Carpal Tunnel Syndrome


Carpal Tunnel Syndrome. It’s the office worker’s ‘tennis elbow’. The problem with both of these diagnoses is they are poor over-generalizations and affect more than one isolated population. Carpal Tunnel Syndrome (CTS) affects more than just the office worker. It is prevalent in pregnant women, trade workers, dentists, and more.

Conventional Carpal Tunnel Syndrome Treatment

The popular treatment for CTS is the release of the transverse carpal ligament. This opens up the carpal tunnel that the median nerve passes through. The idea is to release a ligament that is thought to be cramming the nerve causing all the pain, numbness, and tingling.

Unfortunately, the recurrence rate of CTS symptoms is as high as 25% after the first surgery. Of those who undergo a second surgery, 95% will have lingering symptoms, rendering the second surgery useless.

The problem with this approach is the assumption that the only place the median nerve could run into trouble is the carpal tunnel. That is a very myopic view of CTS. The median nerve can be traced from the thumb, index, middle, and half of the ring finger, through the meaty part of the hand, into the wrist, in and out of a couple of muscles in the forearm, around the elbow, in a bundle near the bicep, around the shoulder and then splits into the various nerves that enter the spinal column and joins the spinal cord. Each and every one of those spots can entrap the median nerve resulting in CTS symptoms.

The Assessment of Carpal Tunnel Syndrome

It is essential in the evaluation of CTS that the full path of the median nerve and contributing structures are assessed. We start by setting baselines. It is important to know what triggers the CTS symptoms and lets us know where a patient stands from a function point of view.

We then start at the neck, working our way down the pathway. In each area we assess, we then retest those baselines we sat at the beginning to see if we are making a change.

The Treatment Option

One of the common treatments we end up prescribing is ‘nerve flossing’ of the median nerve. In short, through movements, we can get the median nerve to slide back and forth just like a piece of floss. In doing so we can release the nerve from entrapments that may be causing those dreaded symptoms.

Nerve flossing as a treatment is quite exciting because it is very adaptive. A full range of motion can be used for most cases and will clear up most entrapments along the pathway. For more nuanced cases, the movement can be broken down to target a specific direction of sliding or a specific problem area.

Nerve flossing is also something we can teach you while social distancing during this COVID era. It’s something you can do at home with no assistance. Even if you’re not currently experiencing any CTS symptoms, it’s an efficient, simple, quick thing to check. Nerves can get entrapped before you start to notice the symptoms.

Nerve flossing is only one of many ways we have to treat CTS.

Nerve flossing is only one of many ways we have to treat CTS. Not every treatment works for every patient so it is important that we find the right treatment for each patient. There are even times when surgery is recommended but is and should be a last resort. Surgery is great at opening the space in the carpal tunnel but comes with other risks. Conservative treatments are equally effective, if not more effective, and less invasive on top of, clearing up entrapments along the whole nerve. So now that you have finished the article scroll back up, watch the video, and learn how to floss your median nerve! If nerve flossing isn’t helping or you are still having problems, be sure to schedule an appointment with us.

Tom Cotter, DC, DACRB