Carpal Tunnel and
Pronator Teres Syndromes
Typical History
In carpal tunnel syndrome a patient experiences a gradual onset of worsening numbness in the thumb and first two fingers. However, if numbness is also present in the palm of the hand it is not true carpal tunnel syndrome. In such cases pronator teres syndrome is a more likely cause of the problem. This confusion has lead to many unsuccessful carpal tunnel release surgeries which could easily be avoided.
Anatomy of Carpal Tunnel and Pronator Teres Syndromes
The median nerve is one of the major nerves supplying the front of the forearm and hand. This nerve passes through two parts of a muscle at the elbow (pronator teres) and then continues to pass through an arch of bones and ligaments in the wrist (the carpal tunnel). If the pronator teres muscle is tight or scar tissue develops at either location the nerve becomes pinched causing symptoms in the hand (and possibly the forearm).
In both conditions repetitive stress is the most common cause. Any activity in which a person repeatedly uses their hands, especially with the palms turned down, can cause either of these conditions. Common activities that cause these problems include typing, cashier input, knitting, mixing ingredients for cooking and horse back riding (working the reigns).
Your doctor will examine your elbow and wrist and perform tests designed to stretch and compress the median nerve and the muscles that the nerve passes through. In pronator teres syndrome a tender muscle (the pronator teres) is often identified at the elbow.
Your doctor will likely mobilize the joints in the neck, shoulder, elbow and wrist to relieve stress throughout the path of the median nerve. Active Release Techniques are very effective in freeing the median nerve at sites which are entrapped and may be incorporated to facilitate recovery. Therapies such as diapulse with ice accelerate recovery by reducing inflammation. Home stretching of the forearm muscles (extending your wrist and holding it in that position for 30 seconds twice per day) may also be advised.
Prognosis
Following the protocol devised at Cummings Chiropractic Family Wellness, significant relief can be anticipated within two weeks. This is well ahead of the standard weeks to months that are often suggested. While under our care you can assist the progress by avoiding the activity which is causing your condition which our doctors will assist you in identifying.
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