Carpal Tunnel Syndrome and Massage Therapy
In most patients, carpal tunnel syndrome gets worse over time, so early diagnosis and treatment are essential. Early on, symptoms can often be relieved with simple measures like wearing a wrist splint or avoiding specific activities.
The carpal tunnel is a narrow passageway in the wrist, about an inch wide. Small wrist bones called carpal bones form the floor and sides of the tunnel.
The median nerve is one of the central nerves in hand. It originates as a group of nerve roots in the neck. These roots come together to form a single nerve in the arm. The median nerve goes down the arm and forearm, passes through the carpal tunnel at the wrist, and goes into the hand. The nerve provides feeling in the thumb and index, middle, and ring fingers. The nerve also controls the muscles around the base of the thumb.
Carpal Tunnel Syndrome occurs when the tunnel becomes narrowed or when tissues surrounding the flexor tendons swell, putting pressure on the median nerve. These tissues are called the synovium. Usually, the synovium lubricates the muscles, making it easier to move your fingers.
When the synovium swells, it takes up space in the carpal tunnel and, over time, crowds the nerve. This abnormal pressure on the nerve can result in pain, numbness, tingling, and weakness in the hand.
Symptoms of carpal tunnel syndrome may include:
- Numbness, tingling, burning, and pain—primarily in the thumb and index, middle, and ring fingers
- Occasional shock-like sensations that radiate to the thumb and index, middle, and ring fingers
- Pain or tingling that may travel up the forearm toward the shoulder
- Weakness and clumsiness in hand—this may make it difficult to perform fine movements such as buttoning your clothes
- Dropping things—due to weakness, numbness, or a loss of proprioception (awareness of where your hand is in space)
In most cases, the symptoms of carpal tunnel syndrome begin gradually—without a specific injury. Many patients find that their symptoms come and go at first. However, as the condition worsens, symptoms may occur more frequently or may persist for longer periods of time.
Night-time symptoms are very common. Because many people sleep with their wrists bent, symptoms may awaken you from sleep. During the day, symptoms often occur when holding something for a prolonged period of time with the wrist bent forward or backward, such as when using a phone, driving, or reading a book.
Many patients find that moving or shaking their hands helps relieve their symptoms.
There are surgical and nonsurgical treatments. Treatment often starts with the wrist splint. The goal is to keep the carpal tunnel in a neutral position and provide support and ease the load of the synovium tissues.
Other options may include:
- Steroidal or non-steroidal anti-inflammatory medications
- Corticosteroid injections into the wrist; these may be able to reduce inflammation and melt the excess connective tissue
- Exercise to stretch and mobilize tight tendons
- If no other interventions are successful, surgery is the last option. The transverse carpal ligament is split, and some of the excess connective tissue is scraped away.
Depending on the type and severity of the Carpal Tunnel Syndrome, massage may be adjusted to serve the needs of the client.
Edematous CTS responds well to massage that focuses on draining the excess fluid.
Fibrotic CTS may improve with massage, depending on how thick, and where, the fibrosis is.
Carpal Tunnel Syndrome due to subluxation may benefit from massage and traction, but adjustments are out of the scope of practice for a massage therapist.
Communication between client and massage therapist is critical in massage therapy treatments. If symptoms continue or worsen stop massage treatments; if the client is finding relief, continue treatments to dissipate symptoms.