By David Lauterstein
What is the “carpal tunnel”?
The main nerve and tendons going to your palm and your fingers run through the middle of the wrist. On the palmar side of your wrist there is a ligament running above them. It’s called the “transverse carpal ligament”. This ligament is basically the roof of the carpal tunnel – it helps hold these tendons (NINE tendons!) and the median nerve in place.
It sometimes happens that the transverse carpal ligament is too tight and/or the tendons or nerves inflamed from overuse, then the tendons and nerve rub against that ligament – there is in effect not enough room in the carpal tunnel for these important structures to freely move.
This can cause a downward spiral of inflammation, irritation, pain, and weakness. The surgical approach to this is quite drastic. It is to cut through the transverse carpal ligament. This is pretty tricky and often people who have carpal tunnel syndrome find the surgery to be not as effective as they’d hoped – though about 50% feel it to be very effective.
It is therefore entirely appropriate to explore conservative therapies first. Primary among them is massage therapy because this is essentially a myofascial problem (which can then also irritate the median nerve) – therefore work with the muscles and tendons is the most direct approach to treatment.
The therapist should first evaluate whether it is in fact carpal tunnel syndrome. Then they should focus on the shoulder girdle muscles – pectoralis minor and subscapularis – that can impinge nerves and vessels on their way down to the arm.
Then muscles of the upper arm and forearm can be addressed through moderately deep massage and body mobilizations. Finally, if the client is not experiencing acute irritation there, work directly with the transverse carpal ligament can be incredibly effective. Rather than snipping through it as a surgeon will – the therapist,with sensitive cross fiber (“deep transverse friction”), can systematically restore length to that ligament again without incurring the risks involved in surgery.
That said, sometimes surgery is the only and best solution. So therapists should always have a list to give their clients, to steer them to other superb health professionals, as appropriate.