA and I are in complete agreement. So I am perplexed as to why this very simple cause and effect is largely absent from the medical cannon on CTS, thumb arthritis, and other structurally related medical conditions.
Although we often think of CTS as a computer or tech related problem, this is only a small slice of those affected. Studies indicate that up to 75% of dental professionals experience carpal tunnel symptoms at some point in their careers. Jobs that require manual labor, such as carpenters, electricians, plumbers, and factory workers, also have a high incidence of CTS. Musicians face this problem all the time.
On the positive side, I would rate those cases that involve carpal tunnel symptoms as some of the most solvable cases we get in our office. Similar to the thumb, the hand and wrist are easy to access and reposition. Various stretches and self-massage techniques are also available to aid in recovery. I will demonstrate these techniques in my next article, so stay tuned. In the meantime, if you are experiencing the pain, numbness, or loss of strength associated with carpal tunnel syndrome, make sure to schedule an appointment with a health care practitioner who understands the importance of correct hand and wrist positioning in resolving this issue.
Double-crested Cormorant on banner by Cleve Nash |
