Carpal Tunnel? - Compression of the Median Nerve

by Gary A Clark, myotherapist

Carpal Tunnel Syndrome (CTS) is a fairly common complaint in our society. It is not an actual disease, but a collection of symptoms, or a syndrome.

Your doctor will probably tell you that the pain of carpal tunnel syndrome is caused by compression of the nerves as they pass through the carpal tunnel of the wrist, and that it requires surgery to relieve the pressure. That can sometimes be so. Alternatively, it may not. A friend recently had the carpal tunnel operation and sadly she was worse afterwards. Then her doctor told her that the surgery doesn’t always work!

So if it is only compression within the carpal tunnel, why doesn’t the surgery always work?

The answer could be because there are many other conditions that can mimic carpal tunnel syndrome.

Lets start with the Median Nerve. Its entrapment of the Median nerve within the carpal tunnel of the wrist that causes the pain of CTS. So, could entrapment of this nerve anywhere along its length cause pain similar to CTS? You’d better believe it.

Lets just follow the median nerve from its origin. The brachial plexus, of which the median nerve is a part, exits the spine between the fourth cervical and the first thoracic vertebrae, passes between the scalene muscles, passes under the clavicle, behind the upper end of the pectoralis minor in the shoulder then down the arm, through the elbow and down through the wrist.

Also passing through the elbow is the deep radial nerve which can also be entrapped.

So apart from the wrist where can the median nerve be trapped? For a start, tight scalene muscles can definitely cause entrapment particularly if they are tight with trigger points as a result of a whiplash injury. Next the median nerve can also be trapped between the clavicle and the first rib, Thirdly where it passes behind the pectoralis minor it can also suffer entrapment if that muscle is tight as often happens if the arms are kept extended to the front for extended periods of time. A common occurrence with computer users, holding the “mouse” with no other support for the arm for sometimes hours at a time. When the problem occurs in the shoulder, it’s called thoracic outlet syndrome..

So you see there is at least three other places where the median nerve can become entrapped. Then there is the deep radial nerve, which can be trapped by the supinator in the elbow (called tennis elbow), plus there is referred pain from the scalene muscles, which can also cause pain in the arm, wrist and hand.

Lastly the muscles in the forearm which control all hand and finger movement can become tight through overwork and cause tendonitis, or swelling of the tendons where they pass through the carpal tunnel. Clearly this is a form of CTS but if the swelling of the tendons is reduced by treating the associated muscles, then the problem will resolve without surgery.

Personally I look upon surgery as a last resort only to be used when all non-invasive forms of treatment have been exhausted.

about the author: Gary A Clark is a myotherapist and founder of Pain Busters Clinic, where he helps his clients find lasting relief from their chronic muscle pain. For more information or to make an appointment phone Gary Clark at Pain Busters Clinic (Western Australia) 9472 3852 or 0402 945 700

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