All Posts tagged Median Nerve

Part 2 of 2: Is it Carpal Tunnel or Is it Something Else? Median Nerve Entrapment Sites

Part 2 of 2: Is it Carpal Tunnel or Is it Something Else? Median Nerve Entrapment Sites
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In part 1 of 2 of Is it Carpal Tunnel or Is it Something Else?, you were introduced to the common signs and symptoms of carpal tunnel syndrome.  In part 2 of this blog, you will learn about other compression sites and conditions influencing the median nerve, which may resemble the signs an symptoms of carpal tunnel syndrome.  Why is this important, you ask?  First off, if you think you may have carpal tunnel syndrome, you want to be 100% certain.  Second, you don’t want to receive treatment to an area of the forearm that may not be the area or reason for your health problem.

Of course, let’s get started with Forearm Anatomy!

Brachial Plexus 1

Brachial Plexus 1

Nerves of the forearm and hand originate in the neck area off the spinal cord.  The spinal cord (the main cord coming from the brain) breaks down into many smaller branches (roots, trunks, divisions, and cords) of nerves that travel from the neck, through the shoulder, via the arm and down to the wrist and fingers.  Nerves bring the ability to move and feel to our bodies.  Specifically, the MEDIAN NERVE nerve is one of the nerves that provides movement and sensation to the forearm and hand.As you learned in the first blog, nerves can become compressed or squeezed by soft tissue such as muscles and ligaments.  Moreover, compression of a nerve occurs due to various reasons such as sport injuries, repetitive strain/sprain, a tumor (very uncommon), etc.   The nerve involved in carpal tunnel syndrome is the median nerve at the wrist.  As you recall, when this nerve is squeezed around the wrist, a patient may experience frequent burning, tingling, and/or numbness in the palm of the hand and the fingers. Some sufferers say their fingers feel swollen and weak, even though little or no swelling is apparent. The symptoms often first appear in one or both hands during the night. The person may wake up feeling the need to shake out the hand or wrist. Continued carpal tunnel may result in decreased grip strength and muscles wasting at the base of the thumb. Furthermore, some people are unable to tell between hot and cold by touch.

In part 1, we gave the analogy that a traffic jam on a road resembles a compressed nerve.  When a road is blocked with many cars, cars move slower than normal.  A nerve that is squeezed or compressed transmits signals of movement and sensation slower to the hand.  Now, to make things a little more complex, think of a busy highway….throughout the highway you have many areas in which traffic is slower than others.  Let’s call these bottleneck areas. Throughout a stretch of road, there maybe multiple areas of blockages or bottlenecks.  A nerve can also be blocked in various areas in the arm.  Thus, it is important to examine the entire nerve pathway to be sure that no other areas are affected.

Ok, let’s get to the point….

Carpal tunnel syndrome symptoms appears similar to other compression syndromes/sites of the MEDIAN nerve.  There are four regions where this blockage can occur below the shoulder.

1) Supracondylar process of the humerus and struther’s ligament (what a mouth full!):

The median nerve maybe compressed as it passes under a bony spur (normal variant) in the arm.  This would cause weak hand grip, a hard time turning the forearm to a position in which the palm is facing down and it would also create tingling into the 1st to 4th fingers (never the 5th finger).  The presence of having a difficult time turning the forearm into a position in which the palm is facing down is what differentiates this compression problem area from carpal tunnel syndrome.

2) The Lacertus Fibrosus:

The median nerve travels in front of the elbow (palm up side).  The lacertus fibrosus is another area of compression and it is located just before the elbow. One must suspect that the lacertus fibrosis is the problem when pain is experienced in the forearm with resisted elbow flexion.

3) Pronator teres

The pronator teres is located just after the elbow on the palm up side of the forearm.  This area of compression is VERY COMMON and confused many times with carpal tunnel syndrome.  The nerve gets compression as it travels between the two pieces of PRONATOR TERES (Top and Bottom) muscles.  When the muscle is tight and squeezes the median nerve, patients will complain of pain following resisted bending of the the long finger.  Furthermore, the pronator teres muscles will be very tight and tender to touch and may produce symptoms down the forearm when touched.  Usually, patients that do a lot of work with their hands and arms (plumbers, electricians and receptionists) experience this type of compression condition. Increased activity makes this condition worse.  Furthermore, just like the compression areas above, a pronator teres compression will cause tingling to the 1st to 4th finger (palm side).  Pronator teres compression is commonly confused with carpal tunnel syndrome!

4) Anterior Interosseus Nerve (Branch of Median Nerve) 

Brachial Plexus

Brachial Plexus

The Anterior Interosseus Nerve can become compressed in the forearm (palm side up). It is important to note that compression of the median nerve has two presentations.

1) The pronator syndrome in which patients have pain and paresthesias mimicking carpal tunnel syndrome (above),

and

2) the anterior interosseous nerve syndrome in which patients have muscle weakness in there hand (thumb side).

If the Anterior Interosseus Nerve is involved, the patient will not be able to make the ‘OK’ sign with his/her thumb and index finger.  Also, with the forearm flexed, the patient would have difficulty/weakness turning the palm from facing their torso to away from them.

How to you treat a median nerve compression?

Soft tissue therapy, electrotherapy and stretching often helps to relax tight muscle and decompress the tension placed on the nerve.  In my practice, I apply a combination of chiropractic treatment modalities.  I also have found acupuncture to provide pain relief as well periodically decrease the tingling sensations experienced.  Acupuncture also helps by relaxing the tight muscles in the forearm, which is beenficial since it may reduce compression of the nerve.

Conclusion:

Yes, I know, it is overwhelming and sometimes confusing to understand the course of a nerve.  The point I am trying to get across is that the body is tricky and you must not jump to conclusions.  If you or someone you know is experiencing tingling or has a decreased ability to move their forearm or hand, it is not automatically a case of carpal tunnel syndrome.  You must screen whatever nerve is corresponding to the area of interest very carefully.  If you have any questions, please feel free to comment and/or message me.

MEDICAL DISCLAIMER: The following information is my personal notes about this subject matter. It is intended for informational purposes only. Consult a health practitioner to help you diagnose and treat injuries of any kind.

Thank you for reading this post.

Dr. Luciano Di Loreto, HBSc., DC

www.fitforlifewellnessclinic.com

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Dr. Luciano Di Loreto graduated from the Canadian Memorial Chiropractic College (2010) as a Doctor of Chiropractic and obtained a certificate in Medical Acupuncture at McMaster University (2010). At his practice located in Vaughan, Ontario, Canada, Dr. Luciano Di Loreto combines evidence-based chiropractic care with a multidisciplinary and collaborative approach to health care. He is an approachable, passionate, and diligent practitioner with a focus on delivering exceptional acute, preventative, rehabilitative and supportive care for a variety conditions relating to the muscle, nerve, and bone. During his spare time, Dr. Luciano Di Loreto takes pleasure in spending time with his family and friends. He enjoys fishing and playing sports.

Fit for Life Wellness & Rehabilitation Centre is a health clinic located in Vaughan, Ontario, just north of Major Mackenzie on Weston Road (Located in the Vellore Medical Centre & Walk In Clinic). If you have questions for Dr. Luciano Di Loreto, please comment and we will get right back to you promptly with information on your conditions/concerns.

 

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Part 1 of 2: Is it Carpal Tunnel or Is it Something Else?

Part 1 of 2: Is it Carpal Tunnel or Is it Something Else?
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I have a number of patients that mention that they have carpal tunnel syndrome. When I ask them how they know, they can’t explain.  After a history and physical assessment, I often recognize that their symptoms are in fact not related to carpal tunnel. Why the confusion? One thing that I have learned, while practicing, is that tingling in the forearm does not always equate to carpal tunnel syndrome.

In part 1 of this blog, I will provide specific information pertaining only to carpal tunnel syndrome. This will create a firm base for part 2 of the blog – when I explore and explain other nerve conditions which create symptoms similar to carpal tunnel. Let us begin…

What is Carpal Tunnel Syndrome?

Ok, so what is it?  Carpal tunnel syndrome, simply stated, is when a nerve in the forearm is squeezed at the wrist. More specifically, carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the hand, becomes compressed at the wrist. The median nerve controls sensations to the palm side of the thumb and fingers (half of the fourth finger and not the little finger). The median nerve also provides motion to small muscles in the hand. The carpal tunnel is a narrow, tight, passageway of ligament and bones at the base of the hand. This tight box is home to the median nerve as well as tendons that attach to muscle and allow our hands to move. Sometimes, the carpal tunnel soft tissues thicken and/or swell. As a result, the tunnel narrows and causes the median nerve to be compressed. This creates pain, weakness, and/or numbness in the hand, wrist and may radiate up the arm.

Let us provide you with an analogy.  Think of when a four lane road merges to become a two lane road.  This creates a bottleneck in the road, which usually leads to heavier traffic due to the less room to manoeuvre.  The more the road reduces, the less the passageway for cars to pass.  Numerous reasons can cause the passageway to shrink (accidents like trauma/injury in a wrist, floods like swelling/inflammation in a wrist and construction like scar tissue/tissue rebuild/healing in a wrist) – the bottom line is that the same amount of cars still need to get through to the other side, but with obstacles or a bottleneck, it becomes harder and thus more issues (symptoms) can arise. This is what occurs when someone has carpal tunnel issues – that is – their passageway for the median nerve is being blocked or squeezed.

Symptoms usually start slow but gradual. Usually, it starts with frequent burning, tingling, and/or numbness in the palm of the hand and the fingers. Some sufferers say their fingers feel swollen and weak, even though little or no swelling is apparent. The symptoms often first appear in one or both hands during the night. The person may wake up feeling the need to shake out the hand or wrist. As symptoms progress, patients complain that they feel tingling during the day. Continued carpal tunnel may result in decreased grip strength and muscles wasting at the base of the thumb. Furthermore, some people are unable to tell between hot and cold by touch.

Causes of Carpal Tunnel Syndrome

Carpal tunnel syndrome is often the result of a combination of factors. These factors are responsible for increasing pressure on the median nerve and tendons in the carpal tunnel. Most likely the disorder is due to genetics. Some individuals are born with a smaller carpal tunnel. Moreover, trauma or injury to the wrist that causes swelling, sprains or fractures, rheumatoid arthritis, mechanical joint issues at the wrist, stress, vibrating hand tools, fluid retention during pregnancy or menopause or the development of a cyst or tumor in the canal. Sometimes no cause(s) are identified.

Who Develops Carpal Tunnel Syndrome

Women are more likely than men to develop carpal tunnel syndrome. Carpal tunnel syndrome usually occurs only in adults and not in children.

How is Carpal Tunnel Syndrome Diagnosed?

There are a variety of tests that are used to produce symptoms of carpal tunnel syndrome.  In the Tinel test, the practitioner taps on or presses the median nerve in the patient’s wrist. The test is positive when tingling in the fingers occurs. The Phalen test, or wrist-flexion, involves having the patient hold his or her forearms upright by pointing the fingers down and pressing the backs of the hands together (like a reverse prayer sign). The presence of carpal tunnel syndrome is suggested if one or more symptoms, such as tingling or increasing numbness, is felt in the fingers within 1 minute.

Diagnosis is confirmed by electrodiagnostic tests such as nerve conduction studies. Often it is necessary to confirm the diagnosis by use of electrodiagnostic tests. In a nerve conduction study, electrodes are placed on the hand and wrist.  Furthermore, ultrasound imaging can show impaired movement of the median nerve and Magnetic resonance imaging (MRI) can show the anatomy of the wrist.

How is Carpal Tunnel Syndrome Conservatively Treated?

Treatments for carpal tunnel syndrome should begin as early as possible. Underlying causes such as diabetes or arthritis should be treated first.

I treat carpal tunnel syndrome by using a variety of chiropractic techniques electrotherapy, ultrasound, laser, cyrotherapy and exercises.  Furthermore, soft tissue therapy techniques over the forearm, wrist and palm of the hand as well as acupuncture are beneficial.  Patients usually feel relief with two to three treatments over the course of 4 to 6 weeks.

Now that you know more about carpal tunnel syndrome…let me explain why people get it confused with other nerve issues located in the forearm.  In part 2 of this blog, I will explore and explain other nerve conditions which create symptoms similar to carpal tunnel.

 

Dr. Luciano Di Loreto, HBSc., DC

www.fitforlifewellnessclinic.com

—–

Dr. Luciano Di Loreto graduated from the Canadian Memorial Chiropractic College (2010) as a Doctor of Chiropractic and obtained a certificate in Medical Acupuncture at McMaster University (2010). At his practice located in Vaughan, Ontario, Canada, Dr. Luciano Di Loreto combines evidence-based chiropractic care with a multidisciplinary and collaborative approach to health care. He is an approachable, passionate, and diligent practitioner with a focus on delivering exceptional acute, preventative, rehabilitative and supportive care for a variety conditions relating to the muscle, nerve, and bone. During his spare time, Dr. Luciano Di Loreto takes pleasure in spending time with his family and friends. He enjoys fishing and playing sports.

Fit for Life Wellness & Rehabilitation Centre is a health clinic located in Vaughan, Ontario, just north of Major Mackenzie on Weston Road (Located in the Vellore Medical Centre & Walk In Clinic). If you have questions for Dr. Luciano Di Loreto, please comment and we will get right back to you promptly with information on your conditions/concerns.

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