Carpal Tunnel Syndrome

Numbness and tingling in the hands are common complaints for those with Carpal Tunnel Syndrome. However, conditions with similar symptoms exist that may be addressed with more conservative treatments; two such conditions are Thoracic Outlet Syndrome and Active Trigger Points.

The U.S. National Library of Medicine defines Carpal Tunnel Syndrome as “pressure on the median nerve […] that can lead to numbness, tingling, weakness, or muscle damage in the hand and fingers.” The Median nerve supplies sensation and movement to the thumb, index, middle, and half of the ring finger. The area of the wrist where the median nerve enters the hand is called the carpal tunnel. Any swelling of the structures passing through the tunnel can cause compression on the median nerve and consequently give rise to the symptoms discussed. There are both surgical and non-surgical treatments for Carpal Tunnel Syndrome.

Symptoms that mimic those associated with Carpal Tunnel Syndrome may be caused by other musculoskeletal conditions, such as Thoracic Outlet Syndrome (TOS) and Active Trigger Points. Thoracic Outlet Syndrome may result in muscle weakness, numbness and tingling, as well as signs of poor circulation in the arm and/or hand. These symptoms arise due to compression of nerves and blood vessels in the Thoracic Outlet, the space between the rib-cage and the collar bone. Compression may be caused by injury, over-use (such as desk work), or pre-existing conditions such as an extra cervical rib. Presentation mimics Carpal Tunnel Syndrome with similar numbness and tingling but involves the entire hand and not just the previously mentioned portion as seen with CTS. Also, TOS usually involves symptoms throughout the arm while carpal tunnel normally just involves the hand and those structures “downstream” of the wrist.

Active Trigger points indicate specific spots located along skeletal muscles that have become hypoxic (low in oxygen supply) and tight, are associated with decreased blood flow. They present with local and referred patterns of pain, and can be caused by acute trauma (damage) or repetitive microtrauma to the area. Trigger points in the shoulder may cause referred pain throughout the arm and cause altered sensation in the lower arm (Alvarez DJ and Rockwell PG, 2002). The referred pain and symptoms that can arise from the trigger points mimic the symptoms of CTS. Trigger points in the upper and lower arm for example, may irritate nerves that supply structures in the arm and hand. These symptoms are similar to CTS, however the underlying cause is different, and therefore treatment to alleviate the symptoms should be modified.

Your provider can assist you in treating these syndromes to relieve pain and numbness in the hands. Treatments, such as Active Release Techniques and Graston, may be effective in releasing scar tissue that causes these symptoms. As well, your provider can refer you to the proper medical professional if carpal tunnel syndrome is suspected or a surgical intervention is required.

References
A.D.A.M. Medical Encyclopedia. Atlanta (GA): A.D.A.M.; 2011. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001469/
Alvarez DJ and Rockwell PG (2002). Trigger Points: Diagnosis and Management. American Family Physician, 65, p653-660. http://www.aafp.org/afp/2002/0215/p653.html.