Carpal tunnel is a diagnosis that often gets blamed for all hand and finger pain. But what is carpal tunnel?
Lets start this journey at the beginning of the median nerve. The median nerve is what gets irritated in Carpal Tunnel Syndrome. Along this journey of the median nerve I want you to remember that nerves like their space, if their space is crowded or narrowed they get MAD, and when nerves get mad they cause pain, burning, numbness, tingling, and/or aching. Where ever the nerve gets irritated is causes symptoms down stream to all the other branches and structures below the site of irritation. Nerves have 1 or 2 functions only. Neves can carry sensory information, control muscle action (motor) or some nerves can do both. So if a nerve is irritated you may experience sensory or motor symptoms. If a motor nerve is damaged you may also see atrophy (muscle shrinkage) because the motor nerve isn’t make the muscle move, so the muscle shrinks.
Ok, back to the median nerve. The median nerve journey starts at the brachial plexus. The brachial plexus is a bunch of nerves hanging out together that merge to form new nerve structures further down stream. You can see in the picture the red circle is around the nerve roots of C5, C6, C7, C8, and T1, these form the brachial plexus. Then you can see in pink down stream that these nerves have joined together and form the median nerve. The brachial plexus and these nerve roots combined in different ways form different nerves, but in these pictures I’m just isolating the median nerve’s journey.
The nerve roots come out near the discs in the spinal column, if you have a bulging or herniated disc, the nerve root’s space is encroached up, and they don’t like it. When you have an irritated nerve at the neck it is called a Radiculopathy, and this is the start of how an injury up stream can cause down stream effects. If a nerve in the red circle above is irritated the structures that it makes down stream will also be irritated. This is how a neck irritation can cause pain all the way down to your hand!
The next place where the median nerve can get irritated is behind the elbow, in the blue circle. This location is the cubital tunnel. Remember an irritated nerve causes effects down stream of the issue. If the median nerve is irritated or not moving fluidly through the cubital tunnel this can cause weakness in muscles down stream, aching, numbness/tingling, and burning. When a nerve gets irritated outside of the spine it is called peripheral neuropathy. The median nerve being irritated at the cubital tunnel is the first common place where the median nerve can have a peripheral entrapment.
The next common entrapment site of the median nerve as we travel down the hand is the carpal tunnel, seen circled in yellow below. The red circle below is where people commonly experience some of the down stream effects of the median never being entrapped at the carpal tunnel. But don’t forget, even a radiculopathy at the neck can cause down stream effects the whole way along the pink highlights median nerve in all of the pictures.
So why is it called the carpal tunnel?
The bones circles in green are called your carpals, the bones circled in yellow are your metacarpals, and the fingers circled in blue are your phalanges. The median nerve passes across the carpals, this forms the bottom and side walls of the tunnel, and the top of the tunnel is called the flexor retinaculum. The flexor retinaculum is a protective layer to protect all the structures passing through the tunnel, but when this protective top of the tunnel becomes inflamed, swollen, or gets scarred the median nerve becomes irritated & compressed. Carpal Tunnel. The down stream effect can cause hand weakness, numbness/tingling, or hand muscle atrophy, especially common on the thumb. Carpal tunnel is specifically symptoms on the thumb side. If you have symptoms in your pinky or on your pinky side that is nerve irritation from a nerve traveling through a different tunnel, potentially the tunnel of Guyon, and the ulnar nerve.
So how do you know if your nerve is irritated at the top near the neck or the bottom at the carpal tunnel? See you doctor! Your doctor will know how to figured out what muscles or sensory areas are controlled by what nerves, chiropractors are great at this. No matter where the nerve is irritated a chiropractor can help!
As a chiropractor how do I treat it?
A chiropractor will help optimize the range of motion of the joints that the median never passes around, lots of soft tissue work, ergonomic tips, and decreasing inflammation through diet/life style changes. If conservative treatment is not effective your chiropractor will know who to send you to for a potential surgical consultation. But chances are great that chiropractic care can help immensely.
Written by Dr. Ellora Pollard.
Dr. Pollard and Dr. Meenan are currently accepting new patients. Please call 412-341-2505 or check out our online scheduler to set up your appointment.