Carpal
Tunnel Testing – What
Are My Options?
Carpal Tunnel Syndrome (CTS) is a devastating
injury that affects hundreds of thousands of
people annually, with those numbers continuing
to increase each and every year.
Carpal tunnel syndrome is one of many repetitive
strain injuries that are everywhere, in homes,
offices, assembly lines, football teams, book
clubs, construction sites, dental offices,
everywhere! Because carpal tunnel syndrome
is so commonplace, and its effects so devastating,
it is important to be knowledgeable of how
it occurs, what its symptoms are and which
testing methods should be utilized if symptoms
are present.
Carpal tunnel syndrome is a disorder affecting
the median nerve, which supplies function to
the thumb, index, middle and one half of the
ring finger. Usually the symptoms are most
prevalent in the thumb, index and middle fingers
(Sometimes one-half of the ring finger) and
include numbness, tingling, paresthesia (pins
and needles), pain and tightness in the front
of the hand, wrist and forearm. These symptoms
do not have to occur simultaneously, and may
only affect one finger one day and then three
fingers a few days later.
If a doctor provides a carpal tunnel diagnoses
and the symptoms are in the ring and little
fingers, it is NOT carpal tunnel syndrome!
The ulnar nerve, not the median nerve, supplies
function to the ring and little fingers. Repetitive
strain disorders affecting these two fingers
are usually either Guyon's syndrome, entrapment
of the ulnar nerve in the guyon's canal at
the wrist junction, or cubital tunnel syndrome,
entrapment of the ulnar nerve at the elbow
junction. This is a common mistake made by
many, many physicians and is completely inexcusable
as they often recommend surgery for the patient,
causing the patent to undergo an unnecessary
procedure, and for the wrong disorder.
If symptoms of carpal tunnel syndrome do arise,
doctors will recommend that a nerve conduction
velocity (NCV) test or an Electromoyogram (EMG)
is performed to see if carpal tunnel syndrome
truly exists. These tests are often painful
to the individual being tested, very expensive,
and often give false positives and false negatives.
This is why it is recommended that manual carpal
tunnel tests be performed in order to obtain
an accurate diagnosis.
Manual carpal tunnel tests take no longer
than 10 minutes, have an 85% accuracy rate,
are painless and are very cheap in comparison
to the NCV and EMG tests. The following are
effective manual tests used for diagnosing
carpal tunnel syndrome.
- Phalen's: The wrist is
flexed for 30 to 60 seconds in order to compress
the median nerve and duplicate possible symptoms
- Reverse Phalen's: The
wrist is extended for 30 to 60 seconds in
order to stretch the median nerve and duplicate
symptoms. Stretching the median nerve if
the median nerve is impinged will duplicate
symptoms associated with carpal tunnel syndrome.
- Tinnel Sign: Tapping
over the median nerve at the wrist junction.
- Compression Test: Direct
pressure is applied over the median nerve
for 30-60 seconds to see if carpal tunnel
symptoms are exhibited.
If a positive diagnosis comes back, most doctors
will push for surgery, a procedure that has
a terrible success rate and is to only be performed
as a last resort once all other conservative
treatment methods have been utilized. The following
statistics reveal why conservative therapy
should be implemented over surgery.
“The fail rate for carpal tunnel surgery
is over 50%. Many times I meet women who
have undergone multiple surgeries, still
unable to work and struggling with chronic
pain.” Source: Sportstouch / Kate Montgomery
“Carpal tunnel surgery has about a 57%
failure rate following patients from 1-day
to 6-years. At least one of the following
symptoms re-occurred during this time: Pain,
Numbness, Tingling sensations.” Source:
Nancollas, et al, 1995. J. Hand Surgery.
“Oftentimes, the surgery fails to produce
any lasting help. A published study by Dr.
Strasberg, at the Washington University School
of Medicine, reported some startling results.
This study, involving patients requiring a
second surgery for CTS, revealed that only
53% of the patients showed significant improvement
in their symptoms.”
Conservative therapy is the key to a successful
recovery so implement the following criteria
in order to reduce the possibility of getting
carpal tunnel syndrome, or if you already have
it, to eliminate it. The recommended conservative
carpal tunnel syndrome treatment consists of
the following:
Stretches: Stretch the finger
and wrist flexor muscles and the finger adductor
muscles to reduce hypertonic muscles that are
responsible for compressing the carpal tunnel
and the median nerve within. Stretching these
muscles also elongates the palmar fascia and
the transverse carpal ligament, which helps
to increase the size of the carpal tunnel.
Exercises: Exercise the
finger and wrist extensor muscles and finger
abductor muscles in order to maintain the length
of the muscles that was created by performing
stretches. Strengthening these muscles through
direct extension/abduction exercises also helps
to support and stabilize the carpal bones and
therefore maintain and even increase the size
of the carpal tunnel. Performing these types
of exercises also forces the flexor muscles
to relax through a principal known as “reciprocal
inhibition.”
Author: Jeff
Anliker, LMT, is a Therapist and Inventor of
Therapeutic Exercise Products that are utilized
by Corporations, Consumers and Medical Facilities
around the world for the prevention
and rehabilitation of repetitive strain
injuries. ergo-intervention.com |
