Now, this is where it gets tricky, and I want to highlight this because it is so important: many other problems, such as thoracic outlet syndrome, or myofascial trigger points, can create a state similar to and mistaken for carpal tunnel syndrome. Carpal tunnel can occur as a secondary problem from restrictions in the thoracic outlet, the place where the nerves and blood vessels enter the arm. Many muscle trigger points, from the forearm to the neck and shoulder, can send pain into the arm, wrist and hand, mimicking carpal tunnel pain. None of these problems can be solved with carpal tunnel surgery. If you suspect you have carpal tunnel syndrome here are some suggestions you might want to try:
1. Begin with a conservative approach, visit a massage therapist, specifically a neuromuscular therapist (NMT). Ask your therapist if they do "neuro" or trigger point work. Be warned. good Trigger point work will keep you coming back. Bad trigger point work will turn you away from massage forever. Do your homework: ask for recommendations; check your therapists credentials; make sure you find someone who knows anatomy and trigger point pain patterns. A good massage therapist will check your forearm, upper arm, shoulder and neck for trigger points that may be causing or adding to the problem. Remember that good trigger point massage is neither comfortable nor painful and ideally should be performed on the boarder of pain, not beyond. Your first treatment should give you some immediate relief, but you may still need several treatments to improve. (Note: My personal preference is for a massage therapist who understands anatomy and uses methods rooted in science based research.) I personally prefer a massage therapist who has a healthy skepticism of the claims of treatment to one who believes massage is the cure for all problems.
2. Begin self-treatment. In conjunction with massage learn about stretching your forearm flexors and strengthening your extensors. Stretching alone my aggravate symptoms. Muscle manipulation, either by self treatment or massage should be joined with stretching. Learn how to treat yourself. Get The Trigger Point Therapy Workbook by Clair Davies and learn to use it. Take this book with a grain of salt. I personally think some of the claims are a little over the top, but the self treatments can be useful.
3. Change aggravating activity. Look for repetitive motion activities that may be creating the problem and modify or eliminate them. Postural problems may exacerbate the problem, so become aware of how you use your body and make appropriate changes. If you need help doing these things then seek it out.
4. Use orthopedic tests to check for positive signs of carpal tunnel syndrome. Here are two tests that you can try. The first is Phalen's test and the second is Tinel's sign or the tap test. Check with a doctor or orthopedist to make sure you are doing the tests correctly. If your doctor is not familiar with orthopedic testing then find a doctor who is.
5. Find a good doctor. Some people are diagnosed with carpal tunnel by doctors who NEVER touch them. If this is the case, you need to find a new doctor. If you can, find a doctor who knows orthopedic testing. In addition to carpel tunnel tests, make sure your doctor checks for thoracic outlet syndrome. Be aware surgeons recommend surgery. If you do have true carpal tunnel, surgery can help. If I were in the situation, I would never have surgery without a second opinion. Remember that sometimes, even with surgery, offending activities can cause the pain to return, so they must be modified or eliminated.
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