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Therefore, you can see
that carpal tunnel syndrome is very
often loosely diagnosed. Thus, we need
to use a broader perspective for
treating the symptoms that involve other
nerve entrapments in the shoulder, arm,
elbow, wrist and hand.
The three major nerves
that account for approximately 90% of
nerve compression or entrapment in the
arm are the ulnar, radial, and median.
Any compression or entrapment of any of
these nerves anywhere along their
pathways from the neck to the fingertips
can cause a client to experience the
symptoms that were mentioned in the
first article. The good news is that
specialized massage therapy techniques
are often the most effective treatment
when correctly and efficiently applied.
Nerve entrapments come
from many sources. The most common
factor in the entrapment of any of the
nerves of the arm is structural
imbalance. "How?" you ask. Internal
rotation of the shoulder is involved
with 90% of all nerve entrapments of the
arm, including carpal tunnel. When the
pectoralis muscle groups are contracted
in internal rotation they compress the
brachial plexus. This internal rotation
of the shoulder leads to an internal
rotation of the elbows, wrists, and
hands. In looking at the upper arm, the
shortened contracted fibers will be the
coracobrachialis. The biceps brachii
become involved by being held in a
stretch position as well as tightening
in compensation for the internal
rotation. The median and ulnar nerve
pathways are in close proximity of these
muscles and the humerus. Thus the
internal rotation creates a compression
of these nerves. When these nerves cross
the elbow, they are compressed on the
medial epichondyle by the pronator teres
and the brachialis that are shortened
due to the internal rotation. Internal
rotation will cause a compensating
tightening in the brachioradialis
resulting in compression the radial
nerve. With the pronation of the hand
from internal rotation the pronator
quadratus along with the flexors
compress the median and ulnar nerves,
while the compensating extensors are
pulled tightly over the branches of the
radial nerve compressing them. Thus, we
have opposing muscle activity involved
in the internal rotation. We have the
muscles on the inside of the arm
responsible for the rotation contracting
over the median and ulnar nerves, and
the compensating muscles on the outside
of the arm contracting to restrict the
degree of internal rotation compressing
the radial nerve and its branches. I
hope I haven’t lost you with this
detailed structural explanation. Suffice
it to say that if you trace the nerve
pathways of the median, ulnar, and
radial nerves, you will see the
potential for compression along the
whole pathway of each nerve.
There is another
complication due to internal rotation
that is very important in the
understanding of how these conditions
become chronic. When the shoulder and
arm are in internal rotation and the
wrist is pronated, the flexors and
extensors of the arm are considerably
weakened. Structurally they are in what
we will refer to as strain patterns.
Generally, when the muscles are in
strain patterns they have about 25% of
their normal strength and function.
However, people still have to do 100% of
their normal task. This means they will
be doing 100% of their normal task with
25% of their normal strength (thus, the
symptom of weakness and inability to
hold anything). With repetitive motion
the muscles quickly fatigue causing the
muscle fibers and connective tissue to
develop micro tears. When this
repetitive motion is performed daily,
these micro tears will form, heal, and
then be reinjured, oftentimes with only
minimal soreness, until adhesions build
up further entrapping nerves and
creating increased pain and symptoms as
previously discussed. Another negative
result of strain patterns with only 25%
of the normal muscle strength available
for a task is a rapid build up of
ischemia and waste products causing
"hot" trigger points. This ischemia will
produce swelling and inflammation, both
further compressing and irritating the
nerves. If you would like to get a quick
idea of how this works, sit in a chair,
internally rotate your arm, pronate your
hand, and pick up a 10 lb weight in a
curl 10 times. Note the difficulty, the
fatigue, and the discomfort!
Now that we understand
the weakness caused by internal
rotation, i.e. strain patterns, we can
also understand how the arms and hands
and wrists are set up for injuries. One
injury that is often overlooked is any
trauma that causes further imbalance of
the spine as well as the overall
structural imbalance of the person. An
example would be a whiplash injury that
causes an increased internal rotation of
the shoulder putting the arm in jeopardy
for the problems and conditions
mentioned above. I have had many clients
who did not have carpal tunnel symptoms
until after an auto accident. In the
process of treating the internal
rotation of the shoulder as it related
to the neck, the nerve entrapment
symptoms of the arm showed improvement.
Often, the clients thought their arms
were sore due to the shock of holding
the steering wheel, when in reality
their pain was a result of the increased
imbalance of the neck and shoulder due
to the whiplash that caused the internal
rotation. An important observation here
is that the arm did not hurt immediately
at the time of the accident - the pain
showed up a week to a month later.
Other injuries that
involve nerve entrapment of the arms
include rapid injuries such as sprains,
strains, breaks, or contusions, all of
which can increase internal rotation,
but definitely have scar tissue and
adhesion build up along the nerve
pathways. We also have pattern injuries.
An example would be tennis players who
normally use their arm in an
inappropriate pattern which, over a
period of time, causes adhesion build up
from damaged tissue - i.e. tennis elbow.
Another of our most common nerve
entrapment patterns is the 20th century
computer operators using their arms in
internal rotation at the computer
terminals. There are almost as many
pattern injuries as there are
professions.
Fortunately, SET is very
effective in treating old structural
pattern that contribute to Carpel Tunnel
and Nerve Entrapment Syndromes.
Don
McCann, founder Structural Energetic
Therapy |
