Carpal Tunnel Syndrome Is It All In Your Hand?

By Heather Allen, MS, PT

Carpal tunnel syndrome is a common diagnosis for people who experience pain, numbness and tingling, and weakness in the hand or hands. Traditional means of treatment can include bracing, medications, physical therapy, and sometimes surgery.

Unfortunately, surgery isn't always effective and patients can experience a return of their symptoms. So why does the pain return? Sometimes the problem comes back because the issue was never in their hand in the first place it was in their shoulder.

Carpal tunnel syndrome is a label for what happens when excessive pressure is put on the median nerve in the wrist. There is a small boney tunnel through which this nerve passes to serve the hand. When this nerve is compressed, it results in pain, numbness, and tingling and weakness of grip.

In some cases the pain can get so extreme it spreads up the arm from the wrist.

When surgery is performed, the doctor cuts the tissue that forms the roof of this tunnel to give the nerve more room to move relieving the pressure.

So how is it that this procedure can result in some patients having return of pain? The carpal tunnel is not the only region where this nerve can get pinched to cause these symptoms. The nerve can also get pinched in the shoulder as it passes down into the arm.

When nerve impingement occurs in the front of the shoulder it's called thoracic outlet syndrome and can result in symptoms mimicking those of carpal tunnel syndrome. The thoracic outlet is the region through the front of the shoulder where the nerves and blood vessels from the neck and chest pass through into the arm.

If the muscles, connective tissue, and fascia in this region become tight and restrictive, they put pressure on the nerves traveling to the hand and create the same complaints. Hence, when pressure is relieved surgically at the wrist, but tightness in the shoulder goes unaddressed, the pain symptoms return.

So how can you make sure you get an accurate diagnosis before you sign up for a potentially unnecessary surgery? Be sure to have your shoulder examined while being seen by your physician.

If you are in physical therapy, be sure your therapist has done a complete evaluation and has included treatment of your shoulder in your plan of care. Including myofascial release in your care will ensure resolution of pain and full recovery of function.