Carpal Tunnel Syndrome is a commonly misunderstood condition. It is generally thought of as a condition that arises due to pressure of the Median nerve, as that nerve and nine tendons pass through the carpal tunnel at the wrist (also known as the Flexor Retinaculum).
Because this is the common understanding of the condition’s origin, treatment usually involves anti-inflammatories, physical therapy on the wrist, and surgically cutting the transverse carpal ligament that overlies the carpal tunnel.
What is not commonly understood is the concept of ‘Double Crush’ involving the Median nerve. Double Crush is a phenomenon that refers to a nerve experiencing pressure at two or more locations along its path.
Nerves exit the spine column at each level of the spine and travel to their final destination in the body. In the case of the Median nerve, there are several areas of potential pressure from the spine to its destination at the hand. There are also many underlying reasons that the pressure is occurring at those locations. We will look at some commonly involved areas relating to the Median nerve.
The first area the Median nerve can experience pressure is as it passes through the Scalene muscles of the neck. Increased tension in the neck muscles can be a result of stress, improper movement patterns, altered breathing patterns, poor ergonomics, or poor posture.
The second area that the Median nerve can experience pressure is as the nerve passes between the collarbone and the first rib. Some individuals will have a genetically smaller space at this location and poor posture compromises the space in others.
The third area that can experience increased pressure is as the nerve passes through the region of the pectoral muscle. We tend to be a forward drawn society, constantly fighting the battle to draw into the fetal position that we came from, and is made worse by sitting and working at our computers. As a result of poor posture and forward positioning of our shoulders, the
pectoral minor muscle can become shortened and tight, applying pressure to the Median Nerve as it passes through this region.
The fourth area the Median nerve commonly experiences pressure is as the nerve runs through a muscle in the forearm, just beneath the elbow, called the pronator teres. This muscle can become tight in some individuals who spend a great deal of time working with their hands, and can increase pressure on the nerve.
The fifth place that the Median nerve can experience pressure is through adhesions in the connective tissue/fascia anywhere along its path. If these adhesions can be identified, various techniques to release the nerve from those adhesions can be employed (including massage, chiropractic, and medical injections), freeing the nerve and reducing the pressure.
The sixth place the nerve can experience pressure is as the Median nerve and the nine tendons of the forearm run through the carpal tunnel of the wrist. This is generally caused by inflammation of the nerve and/or tendons passing through such a small area. This is the most identified cause of nerve pressure associated with Carpal Tunnel Syndrome.
The Double Crush Phenomenon supports the idea that local damage to the Median nerve along its course, may sufficiently impair the overall functioning of the nerve, so that it becomes more susceptible to injury than would normally be experienced in the wrist. Often multiple areas of pressure lead to the symptoms experienced in the wrist, not just isolated pressure at the wrist as commonly thought. This is the reason so many people who have the carpal tunnel release surgery continue to experience carpal tunnel symptoms even after surgery.
Senior Physical Medicine patients experiencing Carpal Tunnel Syndrome can expect to have all of their contributing physical issues identified and treated with care and precision. After identifying the route cause of the Carpal Tunnel Syndrome symptoms, Senior Physical Medicine will be able to treat the problem that is causing the symptoms, thus avoiding an unnecessary surgery.