Carpal Tunnel Syndrome

Many women who have been pregnant are familiar with the feeling of tingling and numbness in the hands. This often happens in the pre and post-natal period, but can also occur later on after several months of lifting babies in and out of cribs and such. Women are then diagnosed with carpal tunnel syndrome and either told to live with it, or if it is severe, to have surgery.

Carpal tunnel syndrome is by definition a compression of one of the nerves to the hand as it passes through a narrow tunnel in the wrist bounded by bones and tough connective tissue. This tunnel is quite small and so theoretically structures within it can become compressed fairly easily. Supposedly if the nerve gets compressed here, symptoms are produced in the hand.

It’s Not All That Simple

A few things here cause me to scratch my head. First of all, along with one of the main nerves to the hand, the carpal tunnel also contains the tendons of muscles that bend the thumb and fingers. If there is adequate compression in the carpal tunnel to irritate the nerve, then how do all these tendons (nine to be exact) get away unscathed? Granted nerve tissue is exquisitely sensitive, but still you would think there would be some effect on at least some of those tendons if the carpal tunnel is compromised. Yet, people who have been diagnosed with carpal tunnel syndrome almost never demonstrate symptoms associated with irritated tendons.

Secondly, the condition often occurs in both hands either simultaneously or sometimes symptoms will shift from one side to the other. If this is in fact a localized problem, then what are the odds it would manifest itself in both sides at the same time? That would be kind of like coincidentally developing tendonitis in both elbows at the same time. What are the odds? The fact that symptoms often occur in both sides leads me to believe the cause might in fact lie more centrally.

Thirdly, I can honestly say that of all the people I have seen with this condition, no one has ever gotten better by treating their wrists. In fact, when someone is given a diagnosis of carpal tunnel syndrome I inwardly cringe, for this tends to narrow the focus solely onto the wrists where the carpal tunnel lies. This usually stops health care givers from looking anywhere beyond, and prevents them from finding the true underlying cause.

The Problem Lies More Centrally

In my practice, I step back and look at the whole person with an understanding that everything is connected and problems in one area can be caused by difficulties in a very distant area. In my experience, those who display symptoms of numbness and tingling in the hands all have one thing in common – their upper bodies are too bent forward.  If we look at women post-partum it makes sense that things like feeding babies (particularly if breast feeding), carrying infants around, and doing all those baby-related activities generally involve bending forward through the upper body, sometimes for extended periods of time.

This excessive flexion through the upper body causes compression and tightness in the area around the back of the armpits. This is important because through this area pass all of the major nerves and blood vessels to the arms and hands. Compression of the blood vessels can lead to a back-up of circulation in the arms and then potentially swelling further down in the limb including the carpal tunnel. The nerves can also get compressed in the back of the armpit and depending on which nerve fibres are hit, this can produce symptoms in the hands. Often people with carpal tunnel syndrome also experience pain and numbness in the forearms as well, which can only be explained by nerve compression further up than the wrists.

Take the Test

In my experience, improving the overall ability of the upper body to maintain itself more upright rather than bent forward, as well as freeing up the area around the back of the armpits relieves the symptoms in the hands. If you are have been told you have carpal tunnel syndrome, take this quick test. Look at yourself in a mirror side-on (or ask a loved one to help) and see if you are too bent forward through your upper back. Then pinch the back wall of your armpits and see if the muscles there are really hard. I’m willing to bet a good Starbucks coffee that you have both of these things going on. If so, treatment aimed just at your wrists isn’t going to provide any lasting relief. Come and see us and we will look at the big picture and address the underlying cause so you can get back to taking care of those little ones like no one else can.

COVID Safety

Please note that three layered masks continue to be mandatory for everyone entering the clinic despite the lifting of this requirement by the Ontario government. We continue to prioritize your health by minimizing the number of people in the clinic, screening for illness, and cleaning regularly. Please contact us if you have any questions or concerns. We look forward to serving your health care needs.