Carpal Tunnel Syndrome: a painful condition of the hand and fingers caused by compression of a major nerve where it passes over the carpal bones through a passage at the front of the wrist, alongside the flexor tendons of the hand. –dictionary.com
Carpal Tunnel Syndrome (CTS) is very common overuse injury that occurs anywhere from 2.7-5.8% of the population, according to the Association of American Family Physicians. In our office, patients who work desk jobs, spend to much time on their phone, lift heavy weights, or have hobbies that require lots of forearm and finger flexion (i.e. knitting, gaming, playing guitar, rock climbing, etc.) are all quite adept at developing CTS. The Association of American Family Physicians also state that the first things you should do if you develop CTS are: reduce your load, get a splint, and get a steroid injection. If in a span of 6 weeks to 3 months that approach doesn’t work, a surgical consult is suggested. The only part of that previous sentence we agree on at our office is a reduced load. Why aren’t they asking the REAL question: what happens to the wrist muscles when they are overused?
location of the carpal tunnel
Overused muscles develop adhesion.
When the load of the muscle exceeds the capacity it was designed for, the body can no longer keep up with the waste it is producing. This is much like when you go balls to the wall during a workout and lactic acid builds up. Lactic acid is actual one of several ways the body acts as a check engine light by telling you, “Slow down! You keep this s#!t up you’re going to get seriously hurt!” When a muscle’s waste builds up from less intense overuse the body doesn’t stop going, but waste continues to build up, which creates inflammation. This inflammation developed from you acting like a textasaurus rex sends a signal to the body that says, “Help! I’m in trouble!” In response, that inflammation attracts these little fellas called fibroblasts that lay down collagen fibers on the overused muscles. These collagen fibers run in many directions and act like glue on that injured muscle fiber. It doesn’t allow it to contract or to stretch, so it the effected muscle fiber is essentially dead weight that the rest of the muscle has to pick up slack for. If healthy tissue is soft and supple, this is firm and tender. This is adhesion.
When a little problem becomes a big problem
A little bit of adhesion is a fairly common thing in the body and generally garners no symptoms. When adhesion persists, especially in the finger and wrist flexors, symptoms will pop up. With the injured muscle fibers essentially doing nothing, the rest of the fibers have to pick up the slack. So if the activity continues and you have fewer and fewer muscle fibers to recruit to do the job, eventually that adhesion lead to increased amounts of inflammation around the muscles, which will lead to more and more adhesion. This adhesion will restrict your range of motion, strength and generally you will tire faster. One area your wrist cannot afford inflammation is the carpal tunnel. It is a band of ligaments around your wrist and it does not stretch. If the muscles in the tunnel are inflamed, they can’t expand outward so they compress the structures inward–particularly the median nerve that give the hand sensation. Eventually this dysfunction will lead to the muscles getting so restricted by adhesion they compress the joint they cross, speeding up the development of degeneration (arthritis) which cannot be reversed.
How do I get rid of adhesion?
Adhesion is stubborn. It requires pressure and tension along the direction of the muscle fibers for it to be removed, and it certainly won’t happen all at once. Stretching and exercise basically tell the healthy muscles around it to be more healthy to mask the area not working (this approach doesn’t work). A brace or strap will limit the load, but does nothing for adhesion. A steroid will reduce inflammation which may be a temporary “fix” but you are just removing the one thing that is trying to stop you from getting more injured (which you will). Soft-tissue mobilization like foam rolling is incredibly ineffective because it only produces pressure, but no tension. As an Integrative Diagnosis provider, we are uniquely trained to evaluate wrist range of motion to assess how much adhesion is there, find the adhesion that is restricting the wrist, and utilize the appropriate treatment to remove it.
How do I keep from getting adhesion?
Load management! We are all different; we have different jobs, hobbies, and genetics. Some people’s jobs will require that same load over and over, which means they are more likely to develop adhesion. Some people’s genetics make their soft-tissue less durable than normal–this means they are more likely to develop adhesion. If you can manage to take appropriate breaks and limit the amount of work you do to a manageable load your body will thank you. If not, adhesion will pop right back up.