Latest / The Driven Athlete / Carpal Tunnel & Nerve Pain Explained | Ep 59

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Carpal Tunnel & Nerve Pain Explained | Ep 59 · The Driven Athlete

• 0:00
  Speaker 1: If you're a driven, active person who wants to reach and pursue a higher quality life with some ambition, then guess what this podcast is for you.
• 0:07
  Speaker 1: This is the Driven Athlete Podcast and here's why it's referred.
• 0:22
  Speaker 1: It's known to be referred nerve pain, numbness, tingling in the hands right, found with people that have occupations or they do a lot of activities involving their hands right, or a lot of crimped, flexed postures of their palms and wrists and fingers.
• 0:40
  Speaker 1: That's been found right.
• 0:42
  Speaker 1: Another classic sign of like having referred pain in the hands and fingers is pain was at that symptom at night, was sleeping All right.
• 0:51
  Speaker 1: So it can be provoked all day with doing hand, upper extremity, clenched fingers and flexed fingers and palm postures and positions and a lot of hand activity and finger activity and then pain at sleeping.
• 1:04
  Speaker 1: The associated sleeping posture is super important with a lot of pathologies that we see and the first thing we usually talk about with our patients is altering their sleep position.
• 1:15
  Speaker 1: If somebody wakes up in the morning and they have increased symptoms or that middle of the night, they have increased symptoms as long as we've ruled out red flags.
• 1:23
  Speaker 1: If we rule out the red flag signs and symptoms and issues, then we're confident it's only musculoskeletal or neuromusculoskeletal and therefore we can intervene and help.
• 1:31
  Speaker 1: Okay, cool.
• 1:32
  Speaker 1: And if a person has that those symptoms get more irritated and noticed in the middle of the night or at the morning, then their sleeping position is usually contributing to making things more irritated.
• 1:43
  Speaker 1: So we talk about sleep position For carpal tunnel.
• 1:45
  Speaker 1: If people sleep with their hands together or flexed, and like cradling their shoulder or their head with their hands, and their hands are flexed and crimped in their fingers, that can contribute to more referred nerve pain in the hands and the fingertips.
• 1:59
  Speaker 1: So the reason why carpal tunnel gets a lot of, it used to get, in my opinion, a lot of attention and it's gotten less, as in like, it's a controversial diagnosis and here's why it's referred nerve pain.
• 2:13
  Speaker 1: Your nerves in your upper extremity, in your arms, start from your neck, all right.
• 2:17
  Speaker 1: They come out of your cervical vertebrae and they go down through the cervical plexus and the brachial plexus and they go from your brachial plexus through the axillary region, okay, which is your armpit.
• 2:28
  Speaker 1: It goes out of your foramina, of your vertebrae, through the anterior scalenes, underneath your clavicle and between your first rib and your clavicle, underneath your pec minor, through your axillary region, down your arm through the antecubital fossa, which is the front part of your elbow, the elbow crease, and then again through your carpal tunnel.
• 2:51
  Speaker 1: Those are all potential entrapment or impingement sites for nerves that pass along all the whole pathway of these nerves.
• 3:01
  Speaker 1: For your arm there's a lot of these entrapment sites, whole pathway of these nerves.
• 3:06
  Speaker 1: For your arm there's a lot of these entrapment sites.
• 3:07
  Speaker 1: The foramina of your neck, okay, the scalene triangle, the scalene muscles you have anterior, middle and posterior those and lateral.
• 3:12
  Speaker 1: So those three scalene muscles are neck muscles on the side of your neck, and the brachial plexus, which is a plexus of nerves, a web, spider web of nerves pass through the scalene triangle and they go out of your neck and down to your arm.
• 3:26
  Speaker 1: So that's already two entrapment sites right there that get sites of irritation.
• 3:29
  Speaker 1: I should say it's not like things are getting out pinched.
• 3:32
  Speaker 1: That's not a right picture from what the research is finding.
• 3:34
  Speaker 1: Again, empirical evidence and research would suggest it's not pinching, it's more just irritation sites, inflammation sites.
• 3:41
  Speaker 1: Right Next, under the clavicle and your first rib, is a small area that the brachial plexus passes through.
• 3:48
  Speaker 1: Again, this neurovascular bundle, this bundle of neurovascular structures, and there's a lot of things passing through there right.
• 3:58
  Speaker 1: So it's a great easy site for things getting pinched.
• 4:00
  Speaker 1: So imagine somebody with forward head posture at the desk right.
• 4:03
  Speaker 1: What does that posture look like?
• 4:06
  Speaker 1: Their neck posture is not great and it's compressing all the facet joints of the posterior part of the neck and their scaling triangles are getting tighter and their shoulders are forward and that's compressing this, narrowing the space between your clavicle and your first rib, pec minor underneath and your pec minor.
• 4:24
  Speaker 1: It passes through that tendon site, okay, to go out of your arm to your axillary region and that's another forward posture, compresses the pec minor space for that neurovascular bundle to get irritated again.
• 4:38
  Speaker 1: And it passes through your arm to your antecubital fossa, with the elbows bent, still kind of compressed, through your arm to your antecubital fossa with the elbows bent, still kind of compressed, and then through your wrist at the carpal tunnel.
• 4:51
  Speaker 1: If the wrists are flexed like that and the fingers are compressed and the palms are compressed for typing or texting and dialing the phone or whatever, that's a lot of sites.
• 4:57
  Speaker 1: That's carpal tunnel is one, antecubital is two, pec minor is three, clavicle and first rib is four, scalene triangle is five, cervical vertebrae and the foramina is six.
• 5:09
  Speaker 1: That's six entrapment sites.
• 5:11
  Speaker 1: So eventually and ultimately, a person battling symptoms in their fingers and their hands, which is nerve symptoms, we have to investigate.
• 5:21
  Speaker 1: There's six other areas that could be contributing, not just the carpal tunnel, that's just the distal, furthest end.
• 5:26
  Speaker 1: That gets a lot of attention.
• 5:28
  Speaker 1: Problem solved right Orthopedic surgeons, very smart individuals and have a ton of knowledge and experience.
• 5:35
  Speaker 1: There's a lot of respect, for sure.
• 5:37
  Speaker 1: The thought that they had was what if we just open up and cut the carpal tunnel to allow more space for the nerve that's getting irritated to have more breathing space?
• 5:48
  Speaker 1: So they go in and they cut the flexor retinaculum, which is the roof of the carpal tunnel.
• 5:56
  Speaker 1: All right, the thought being that they can create more freedom and space for the nerve to breathe and less compression, which would relieve nerve symptoms.
• 6:07
  Speaker 1: But if the source of irritation isn't really from the carpal tunnel and maybe one of those other five locations of impingement or irritation, I should say, is that going to solve the problem?
• 6:16
  Speaker 1: And symptoms persist, unfortunately.
• 6:19
  Speaker 1: So now what do they do?
• 6:19
  Speaker 1: Pain management, which is just meds, right?
• 6:23
  Speaker 1: So solution let's cut a flexor retinaculum, which is not the problem, and then get pain meds when it doesn't work.
• 6:28
  Speaker 1: That's just an interesting solution, direction, right?
• 6:32
  Speaker 1: Anyway, with all this being said, they're trying to help Understandable.
• 6:35
  Speaker 1: I'm saying, if somebody's battling nerve symptoms like this, I would here's my humble opinion if it was me or my wife or my family, the first thing that I wouldn't say is immediately jump into surgery.
• 6:46
  Speaker 1: I'll be like yo.
• 6:46
  Speaker 1: Let's just try some conservative treatment first, interventions first and see if that and maybe even try fixing your sleeping posture that might help contribute, fix your work posture that also might contribute to help lowering the irritation of some of these nerves that are sending signals it's really just nerve signals.
• 7:05
  Speaker 1: The nerves are letting your body know they're irritated, right?
• 7:08
  Speaker 1: So a little bit more education real quick on the carpal tunnel.
• 7:11
  Speaker 1: So the carpal tunnel.
• 7:12
  Speaker 1: Carpal means wrist, wrist bones.
• 7:14
  Speaker 1: The carpal bones in your wrist are those eight bones that look like little pebbles.
• 7:19
  Speaker 1: They're like little rocks right, and they move and glide and slide with each other to create range of motion in your wrist and they form like a cup U-shape.
• 7:26
  Speaker 1: If you look at it from an axial view, straight up the forearm, they kind of look like a U-shape like this and the flexor retinaculum sits on the roof like that.
• 7:36
  Speaker 1: So this space right here is the carpal tunnel, all right, it's a tunnel, like a train tunnel, all right.
• 7:43
  Speaker 1: So here's the carpal bones that make a U and then the flexor retinaculum is a thick band fibro.
• 7:50
  Speaker 1: It's a ligamentous structure, fibrous ligamentous structure that sits on top.
• 7:54
  Speaker 1: It's very thick like the IT band or something and it's the roof and that tunnel.
• 7:59
  Speaker 1: Right there.
• 8:00
  Speaker 1: You have nine tendons and one nerve that pass through, like imagine a hot dog squished or spaghetti strands stuffed together right in the middle of that tunnel, like this.
• 8:12
  Speaker 1: Right, you can see my hand, like that, right, see that.
• 8:14
  Speaker 1: But nine of them.
• 8:16
  Speaker 1: You have nine tendons and those are all flexor muscles of your wrist and your thumb the flexor digitorum profundus and then your flexor digitorum superficialis.
• 8:26
  Speaker 1: There's four.
• 8:27
  Speaker 1: Each, that's eight tendons, and then your flexor pollicis longus.
• 8:31
  Speaker 1: Those nine tendons pass through the carpal tunnel and then right, squished in the middle of that, is one nerve, the median nerve.
• 8:39
  Speaker 1: The median nerve innervates the thumb and the thenar muscles of your thumb, which is that pad of your thumb right here, and it innervates sensory for the first three digits your thumb, your index finger and your middle finger.
• 8:55
  Speaker 1: So symptoms would be like numbness and tingling in these three fingers of your thumb, index finger and middle finger and then, if it's actually carpal tunnel type of issues, there'll be atrophy or wasting of the thenar muscles of your thumb, the pollicis muscles, your pollux, your thumb's called your pollux.
• 9:15
  Speaker 1: Thenar muscles of your thumb, the pollicis muscles, your pollux, your thumb's called your pollux.
• 9:18
  Speaker 1: And this thenar eminence is a group of three large muscles, that sorry, four, four large muscles that create like a pretty big protuberance of muscle tissue and those will waste and atrophy.
• 9:32
  Speaker 1: So, as an example, if we check out somebody's having wrist nerve symptoms down their fingers and their weakness and they have pain in their hands, we'll ask them to squeeze their pinky and their thumb together like this.
• 9:43
  Speaker 1: And if they can't, if it's weak, and we notice that the muscle tissue in their thumb thenar eminence is squishy and atrophied compared to the other side that has no symptoms, right, it's like this one's really strong and it's firm, this one we push and it's weak, right, that means like okay, there's definitely more nerve involvement and the carpal tunnel could be contributing to that more aggressively than maybe other impingement sites from the neck, scalenes, clavicle first, rib pic, minor antecubital region and then the carpal tunnel itself.
• 10:14
  Speaker 1: Maybe the carpal tunnel actually is contributing to some more nerve symptoms.
• 10:17
  Speaker 1: Okay, let's analyze.
• 10:18
  Speaker 1: Why is that happening in the first place.
• 10:20
  Speaker 1: What they're suggesting is the muscle tendons, those nine tendons, from chronic overuse and positioning, are getting inflamed, right, they're getting lit up, they're getting swollen, and then what's that going to do with the space overall and the nerve that's sitting in between there, all in between squished?
• 10:39
  Speaker 1: The nerve's going to get more squished because there's no room for the swelling to go.
• 10:43
  Speaker 1: So in that carpal tunnel the median nerve gets compressed and more squished and it's going to alter the signaling from that point forward, which is down to the thenar eminence of your thumb for the muscle innervation and then the sensory to your first three digits.
• 10:55
  Speaker 1: That's what that looks like.
• 10:58
  Speaker 1: So the thought being well, why is it happening in the first place?
• 11:01
  Speaker 1: What if we fix that?
• 11:01
  Speaker 1: Instead of just cutting the flexor retinaculum and opening more space, I get what they're doing Humbly.
• 11:06
  Speaker 1: My opinion first.
• 11:07
  Speaker 1: I'm biased.
• 11:08
  Speaker 1: I am biased.
• 11:09
  Speaker 1: I would try conservative interventions first.
• 11:12
  Speaker 1: All right, not even meds, I would just try.
• 11:18
  Speaker 1: I mean, if it's unbearable and you can't sleep, then take some meds so you can sleep and go to public shopping and do your job, while intervening on the reason why it happened in the first place with some conservative treatment stuff like physical therapy.
• 11:26
  Speaker 1: Again, I'm a biased dude Sports, physio right, a combination of manual therapy some soft tissue stuff dry needling can be helpful mobility and range of motion with manual therapy work and then some corrective exercises and stability strength training.
• 11:41
  Speaker 1: These things are getting lit up because they're overwhelmed and maybe even not able to perform their jobs as best they could.
• 11:46
  Speaker 1: Set up for failure by posture, set up for further failure by sleeping position.
• 11:50
  Speaker 1: See how this all adds up.
• 11:52
  Speaker 1: Add that up by multiple multiple months Over six months, eight months a year of the same job Over a hairdresser, cosmetologist, a desk worker, maybe a new digital marketer that's doing a lot of texting or Instagram posting and stuff like that on their phone.
• 12:07
  Speaker 1: So their thumbs are always compressed or just their wrists are always compressed and flexed and flexed.
• 12:11
  Speaker 1: That's a great recipe for little micro trauma and micro irritation over many, many, many months.
• 12:23
  Speaker 1: That leads to carpal tunnel type symptoms, neural irritation, and that's sending signals on the chain.
• 12:25
  Speaker 1: So my suggestion is let's fix the problem that happened in the first place and we'll solve the problem right, versus just solving the symptoms or trying to treat the symptoms Again.
• 12:32
  Speaker 1: That's just my humble opinion.
• 12:33
  Speaker 1: I'm always open to comments, questions concerns, conflicting opinions, but it seems like this leads to more of a long-lasting result versus just living on pain meds for the rest of your life, right?
• 12:44
  Speaker 1: Or just trying surgery and then having it not work Anyway.
• 12:47
  Speaker 1: So that's a little bit of education on what the carpal tunnel is.
• 12:50
  Speaker 1: They have one nerve that passes through that carpal tunnel with nine tendons surrounding it.
• 12:54
  Speaker 1: That's a great setup for a little bit of inflammation.
• 12:58
  Speaker 1: There's not much room to breathe and that's going to compress the nerve, all right.
• 13:02
  Speaker 1: If that's not the case as in like they don't have any thenar wasting and atrophy of their thumb muscle, but they do have nerve symptoms, then that tells me I'm going to check the neck first.
• 13:13
  Speaker 1: All right, I'm going to look at the neck, that's what.
• 13:15
  Speaker 1: And usually muscles that surround the neck are going to follow suit to joint irritation.
• 13:21
  Speaker 1: That's going to cause nerve irritation.
• 13:23
  Speaker 1: So I'm not going to look at the muscles first.
• 13:25
  Speaker 1: I'm going to address the root cause of the joint irritation from poor posture and movement patterns first, and that will solve the muscle guarding and tissue guarding and hypertonicity and they'll follow suit, all right.
• 13:41
  Speaker 1: So soft tissue is a tertiary problem, it's not the primary problem.
• 13:43
  Speaker 1: At least that's what we've done.
• 13:44
  Speaker 1: We have great results, and I'm just saying that's what we usually go with.
• 13:47
  Speaker 1: Okay, so I'm taking out the neck first.
• 13:49
  Speaker 1: I'm definitely going to investigate the first rib.
• 13:51
  Speaker 1: It might be hypo mobile and elevated and we can mobilize that and then work on neck stability.
• 13:56
  Speaker 1: Peck minor mobility is definitely important.
• 13:59
  Speaker 1: We can work on soft tissue with the peck minor, some soft tissue work which is not comfortable.
• 14:03
  Speaker 1: But people when they usually come see us, they want results.
• 14:05
  Speaker 1: They don't want foo-foo treatment, they want to get better.
• 14:07
  Speaker 1: All right.
• 14:08
  Speaker 1: So it's pain, it's just discomfort with a purpose, all right.
• 14:12
  Speaker 1: The antecubital region or pronator teres syndrome that's a lot less likely but we can still investigate that too, for sure, and we're going to work on the soft tissue of the flexor pronator mass of those flexor tendons.
• 14:26
  Speaker 1: Where they originate is actually up at the elbow, on the medial epicondyle of the humerus, and that bundle of muscles is called the flexor pronator mass and it's developed as an example, like baseball players or power lifters that do a lot of gripping for deadlifts, or Olympic lifters for gripping the barbell.
• 14:44
  Speaker 1: Those muscles are definitely contributing.
• 14:47
  Speaker 1: They're going to get hypertonic and tense and guarded up here in the forearm.
• 14:50
  Speaker 1: So we can definitely work on that too.
• 14:54
  Speaker 1: We can't neglect the prolonged postures at work and sleeping position.
• 14:59
  Speaker 1: Like I said, it's a game changer.
• 15:00
  Speaker 1: Imagine somebody at work all day on the desk or cosmetology, and they're doing hair and whatever, and their hands are always flexed and using them a lot, all right.
• 15:09
  Speaker 1: And then they go home and watch TV and their hands are still flexed watching TV.
• 15:13
  Speaker 1: And then they go to sleep and their hands are flexed and their fingers are crimped and crunched as they're sleeping all night and then get up and do the same recipe again.
• 15:21
  Speaker 1: That's definitely going to lead some changes.
• 15:23
  Speaker 1: We have to intervene with that recipe at some point.
• 15:28
  Speaker 1: If nothing changes, nothing changes.
• 15:30
  Speaker 1: We have to intervene somewhere right, and I'm definitely going to start there first and then, from a manual therapy standpoint, we're going to check out the neck, the surrounding muscle tissue, with the scalenes.
• 15:39
  Speaker 1: First, rib mobility, pec, minor soft tissue mobility is important.
• 15:44
  Speaker 1: Pronator teres is going to be important, flexor, pronator, mass, soft tissue work, for sure.
• 15:49
  Speaker 1: And then we're going to look at the carpal tunnel.
• 15:51
  Speaker 1: All right, we can do some mobilizations of the wrist and carpal tunnel mobs, carpal bone mobs, soft tissue worker on the wrist, and then dry needling can be really helpful too, and it's really just to help decrease the inflammation of those nine tendons that are passing through the carpal tunnel that are irritating the nerve.
• 16:06
  Speaker 1: The nerve isn't the problem.
• 16:07
  Speaker 1: The flexor retinaculum is not the problem.
• 16:10
  Speaker 1: The problem is the inflammation of the nine tendons that pass through there, coming from and originating from the flexor pronator mass in the forearm.
• 16:18
  Speaker 1: Those are the tendons that are getting lit up.
• 16:20
  Speaker 1: But why, though, all those things kind of combine?
• 16:23
  Speaker 1: And if someone to play sports or they feel those symptoms with their activity in their sport, then we have to investigate in their sport, what are they doing differently that caused these symptoms to arise?
• 16:33
  Speaker 1: Right, things don't hurt for no reason.
• 16:35
  Speaker 1: So we have to find out what are they doing during their golf swing?
• 16:39
  Speaker 1: What are they doing with their pickup ball or squash or tennis?
• 16:43
  Speaker 1: Right, that's different now than it was maybe six months ago, when they didn't have symptoms right, or a year ago.
• 16:48
  Speaker 1: Or all their friends and colleagues that are doing the same amount of tennis and golf that they're doing, but they don't have these symptoms of carpal tunnel type symptoms.
• 16:55
  Speaker 1: Why this person have it?
• 16:56
  Speaker 1: They're doing something different.
• 16:57
  Speaker 1: We have to figure that out and intervene.
• 16:59
  Speaker 1: And if we don't and we just pursue surgery or meds, then when they finally get back to playing, trying to play again.
• 17:06
  Speaker 1: It's just going to come back again because they didn't fix the reason why it happened in the first place.
• 17:09
  Speaker 1: Do you see what this cycle ends?
• 17:10
  Speaker 1: It ends with dependency on pain meds.
• 17:12
  Speaker 1: We would love to help change that, all right.
• 17:15
  Speaker 1: So, anyway, that's a little bit of a deep dive, a little bit into a carpal tunnel syndrome and what it is and maybe how to treat it, and there's definitely some answers of how we can fix this.
• 17:27
  Speaker 1: But ultimately we have to solve why it came in the first place and let's a little bit of insight on why.
• 17:34
  Speaker 1: So if you have any questions about that, don't hesitate to reach out.