Health Insights: Numb hands and the carpal tunnel
If water stops flowing from a hose, then our first instinct is to check for a kink. Undo the kink and the flow resumes. It’s an easy fix. However, if the spigot is closed, we understand that no amount of un-kinking the hose will make the water flow. Similarly, if turning the spigot does nothing, then we’d consider a busted pipe. We could trace the problem all the way to the water treatment facility. There is a hierarchy when it comes to flow.
Just as the flow of water can be obstructed, so can the flow of nerve signals.
A very common example is numb hands. Many who suffer from nerve type symptoms in the hands are diagnosed with carpal tunnel syndrome. They are led to believe that the structure at the base of the hand, the carpal tunnel is to blame.
Look up the chain
This tunnel is formed by wrist bones (carpal means any bone of the wrist) on the back side, and a sheath of connective tissue on the front. The contents are nine tendons and one nerve, the median nerve. True carpal tunnel syndrome is the entrapment of the median nerve as it passes through the tunnel.
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In most cases carpal tunnel syndrome is only a partial diagnosis. By the time the median nerve gets to this tunnel it has passed through five vertebrae in the neck, between two neck muscles, over the first rib and under the collar bone. It then runs behind the pectoralis minor muscle, underneath a slip of the biceps muscle and below two muscles of the forearm.
In addition, there are 17 muscles in the shoulder girdle and seven in the forearm that have trigger point referrals into the hand. Symptoms in the hands can be from any combination of possibilities with 36 variables (72 if it’s both hands), or one structure in the wrist. It’s much easier to just blame the tunnel.
Maintain Good posture
In most cases this syndrome has a neck as well as a shoulder component. We have three scalene muscles along each side of our neck. They run along the sides of our necks and into the first rib. If you put your hand on top of either shoulder and press down, then you’ll feel a hard mass. That mass is your first rib. Yes, all the way up there. The scalene muscles assist in breathing (by pulling the rib upward). People commonly develop poor breathing habits and overuse these helper muscles. We become neck breathers.
To test yourself, place a hand along the side of your neck at its base. If you take a deep breath, do you feel the muscles in your neck stiffen? Or your shoulder rise? A little motion is normal, but a lot is a problem.
In time, these overworked muscles become enlarged and can compress the median nerve that runs between them. As these muscles are attached to the first rib, their over activity leads to an elevated first rib. As the nerve goes over the rib and under the collar bone, it gets pinched. A numb hand can be the direct result of poor breathing habits.
One of the most prone-to-tension muscles in the body is the pec minor. This is noticeable when you lie down.
If one shoulder rests visibly higher than the other, then the pec is likely to blame. This muscle connects the outer portion of our ribcage to our shoulders. With variables such as slouched postures, driving, texting, cycling and computer time, people develop forward shoulders. In time the pec muscle becomes tight and short. The median nerve gets compressed between the rib cage and the tight short pec.
Of important note, the median nerve does not impact the pinky finger. The referral pattern for the pec minor does. If you have symptoms in your pinky, then the carpal tunnel is unlikely the problem.
Respectfully, with numbness, pain or tingling in the hand, it’s hard to ignore the hand. In severe cases where there is muscle wasting or altered sensation, a surgical release of the tunnel may be necessary. But if all you’ve tried is wrist stretches, splinting and rest, then consider looking up the chain. Fixing the kink closest to the source will yield the best results.
Julie Peterson, MPT, is the owner of Concierge Physical Therapy Colorado. She is a certified neurokinetic therapy specialist with a strong background in manual therapy. She can be reached at 970-306-3006 and email@example.com. For more information, visit http://www.conciergeptcolorado.com.