Pain-Free and Fit with Dr. Ric Alexander

Carpal tunnel syndrome (CTS) is a cumulative trauma disorder (CTD), which is also called a repetitive strain or repetitive stress injury (RSI). Cumulative trauma disorders are currently the number one job related ailments in the United States. They cause almost all lower back and neck problems, as well as the majority of shoulder, knee, foot, and other joint pains. The wrist is the most common injury with the hand being second. By 1995, Carpal tunnel syndrome had increased to 50 percent of all reported job-related injuries. Symptoms include pain, numbness, tingling or weakness in the forearms or hands. Pain is often felt in the wrist, thumb and first two fingers. This is the area of the hand supplied by the median nerve. No matter what your job or how you developed it, carpal tunnel syndrome can be very debilitating. 

There are eight bones in your wrist known as carpal bones. They form a U-shape that has a wide band-like ligament across the top (palm side) known as the flexor retinaculum (a.k.a. transverse carpal ligament). Together they form what is known as the carpal tunnel. When someone uses their hands and wrists excessively, the wrist flexor, forearm pronator and numerous finger muscles receive repetitive stress. This causes a build-up of fibrotic adhesions or scar tissue that makes the muscles shorter and tighter. It is sort of like adding straw to a camel’s back until his back eventually breaks. Of course, a severe injury to the muscles can add a lot of scar tissue at one time. When the tightness in the muscles reaches a certain level it leads to misalignments of the wrist, hand and forearm bones. The tightness also causes tendinitis of the wrist and finger flexor muscles. The increased stress causes the muscles to build up more scar tissue at an ever-increasing rate. 

As the tendinitis progresses and the misalignments worsen, there is eventually enough inflammation and swelling to put pressure on the median nerve that goes through the carpal tunnel. This pressure causes neuritis (nerve inflammation) and neuralgia (nerve pain) in the palm side of the wrist and hand. It also affects normal nerve flow to the muscles that the median nerve innervates (controls). These key muscles involved in carpal tunnel syndrome are now weaker and more easily over-stressed. As they accumulate more damage and become tighter, the CTS progresses more rapidly. 

Many of my patients were misdiagnosed with CTS prior to coming to my office. Most of them had only a simple tendinitis of the wrist, hand, thumb or finger muscles. If a problem is musculoskeletal, when you move the joint or use it, the pain is generally worse. Whether you have minor or acute carpal tunnel syndrome, please check out my instructional video – Treat Your Own Carpal Tunnel Syndrome.  My patients who use my instruction experience major to full relief of their CTS symproms, so now I invite you to take your condition into your own hands.  Feel free to comment and a response will be made!

When someone does a physical activity to excess, they strain the muscle which was overused. This can happen to a well-trained athlete who is striving to excel, or a retired person who overdoes it working in their garden. This scenario is often seen in the “weekend warrior” athlete who sits at a desk all week, and then goes all out during the weekend with a physical activity like softball or tennis. The resultant muscle strain (mild tear) creates inflammation and pain. This strain usually occurs near the end of the muscle where it attaches to a bone or blends into its tendon. This creates a condition known as acute tendinitis. This condition could also be created if the muscle is strained from trauma.  The usual treatment for acute tendinitis is to rest the area, apply ice periodically for the first 24 hours, and then to use moist heat. Rest prevents further muscle injury, the ice reduces the initial inflammation and swelling. and the moist heat circulates blood through the area to speed the healing process. Now, if you added gentle massage and stretching to this treatment plan the muscle would probably heal totally back to normal.

However, this is not what the average person usually does!  They may ice once or twice and rest a bit, but most often just take an over-the-counter pain medication and continue on with their normal activities. If the strain was minor, their body may be able to heal the muscle fibers normally. Unfortunately, this is not the usual result because the injured muscle is being used instead of rested. Because of the stress on the muscle, their body heals the injured muscle fibers by binding them together with fibrotic adhesions, or scar tissue. This is done in an attempt to prevent further damage to the injured area. It is a normal protective response of their body.

Formation of scar tissue in an injured muscle causes it to become shorter and tighter than normal. This places more tension and stress on the muscle, making it easier to strain during future physical activities. If the muscle is over-stressed or re-injured further, eventually enough scar tissue will form to shorten the muscle to the degree that it can pull its attached bone out of normal alignment. The result is a joint misalignment which causes a chronic condition to develop. If a tendon receives most of the stress from the joint misalignment then chronic tendinitis develops. If a nerve is stretched or has excess pressure on it from abnormal swelling caused by the joint misalignment then a chronic neuritis condition will develop. This happens most often when the spinal vertebrae are pulled out of their normal alignment (subluxated). If the cartilage of a joint is receiving abnormally high pressure on it because of the joint misalignment, then a chronic arthritis condition will develop. Now, last but not least, if the bursae around the joint receives excess pressure and stress because of the misalignment then a chronic bursitis develops.