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Treatment Work - Conditions

Carpal Tunnel Syndrome (CTS)

As a matter of technical definition, the Carpal Tunnel is created by a band of cartilage called the Flexor Retinaculum that spans the palmar side of the hand just distal to the wrist flexor crease, between the pisiform bone at the base of the little finger and the scaphoid and trapezium bones at the base of the thumb. True CTS is usually caused by repetitive stress injury to the medial nerve where it passes through the carpal tunnel. Also as a matter of technical definition, the medial nerve enervates the thumb, first, middle, and thumb side half of the ring fingers, as well as that side of the palm. The little finger, little finger side of the ring finger, and little finger side of the palm, by contrast, are enervated by the ulnar nerve which passes through an entirely separate “tunnel.” Consequently, if ALL of the fingers/palm are involved, it is by definition either NOT CTS, or if CTS is in fact involved, then so is something else as well.

Phalen's TestThe quickest test is called Phalen’s Test. Press the backs of the hands together, fingers pointed toward the floor, and apply pressure. If CTS is in fact present, the individual will not be able to maintain pressure for more than about six seconds. The pain will be excruciating. Lack of pain performing the test is considered negative for CTS. Even intense pain, however, is not an absolute proof that CTS is present. It is suggestive but not definitive because there are conditions other than CTS that will give positive results from Phalen’s Test.

In the last two years, I have worked with roughly two dozen people, all medically diagnosed with CTS, including with nerve induction tests. Approximately half were being “strongly urged” by their doctors to promptly schedule CTS surgery to prevent the condition from getting worse. Surgery consists of cutting the Flexor Retinaculum to relieve pressure and stress on the medial nerve. Success rate for the surgery, even when true CTS is present, is approximately 50 percent. In other words, even with true CTS, surgery is successful long term in only about half of the cases. A nasty side “benefit” of the surgery, however, is a permanent loss of grip strength. And if CTS is not actually involved? Draw your own conclusions.

And I have yet to work with a case of true CTS. Two of the individuals had ulnar nerve impingement (entrapment of the ulnar nerve at the elbow) while the rest had one or more variants of Thoracic Outlet Syndrome (TOS). Simply and bluntly put, Carpal Tunnel Syndrome is probably the most misdiagnosed soft tissue dysfunction of all.

Any time anyone presents symptoms commonly associated with CTS, it is critical that they also be checked for TOS because the odds are very high that the actual cause of their symptoms is in fact TOS and not CTS.

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