Carpal Tunnel Syndrome, Massage Therapy and Surgery Prevention

Carpal tunnel syndrome is a compression of the median nerve as it passes through the carpal tunnel of the wrist. Caught early enough, carpal tunnel syndrome, or CTS, doesn’t have to progress to the point where it is debilitating or affects activities of daily living. The incidence of surgery, which involves cutting the carpal tunnel ligament (aka flexor retinaculum) could very well be reduced if massage therapy was used more frequently as an early intervention.

Symptoms of Carpal Tunnel Syndrome:

The median nerve is not the only structure that passes through the carpal tunnel – the muscles of the anterior forearm (the forearm and wrist flexors) also figure prominently in CTS. In early stages there is often numbness, tingling or “pins and needles” in the lateral 31/2 digits of the hand (thumb through to 1/2 of the ring finger). There could also be pain and local inflammation or swelling over the wrist on the palmar surface of the heel of the hand. In later or more chronic stages, there could be atrophy of the thenar emminence (muscles which move the thumb), or trophic skin changes in the same area, such as redness, dry or scaly skin. At this stage, there may also be altered sensation in the forearm and axilla (armpit).

In conjunction with the muscle wasting, there may also be difficulty in activities which require fine motor control (i.e. picking up car keys, buttoning a shirt). It is not unusual for people with more severe or chronic cases of CTS to wake at night from pain, which is relieved by moving or elevating the limb.

Who is at risk for Carpal Tunnel Syndrome?

CTS often affects people whose activities of daily living (either work or hobbies) involve repetitive motion of the fingers and hands. (Think of a data entry clerk, a musician, a massage therapist or someone who knits a lot). Repetitive motion causes “hypertonicity” of the muscles of the forearm, and as they pass through the carpal tunnel, the larger size of the tendons impinge the nerve. Left long term, the muscles are unable to function as they should and they become weak.

Injuries to the wrist, with displacement of the carpal bones, may also compress the median nerve or cause swelling of the tendons that pass through the carpal tunnel; edema during late stages of pregnancy or during illness may also narrow the tunnel, compressing the median nerve.

How can massage therapy help prevent and treat carpal tunnel syndrome?

Massage therapy can provide valuable assistance to someone suffering from CTS, either as a stand-alone treatment, or in conjunction with other modalities. Massage can also assist in prevention of the syndrome; when treatment is started early enough, muscle hypertonicity is decreased, and edema can be reduced.

Treatment will depend on the actual cause and stage of presentation of the condition. For example, in a case where repetitive stress is the cause, the therapist will attempt to decrease hypertonicity and myofascial trigger points of the brachium, ante-brachium, all of which are proximal to the site of compression. This can be achieved by doing deep work to the muscles of the arm and forearm, as well as stretching of the forearm flexors.

If the structures in the carpal tunnel are impinged due to thickening or scarring of the flexor retinaculum, friction therapy to break down the tissue can be invaluable, if painful, to reduce compression.

Manual lymph drainage can assist in the reduction of fluid build up post treatment.

The therapist may also stretch the carpal ligament and palmar tissue & fascia, reducing compression of the structures, and finish with a cold hydrotherapy application on the site to reduce any inflammation.

Outside of surgery, there is no “cure” for carpal tunnel syndrome which results from hypertonicity of the forearm flexors. If CTS is caused by a repetitive stress injury (RSI), then maintenance will be necessary. Maintenance in this case will involve a program of stretching, hydrotherapy, massage therapy and possibly a wrist brace. The use of ergonomically correct keyboards for those whose work involves a lot of typing can also be useful.

Depending on the severity of the condition, a treatment plan may involve a few weeks of treatments 2 times per week, in addition to a homecare plan to reinforce the effects of the treatment. As hypertonicity of the forearm flexors is reduced, the frequency of the treatment is reduced to once a week for several weeks.If you have questions concerning the treatment plan, your massage therapist should be more than willing to discuss it with you.

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Jodi Forsythe
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