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The Light At The End Of
The Tunnel
By
Victoria L. Magown,
CMTPT, LMT and George S. Pellegrino, LMT, CMTPT
The deadline for Linda's project was rapidly approaching. Typing
feverishly at her keyboard in spite of pain in her hands, wrists and
arms, she knew people were counting on her to get this project done on
schedule. Working at a computer day after day, made this pain a common
occurrence. "Carpal Tunnel Syndrome?", she mused. For some people this
story is all too familiar.
Many people know the term Carpal Tunnel Syndrome or CTS. How often
have you seen people rubbing their hands to get rid of their pain? When
they notice you observing them, their explanation is "Carpal Tunnel!"
Have you had hand pain and wondered, "Do I have Carpal Tunnel Syndrome"?
Most people use this term to explain pain in their hands without fully
understanding what the term means. The pain of CTS is caused by
compression of the median nerve in the tunnel through the carpal bones.
"Carpals" are the bones of the wrist and the tunnel is the space between
the bones and the flat, broad ligament that crosses over the top.
In Linda's case, the initiating cause was "Repetitive Motion Injury",
currently defined as "injury to tissues due to repeated trauma, usually
associated with writing, painting, typing or use of vibrating tools or
hand tools. More specifically, CTS may be, but is not always, caused by
repetitive motion of the wrist."
Although Linda had many of the signs of CTS, there can be other
causes. As early as 1951, an industrial disease call Occupational
Myalgia, referred to injuries specific to muscles involved in the use of
another modern miracle, the typewriter. Not much has changed.
Carpal Tunnel Syndrome is characterized by pain, numbness and/or
tingling on the palm side of the hand over the thumb, palm, index and
middle fingers. Pain can extend into the forearm and upper arm.
Trigger Points (TrPs) in muscles can cause these patterns of pain.
TrPs are a hypersensitive focus of pain in a muscle that restricts range
of motion and refers pain in a predictable pattern usually away from the
site of the Trigger Point. They can be laid down in muscles through
direct trauma or repetitive motion.
Take for instance the palmaris longus (Illustration A). TrPs in this
muscle can cause a painful, prickly sensation in the palm of the hand,
wrist and forearm. Linda also had pain in her thumb caused by two
muscles in the palm of the hand, the adductor and opponens pollicis
(Illustration B). These muscles can mimic CTS and need to be considered
before surgery.
Another muscle that developed TrPs as a result of her occupation was
the brachialis (Illustration C). Upper arm pain from this muscle was
part of Linda's symptoms, which she never connected to the pain in her
thumb. It was involved as the result of keeping the forearms bent at a
keyboard for hours at a time.
The pronator teres (Illustration D), a muscle that turns the palm
downward as in typing, not only causes wrist and thumb pain, but
compresses the very nerve responsible for CTS, the median nerve. The
tunnel of the carpals is not the only location at which this nerve can
be compressed.
Appropriate treatment by the Certified Myofascial Trigger Point
Therapists at MyoRehab eliminated Linda's pain. A specific Home
Exercise Program and modifications to her workstation prevent the return
of her symptoms.
Are you looking for "The Light At The End Of The Tunnel"?
Do you suspect Carpal Tunnel Syndrome? Give us a call at MyoRehab
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