Let’s start by discussing what carpal tunnel syndrome (CTS) is. CTS is the irritation to the median nerve in the upper extremity that is caused by the carpal tunnel in your hand and wrist. This irritation can be mechanical (by muscle, tendon, ligament, or bone) or chemical compression (increase in edema). Symptoms of this compression are numbness, tingling, pain into the first 3 fingers on the palm side. Weakness in grip strength can occur in severe cases as well. Conservative treatment options include accurate myofascial release techniques, stretches/exercises, and other modality interventions such as low level laser therapy.

The next question is, are their other compression sites like the carpal tunnel that can irritate the median nerve? 

The answer is yes! Based on the anatomical pathway of the median nerve, other entrapment sites include the pronator teres muscle and digitorum superficialis muscles and the Ligament of Struthers. These sites can easily cause mechanical compression on the median nerve as it traverses through these muscles as well as innervating them.

Median nerve through the forearm

CTS Mimickers

Now, they’re other nerve entrapment syndromes that result in similar symptoms those are:

• -Cubital Tunnel Syndrome: This involves the pathway of the ulnar nerve and its innervation. Pain and numbness appear down the medial side of the elbow, down the forearm, into fingers 4 and 5. It's quite common to see symptoms reach the shoulder region as well.

Ulnar nerve pathway through the lower arm and elbow

• -Radial Tunnel Syndrome: This involves the pathway and innervation of the radial nerve. Pain and numbness can radiate down the posterior portion of the forearm down to the posterior side of the hand.

Radial nerve through the arm diagram

• -Cervical radiculopathy: Irritation to the exiting nerve roots of the of the corresponding vertebral level, can radiate pain and numbness down the arm along specific patterns. Irritation of the nerve roots can be caused by herniated discs, bone spurs, and closing of the foramen.

Here is a description of the nerve pathway from your neck to your arm

Other Mimickers Include:

-Diabetic Neuropathy: In the late stages of type 2 diabetes, damage to the peripheral nerves can occur. Symptoms present as with pain, tingling, and numbness that starts in the finger tips as well as the toes and can progress back towards the midline. This is often confused with conditions listed above because of the similarity in symptom presentation but does not have an exact physical mechanism of injury.

-Early on in Pregnancy: During the early stages of pregnancy, a vast amount changes occur, a lot involving hormones that prep the body for change. This can result in edema (swelling) build up in parts of the body and most commonly in the wrist, hand, and forearm. That swelling can cause enough of a compression to irritate the median nerve thus causing CTS symptoms.

Diagnosing and correct treatment for these conditions is the service that we provide to our patients. If you are feeling any of these symptoms, please do not hesitate to have those symptoms evaluated and treated. Interventions such as spinal manipulative therapy, Active Release technique, rehab guidance, low level laser therapy, and massage therapy are all proven to help treat these biomechanical symptoms. Call 907-349-4212 to get on the schedule as soon as this week!

Bryan Matthisen, D.C.

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