What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is a condition characterized by tingling, numbness and pain in the hand and fingers (particularly the thumb, index, middle and ring fingers). These symptoms are often the result of median nerve irritation in the wrist or forearm.
A short list of structures to consider as part of a rehabilitation program includes, but is not limited to: the median nerve, scalene muscles, costo-clavicle space, pectoralis minor, biceps brachii muscle, bicipital aponeurosis pronator teres, transverse carpal ligament, anterior interosseous membrane, palmar aponeurosis and lumbricals.
Why Give Massage Therapy A Try?
Massage therapy as a therapeutic intervention is being embraced by the medical community, it is simple to carry out, economical, and has very few side effects. One area that is being explored is the use of massage therapy for patients who suffer from carpal tunnel syndrome.
Randomized clinical trials have demonstrated that for some patients who suffer from carpal tunnel syndrome there is no significant differences in pain and functional outcomes at six and twelve months when surgical and conservative care are tested (Fernández-de-Las Peñas et al. 2015, Fernández-de-Las Peñas et al. 2017).
Why Does Massage Therapy Work?
The responses to massage therapy are complex and multifactorial - physiological and psychological factors interplay in a complex manner. Research has looked at the bioplastic and neuroimmune responses at both the peripheral and central levels elicited by massage therapy treatments.
Massage has a modulatory affect on peripheral and central processes via input from large sensory neurons that prevents the spinal cord from amplifying the nociceptive signal. This anti-nociceptive effect of massage therapy can help ease discomfort in patients who suffer from carpal tunnel syndrome (Bishop et al. 2015, Vigotsky et al. 2015).
The median nerve passes through many structures and it may be exposed to mechanical irritation at many different points (Filius et al. 2017). Prolonged irritation may result in a reduction of intraneural blood flow. In turn, local hypoxia of a peripheral nerve leads to a drop in tissue pH that triggers the release of inflammatory mediators, known as “inflammatory soup”, this noxious substance can disrupt the normal function of nerves (Fisher et al. 2015). Massage therapy may diminish intraneural edema and/or pressure by mobilizing the median nerve as well as associated vascular structures (Boudier-Revéret et al. 2017).
Carpal tunnel specific work may also involve specific soft tissue treatment to optimize the ability of mechanical interfaces to glide relative relative to the median nerve. Ongoing tissue hypoxia or inflammatory responses lead to molecular signaling that promote the development of fibrosis, this may contribute to further peripheral nerve dysfunction (Fisher et al. 2015). The application of appropriate shear force and pressure impart a mechanical stimulus that may attenuate tissue levels of fibrosis and TGF-β1 (Bove et al. 2016).
Infraspinatus Test in Carpal Tunnel Syndrome
The etiology of myofascial triggerpoints are still not well understood, but that does not deny the existence of the clinical phenomenon.
A contemporary view of 'myofascial trigger-points' is presented by Shah, this categorizes 'myofascial trigger-points' by the a number of measurable characteristics: local and remote inflammation, local acidic milieu, local sensitization, local regions of hypoxia, local muscle stiffness (Shah et al. 2015).
Studies have demonstrated that assessing and treating the infraspinatus muscle may be an effective treatment option for a sub-group of patients with suffer from symptoms that present similarly to carpal tunnel syndrome (Meder et al. 2017).
A recent randomized controlled trial in the journal Brain found that acupuncture improved the outcomes for carpal tunnel syndrome by remapping the brain (Maeda et al. 2017).
Systematic reviews have also shown that manual therapy combined with multimodal care can improve symptoms, decrease disability and improve function for patients who suffer from carpal tunnel syndrome (Huisstede et al. 2017, Piper et al. 2016).
The next step for researchers is to look into what sort of dosage and duration would be needed to optimize the effects of this non-pharmacological approach.
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