Carpal Tunnel Syndrome – Problems with Diagnosis
Is it really Carpal Tunnel Syndrome?
The symptoms and signs of carpal tunnel syndrome are well known and well documented. Yet, despite this – and the fact that the symptoms of carpal tunnel syndrome are experienced by nearly 1 in 25 US citizens – this condition remains a somewhat confusing and misunderstood subject.
Partly this is because carpal tunnel syndrome is a highly complex disorder that can involve different parts of the body’s muscular skeletal structure. Partly it is because the tests used to diagnose this condition are imprecise and often inaccurate, for example delivering false positives, which indicate that the problem is carpal tunnel syndrome when it isn’t.
True Carpal Tunnel Syndrome arises from the compression or entrapment of the median nerve as it passes through the carpal tunnel from the wrist to the hand. This can be an intermittent or continuous condition.
Increased pressure on the median nerve in the carpel tunnel usually results in progressive sensory and motor disturbances in the hand. There is a sensation of tingling or burning in the fingers and a numbness in the hand; pain can even be felt in the forearm – and even in the shoulders and neck.
When confronted with these symptoms, the tendency amongst many healthcare professionals is to immediately apply the label …. Carpal Tunnel Syndrome.
Yet although these are certainly the symptoms of carpal tunnel syndrome, they could just as easily be caused by problems elsewhere. The same or similar symptoms are shown by: a nerve entrapment in the shoulder or neck; by knots – trigger points – in the myofascial tissue of the muscles in the forearm or in the shoulder and neck; thoracic outlet syndrome.
Diagnosis of carpal tunnel syndrome is therefore somewhat tricky at the best of times. When someone is already suffering from an existing condition such as an auto-immune disease, diagnosis becomes increasingly difficult.
There are three fundamental problems when it comes to diagnosing Carpal Tunnel Syndrome.
If there is a nerve entrapment, it is difficult to determine where this occurs;
There are stress related conditions that mimic the symptoms of Carpal Tunnel Syndrome … making it difficult to determine whether someone is actually suffering from Carpal Tunnel Syndrome … or something else;
There is a range of health conditions that not only make people more susceptible to the development of carpal tunnel syndrome … but also produce symptoms themselves that are similar to those of carpal tunnel syndrome.
Carpal Tunnel Syndrome is a condition where the median nerve is compressed or trapped. However, it is often difficult to identify where the entrapment is taking place. There are several muscular and nerve entrapment conditions that arise from bad posture. These can often result in symptoms similar to those of carpal tunnel syndrome.
Example: one, often quoted example, is a case where the symptoms were typical of carpal tunnel syndrome. The patient had all the symptoms of carpal tunnel syndrome, the doctors diagnosed the problem as carpal tunnel syndrome, …. but, after more extensive examination, the real problem was found to be with the pectoralis minor muscle in the shoulder.
Although this was diagnosed as a case of carpal tunnel syndrome it had nothing to do with the carpal tunnel at all. Any conventional treatment for carpal tunnel syndrome would have been a total waste of time.
Numbness and tingling in the hands are the most easily recognised symptoms of Carpal Tunnel Syndrome. Yet even where there is compression of the nerve in the carpal tunnel, the pain might be felt anywhere along the nerve pathway. The brain registers the pain but cannot tell precisely where the pain originates. The corollary of this is that compression of the nerve could be coming from anywhere along the nerve pathway … from the hand to the shoulder to the neck.
Identifying the real source of the problem:
We need to be very careful when it comes to identifying the source of the problem as being in the carpal tunnel. It is all to easy to come up with false positives – diagnosing carpal tunnel syndrome when it is something else.
We have already quoted the example of the pectoralis minor muscle creating symptoms that mimic those of carpal tunnel syndrome. A similar situation can occur, where the symptoms indicate nerve compression or entrapment but the impingement occurs in the thoracic outlet – the opening behind the collarbone through which the nerves (and blood vessels) pass on their way to the arm.
Any impeded return of blood and lymph from the arm can often be the cause of swelling in the wrist and hands. It is this that may be causing the restriction in the carpal tunnel. In this situation it is the thoracic outlet that needs attention, not the carpal tunnel itself.