Tunnel Syndrome
is a general term that encompasses any injury
where a nerve is entrapped within a bony structure
forming a tunnel, canal or groove, through
which the nerve passes - including but not
limited to, carpal tunnel syndrome, cubital
tunnel syndrome and guyon’s tunnel syndrome. Wherever
there is a canal or tunnel and a nerve can
be impinged, there is a “tunnel syndrome” just
waiting to appear, keeping you from performing
your job adequately or stopping you from enjoying
everyday activities. So what can be done? Let’s
take a look at cause / effect, symptoms and
treatment of “Tunnel Syndromes” to
better understand how you can prevent the condition
from developing or how to rehabilitate an existing
condition.
Causes of “Tunnel Syndromes”:
Interestingly enough, most Tunnel Syndromes
are not due to disease, as many physicians
would like people to believe, but instead are
caused by the nerve being entrapped / impinged
by surrounding muscle tissues that are overly
tight and restrictive, causing compression
of the nerve and the resulting symptoms.
Effects of Nerve Entrapment
Caused by “Tunnel Syndromes”:
- Primary Swelling: This
form of swelling occurs due to diseases like
diabetes, gout, arthritis, etc. Disease
can cause the nerves and other soft tissues
to swell, resulting in conditions like Carpal
Tunnel, Cubital Tunnel and Guyon’s
Syndrome, but this incidence rate is extremely
low compared to the number of the cases that
are reported each year.
- Secondary Swelling: This
form of swelling occurs when the soft muscles
and other soft tissues surrounding the nerve
become extremely short, tight and restrictive,
resulting in increased friction every time
the muscles surrounding the affected nerve
are used.
Increased friction results in irritation
and swelling, a secondary response to the
short, tight, restrictive muscles compressing
the region. The swollen soft tissues
and nerve(s) become much larger and will
no longer fit adequately within the confined
space of the tunnel. This can
actually make it look as if the tunnel is
too small and is the true “cause” of
the resulting condition. (A mistake made
by many physicians / therapists).
This is one of the reasons why surgery is
performed so often, as they attempt to increase
the space around the affected nerve in order
to relieve the pressure. This may help
for a small amount of people, but in most
cases the condition comes back as the individual
becomes more active and the short restrictive
muscles are still present.
- Example: Carpal
Tunnel Syndrome - One of the
main reasons for the development of this
disorder is due to the overuse of the
finger flexor muscles and finger adductor
muscles in unidirectional (one way) movement
patterns, (Gripping, squeezing, typing,
etc.). These actions make the flexor
/ adductor muscles stronger, shorter
and tighter than the extensor muscles.
This result is a "muscle imbalance" between
these two groups of muscles, causing
the flexor muscles to impinge the underlying
soft-tissue structures, including blood
vessels, the flexor tendons and the median
nerve.
This is a dual action process, as the carpal
bones are not supported in place by the weaker
extensor muscles, causing them to drift inward
and into the carpal tunnel space. Once
again, traditional treatment of this disorder
involves severing the carpal ligament to
increase the space within the tunnel, when
in fact, simple exercises would pull the
carpal bones up and out of the carpal tunnel,
enlarging the space and reducing pressure
on the tendons and median nerve within.
Symptoms of “Tunnel Syndrome”:
- Carpal Tunnel: Median
nerve entrapment at the wrist junction within
the carpal tunnel causing pain, numbness,
tingling, paresthesia (pins and needles),
loss of coordination of the thumb, index,
middle and sometime one-half of the ring
finger and decreased muscle mass of the thenar
eminence (base of thumb) in advanced cases.
- Guyon’s Tunnel: Ulnar
nerve entrapment at the wrist junction within
in the guyon’s canal, resulting in
pain, numbness, tingling, paresthesia (pins
and needles), loss of coordination in the
ring and little finger and decreased muscle
mass of the hypopthenar eminence (base of
ring/little finger) in advanced cases.
- Cubital Tunnel: Entrapment
of the ulnar nerve at the elbow junction
within the cubital tunnel, resulting in pain,
numbness, tingling, paresthesia (pins and
needles), loss of coordination of the ring
and little finger and decreased muscle mass
of the hypopthenar eminence (base of ring/little
finger) in advanced cases.
Note: The symptoms
are virtually identical in Guyon’s
Syndrome and Cubital Tunnel Syndrome as the
nerve affected is the same (ulnar nerve)
in both disorders.
How
to Effectively Treat “Tunnel
Syndromes”:
Depending on the underlying cause, there are
several reasonable treatments that can be utilized.
- For primary swelling: Addressing
the underlying disease with disease-specific
medications can significantly reduce the
swelling of local tissues that result in
compression of the associated nerve(s).
- For secondary swelling:
The underlying (primary) muscle and joint
imbalances need to be eliminated in order
to decrease the compression that resulted
in the irritation and swelling (secondary)
of the associated tissues. When the strength
and length of muscles surrounding the joint,
such as the wrist or elbow, are equalized,
the muscle and joint imbalance disappear
along with the resulting compression of the
local soft tissues, nerves and blood vessels.
When muscles on one side of the joint are
strong, tight and restrictive while the opposing
antagonist muscle group(s) are weak and loose,
the tight restrictive side will compress the
underlying soft tissues, blood vessels and
nerves, while the weak side, due to the tensile
strain imposed on the tissues, can suffer severe
muscle spasm and segment hyper-stretching of
the entrapped nerve as it attempt to hold the
bones in the proper position (alignment). Stretching
and lengthening the strong, restrictive muscles
and strengthening and tightening the weak,
loose muscle structures with the Flextend /
Restore exercises will allow the affected joint
to align in the functionally correct neutral
position, eliminating the symptoms of the condition.
Other reasonable therapies
that can assist with recovery include non-invasive
methods like massage, physical therapy, chiropractic
and appropriate stretches for the condition.
Read on for further advice
on carpal tunnel syndrome.
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