May 282017

What Is Carpal Tunnel Syndrome?

A doctor speaks. Most people don’t realize how sitting at a desk all day long can really do a number on their shoulders. Many people who sit at a desk just like you do have a lot of aches and pains, the cause of which, they really can’t put a finger on. The first time that I was able to connect the dots was on one of my patients who had these nebulous carpal tunnel syndrome symptoms.
She had numbness and tingling down into her right hand and so I was treating her wrist and forearm as usual. However, I really wasn’t getting anywhere with it. Like most physical therapists with a carpal tunnel patient, I had the patient doing wrist curls and hand squeezes with light resistance and then a combo of ultrasound and ice. Some of you may have had this same treatment. Hey, for some patients it does address their problems and they get a real benefit from it. However, this time there was no great benefit. In fact, the patient felt as though she wasn’t getting anything out of coming to see the physical therapist.
At that time, I had to change course and ask her what exactly she felt would help her the most.A? She replied “I think I just need a good massage”. While I do hear this from many of my patients, I try not to use the “spa treatment” on them because most of the time, it doesn’t address the real problem. This time, though, I felt that my patient was onto something.
I started the massage on her hand and wrist and when I finally reached her shoulder I started getting some positive responses from the patient. She directed my to the back side of her shoulder right where the arm meets the body. As I massaged her shoulder, she kept telling me that I needed to dig deeper and deeper and that whatever I was doing felt good. I also got a similar response as I stripped the muscles on the inside of the arm (there were actual knots in the medial tricep muscle).
After about 10 minutes of aggressively kneading and stretching the inside of her arm and shoulder blade muscles, our session was over and the patient left with positive comments but no real change in her symptoms at the time. On her next visit 2 days later, she was scheduled to see a different physical therapist. Right before he started to work on her he whispered to me that I needed to “look” at her arm.
When I went into see the patient there were a couple of bruises on the back side of her shoulder. “Have you seen the back side of your shoulder?” I asked.
“No”, she replied.
“Well, it’s kind of bruised. I think that I may have been a little too aggressive and I apologize. Is there something I can do for this?” I asked in a very nervous tone.
“I want the same type of massage you gave me last time. I have not had any symptoms since you worked on my shoulder and it feels GREAT!” She stated. I was relieved.
While the following may not be true for all carpal tunnel patients, it is true for anyone who spends the majority of their time at a desk and computer. Sitting with your arms at your side performing work produces a constant strain on several muscle groups in order to stabilize your shoulders and arms. The medial head of the tricep is one of these muscles. Many of the nerves and blood vessels that supply the hands and forearms run through or near the inside triceps muscle and their duties can be decreased when these muscles get short and tight.
I have since avoided aggressively massaging my patients like this and have since incorporated triceps exercising and stretches when treating carpal tunnel patients. The seated overhead triceps extension with light weights is an excellent way to stretch and strengthen the back of the arm. There are other stretches and exercises too. If you don’t want to lift weights you can still stretch the back side of your arm by going overhead and reaching for the middle of your back. This is an excellent way to keep the shoulder stretched out and stay limber.


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