Sarah Cherny – Practitioner of Chinese Medicine (Acupuncturist & Herbalist)
Health Space Clinics, Potts Point, NSW
CARPAL TUNNEL SYNDROME – A SERIOUS PAIN IN THE WRIST!
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CARPAL TUNNEL SYNDROME (CTS)
⇒ Carpal Tunnel Syndrome occurs when there is compression of the median nerve that passes through the carpal tunnel in the wrist, causing pain and various other symptoms. The condition can become debilitating. The underlying cause may be multifactorial and can be difficult to distinguish.
Figure 1: The Carpal Tunnel (Our Health Network 2006)
Symptoms:
- Numbness
- Parasthesia
- Pain, often at night
- Referred pain into the arm / shoulder
- Hand weakness
- Darting wrist pains
- The palmer aspect of the thumb, index finger and middle finger and half of the ring finger are affected.
(Better Health Channel 2010)
Western Medicine – Pathological Process
A single, or combination of factors, can cause carpal Tunnel Syndrome. Several associated aetiological factors are:
Genetics – Some individuals are born with smaller than usual carpal tunnels, hence they are prone to Carpal Tunnel Syndrome as it is more likely that there will be compression on the median nerve.
Arthritis – Can cause inflammation and swelling of the joints. It is particularly common with Rheumatoid arthritis.
Pregnancy – Can cause temporary fluid retention causing compression. This usually resolves post-partum.
Injury – Injuries such as fractures can dislodge and irritate the spaces creating compression on the nerve.
Repetitive Strain Injury (RSI) – Repetitive hand movements and postures such as long distance driving, sewing, assembly line work, typing and working with tools that vibrate such as jackhammers can cause Carpal Tunnel Syndrome.
Idiopathic – Carpal Tunnel Syndrome can occur for no apparent reason.
(Better Health Channel 2010)
Treatment Options
- Wrist splint to relieve the nerve compression
- Corticosteroid injections
- Surgery to open up the carpal tunnel and relieve the pressure
(Merck 2008)
Diagnosis
Differential diagnosis is strongly suggested using several orthopaedic tests, outlined below.
Tinel’s Sign
Figure 2: Tinel’s Sign (Carpal Tunnel Syndrome)
⇒ The examiner taps over the Carpal Tunnel.
⇒ A positive test for Carpal Tunnel Syndrome will occur if the individual experiences tingling or parasthesia distal to the site of pressure.
Phalen’s Test
Figure 3: Phalen’s Test (InnovAit 2011)
⇒ Patient flexes both wrists together, examiner holds in position for at least one minute.
⇒ A positive test for Carpal Tunnel Syndrome will occur if there is numbness or parasthesia in the median nerve distribution.
(Kuoch 2009, p.322)
Reverse Phalen’s Test
Figure 4: Reverse Phalen’s Test (InnovAit 2011)
⇒ Both hands placed in prayer position and then pulled backward toward the chest, while keeping both palms together.
⇒ A positive test for Carpal Tunnel Syndrome will occur if there is numbness or parasthesia in the median nerve distribution.
(Kuoch 2009, p.322)
Traditional Chinese Medicine – Pathological Process
According to Chinese Medicine texts there are two primary aetiologies for Carpal Tunnel Syndrome;
- Channel Sinew Taxation damage leading to qi and blood stagnation
- Invasion of Wind-Cold
Channel Sinew Taxation damage
The patho-mechanism behind this aetiology is simply overuse and over-strain of the wrist for extended periods of time. It can also be due to falls and knocks. The continued stress to the area causes qi (energy) and blood stagnation, which then leads to a lack of nourishment to the channels and sinews in the area.
This pathology would be commonly seen in office workers using computers, craftsmen and any form of activity that put repetitive stress on the wrist for long periods of time.
Differentials
To diagnosis this condition, along with some of the orthopaedic tests (discussed above) there would be pain and numbness in the median nerve distribution: the thumb, index, middle and half of the ring finger. There may be difficulty stretching the fingers. Continuing the straining activity would exacerbate the symptoms.
⇒ Additionally there may be points to note from tongue and pulse diagnosis.
(Riley 2003, p.94)
Invasion of Wind-Cold
An old injury or weakened Carpal Tunnel can be vulnerable to a Wind Cold invasion. This can take the form of a traditional Wind Cold invasion (such as being caught outside during cold and windy conditions) or something as simple as exposing the wrists to cold water. Cold congeals qi and blood and causes stagnation.
Differentials
The general signs and symptoms of Carpal Tunnel Syndrome discussed. Additionally there may be atrophy of the abductor muscle of the thumb.
(Riley 2003, p.94)
Principle of Treatment
Three primary principles:
- Nourish the blood
- Soothe the sinews
- Course energy through the meridians
The above treatments are done with a combination of acupuncture using local and distal points. Chinese herbal medicine and moxibustion may also be deemed necessary.
A course of treatments, 2-3 times per week for a fortnight, followed by weekly treatments for 6 weeks will significantly improve or likely alleviate symptoms altogether.
LIFESTYLE ADVICE / EXERCISES
Ongoing Chinese Medicine treatment as well as some massage and stretching to the afflicted area would be advised for a patient suffering this condition. It would also be advised to reduce the repetitive action aggravating the wrist however this may often prove to be difficult as it may involve actions used in everyday work.
