Carpal tunnel is a condition caused by overuse, it can affect one or both hands at the same time. The true definition is when there is a compression against the median nerve. This most commonly happens in the carpal tunnel (this tunnel is made by the bones in the wrist), but it can also be compressed in the elbow, or in the shoulder, where the nerve is still part of the brachial plexus (larger nerve bundle that separates into several different nerves that go into the arm). In any of these cases the symptoms are numbing, tingling or sharp pain going through the thumb, index finger and half of the middle finger. You can experience only one of these symptoms or you may experience all 3 of these symptoms throughout the day depending on what you are doing. Depending on which one of these areas is causing the compression will determine the treatment, however the therapist will generally work on all three of these joints just in case the other areas may be contributing to the condition but not causing it.
The causes for this condition is overuse, but the reasons can be because there is added tissue being built up around the nerve to help protect the muscles around it, scar tissue from a previous injury or surgery (yes having surgery for carpal tunnel can cause you to have it again later in life), muscular tension, breaks or dislocations, and swelling, which happens a lot during pregnancy.
If carpal tunnel is present in the wrist as the cause for the condition, you will be in a face up position for the entire session. If there is swelling present when starting the massage, an ice or cool pack will be placed on the affected wrist or wrists. If it is only one wrist that is affected then treatment will be done on the opposite arm while there is cool on the affected wrist. This does 2 things, 1: it helps with what is called a reflex arc. In this arc when the opposite side is worked on and relaxed it helps the side that is in pain to relax as well, which makes treatment less uncomfortable, and easier to treat. 2: many times when we have one side in pain, we start to use the other side more often, possibly doing new tasks that it wouldn’t ordinarily be doing, which can fatigue that side, or potentially cause an overuse injury there as well.
If both wrists are affected cool will be applied to both wrists, and the therapist will work on the shoulder and elbow of the less painful side. Here any trigger points, and muscular imbalances are treated, and with the swelling some lymphatic drainage may also be started. Then the ice will be removed and work will be started into the wrist and forearm flexors (the muscles that bend the wrist in wards). Here there will not always be any oil used, as there will be fascial work done here as long as it is within your pain tolerance. Other techniques that are used are joint play, and trigger point therapy. This will be done on both wrists and the treatment is ended with more of a relaxation type massage.
If this condition is too advanced, massage may not be able to help you, and you will have to go in for surgery to treat the condition. Surgery is only done when the condition is caused because of a compression of the median nerve in the carpal tunnel, it is very rarely preformed if the cause is in the elbow or the shoulder. After you are fully healed from the surgery, it is usually a good idea to come in for a scar tissue treatment, to make sure that the scar stays functional. Also having a massage for carpal tunnel syndrome after surgery will decrease your chances of having carpal tunnel again, and possibly needing surgery once more.
If the cause for the carpal tunnel is from being pregnant, the only treatment that massage can help with is regulating the swelling, otherwise you will have to wait till after you have the baby for the carpal tunnel to go away. As for breaks and dislocations, you will have to see a doctor to have these bones be put back in place and casted to take the pressure that they are putting against the nerve for the symptoms to go away. However in that case, you will want to come for a massage later to address the scar tissue, to make sure that it doesn’t start to press on the nerve, much like it would after surgery from an advanced form of carpal tunnel.