Carpal Tunnel Syndrome is a commonly misunderstood condition. It is generally thought of as a condition that arises due to Median nerve pressure as that nerve and nine tendons pass through the carpal tunnel at the wrist. Because this is the common understanding of the condition’s origin, treatment usually involves anti-inflammatories, physical therapy on the wrist, and surgically cutting the transverse carpal ligament that overlies the carpal tunnel.
What is not commonly understood is the concept of ‘Double Crush’ involving the Median nerve. Double Crush is a phenomenon that refers to a nerve experiencing pressure at two or more locations along its path.
Spinal nerves exit at each level of the spine and travel to their final destination. In the case of the Median nerve, there are several areas of potential pressure. There are also many underlying reasons that the pressure is occurring at those locations. We will examine some commonly involved areas relating to the Median nerve.
The first area the Median nerve can begin to experience pressure is as it passes through the Scalene muscles of the neck. Increased tension in the neck muscles can be a result of stress, improper cervical spine biomechanics, altered breathing patterns, or poor posture.
The second area that the Median nerve can experience pressure is as the nerve passes between the collarbone and the first rib. Some individuals have a genetically smaller space at this location and poor posture compromises the space in others.
The third area of increased pressure is as the nerve passes through the region of the pectoral muscle. We tend to be a forward drawn society, commonly sitting and working at our computers. As a result of poor posture and forward positioning of our shoulders, the pectoral minor muscle can become shortened and tight. The Median nerve commonly experiences pressure as it passes through this region.
The fourth area the Median nerve commonly experiences pressure is as the nerve runs through a muscle in the forearm called the pronator teres. This muscle can become tight in some individuals and increase pressure on the nerve.
The fifth place that the Median nerve can experience pressure is through adhesions in the connective tissue/fascia anywhere along its path. If these adhesions can be identified, techniques to release the nerve from those adhesions can be employed, freeing the nerve and reducing the pressure.
The sixth place the nerve can experience pressure is as the Median nerve and the nine tendons of the forearm run through the carpal tunnel of the wrist. This is the area most identified as the cause of nerve pressure associated with Carpal tunnel Syndrome.
The Double Crush Phenomenon supports the idea that local damage to the Median nerve along its course, may sufficiently impair the overall functioning of the nerve, so that it becomes more susceptible than would normally be experienced in the wrist.
Often multiple areas of pressure lead to the symptoms experienced in the wrist, not just isolated pressure at the wrist as commonly thought. This is the reason so many people who have the carpal tunnel release surgery continue to experience carpal tunnel symptoms even after surgery.
Palmetto Physical Medicine patients experiencing Carpal Tunnel Syndrome can expect to have all of their contributing physical issues identified and treated with care and precision.