Carpal Tunnel Syndrome: An Osteopathic Perspective.

In most cases it isn’t known why the nerve becomes compressed but it is thought that certain conditions and genetics may increase the risk of developing it. Women are three times more likely to be affected than men (Papanicolaou et al) and it is not uncommon for a woman to develop this during pregnancy or shortly thereafter, when hormone changes cause fluid retention in the arms. Studies have shown there is also a common link between patients with thyroid conditions and carpal tunnel syndrome. Other systemic conditions like diabetes and rheumatoid arthritis can also cause swelling in the wrist and nerve damage respectively. People with ganglion cysts in the carpal tunnel or smaller carpal tunnel areas are also at increased risk of being affected. Additionally, people who work on computers and type regularly tend to develop carpal tunnel syndrome at an increased frequency.

Now that you know what it is and why you might be at risk of developing it, some good news – there are multiple osteopathic treatments that can help relieve those uncomfortable symptoms. As with all treatment approaches, a good osteopath will try to understand the systemic cause or causes of the problem before applying the appropriate treatment.

In the case of treating a patient with carpal tunnel syndrome we would start by looking at the course of the nerve, from where it starts in the neck, through the arm and down into the hand. We would assess to see where the nerve’s function may have been compromised and what structures could be causing this. Compression, reduced joint mobility and muscular tension can affect the circulation in the arm, which may lead to poor nerve conduction.

From an osteopathic perspective, there are many other structures that we would focus on prior to addressing the compression in the wrist. These include:

– The patient’s posture: assessing how this may influence the position of the wrist – Other external factors: a patient’s job, sports they undertake and previous injuries could be predisposing the patient to carpal tunnel syndrome – The head and neck and how they sit on top of the spinal column: these can be affected by problematic structures below and have to accommodate for this – The shoulder and its close relationship with the ribcage: the shape of the ribcage determines how the shoulder sits. Sometimes a patient’s history such as a respiratory condition (e.g. COPD and asthma) could cause poor breathing mechanics and may assist in the overall position of their shoulder, which could affect the neural supply into the arm – Patients who grip tools or type in their line of work: grasping tools firmly and working on a PC/laptop, typing for long hours may lead to muscular tension in their forearms and stiffness in the wrist joints

– Neck joints and corresponding musculature: a restriction of the neck joints and tension within the surrounding muscles could impede the nerve at its origin and affect the supply into the arm

An osteopath would assess a patient, to determine what physical restrictions could be contributing to the problem and then would treat and manage them accordingly. The focus would be to help to reduce symptoms and improve overall function. An osteopath may advise a patient with carpal tunnel syndrome to stretch, alter the type of physical activity they undertake and see a massage therapist in conjunction with osteopath treatment, to assist in helping to reduce muscular tension which in turn will improve drainage within the arm.

Medical alternatives to osteopathic treatment will focus entirely on the wrist and include splinting and/or a cortisone injection, which can be effective in the short term. In extreme cases surgical carpal tunnel release (giving the median nerve more room) would be an option, particularly for those patients with occupationally induced carpal tunnel syndrome.

Carpal tunnel is a common painful ailment. Fortunately there are several options for relieving the symptoms and addressing the causes.