What causes carpal tunnel syndrome to develop? Although there are many professional opinions out there regarding the subject, most do not provide an accurate description of how carpal tunnel syndrome actually occurs.

What is agreed upon is the fact that the flexor tendons and median nerve are operating in a much smaller space than they were prior to the onset of symptoms. Many professionals state that it is the swelling of the involved tissues that is diminishing the space and others say that is caused by a muscle imbalance between the flexor and extensor muscles that is causing the carpal bones to shift into the carpal tunnel, making the carpal tunnel much smaller.

After much research, my opinion is that the swelling is a “secondary effect” of the nine flexor tendons and median nerve having to glide through the carpal tunnel which has decreased in size due to a muscle imbalance*.

How does the carpal tunnel decrease in size? The carpal tunnel decreases in size because the flexor muscles that ‘close' the hands are exercised on a daily basis with virtually every activity we perform, and they become stronger, shorter and tighter than the extensor muscles that ‘open' the hands, thus causing the carpal bones to shift inward, collapsing the carpal tunnel and making it smaller. As the tendons and median nerve slide back and forth in the much smaller space, friction between the tissues occurs.

What does friction in the carpal tunnel cause? Friction between flexor tendons and median nerve within the carpal tunnel causes inflammation and swelling, which puts pressure on the median nerve, resulting in carpal tunnel syndrome. This is the reason that surgeons sever the carpal ligament, making more room for the flexor tendons and median nerve to move around in. If the carpal tunnel is returned back to its original size, prior to onset of symptoms, the friction and swelling is eliminated and the symptoms disappear.

Continually performing repetitive wrist and finger flexion while symptoms are already present will ultimately aggravate the existing condition even more and lead to possible irreversible damage of the flexor tendons, blood vessels and median nerve within the carpal tunnel.

How can carpal tunnel syndrome be eliminated? By stretching and lengthening the overly restrictive flexor muscles that ‘close' the hands and strengthening and shortening the extensor muscles that ‘open' the hands, the carpal tunnel can return to its normal size, decreasing impingement of the tendons and median nerve, which also eliminates friction and causes the carpal tunnel symptoms to disappear.

Now is the time to take the steps to prevent carpal tunnel syndrome or rehabilitate an existing injury by starting a stretch / exercise program for your hands. Speak with your doctor or contact a certified therapist today to implement a good stretch and exercise program to keep you strong, healthy and injury-free!

*REFERENCE MATERIALS:

"If certain muscle groups are underused, opposing muscle groups will be overused. Muscles in either a lengthened or shortened position will be at a mechanical disadvantage and weak. The overused group will hypertrophy, and the underused group will continue to be weak. This combination produces a self perpetuating condition that maintains the abnormal posture and muscle imbalance." Philip E. Higgs, M.D. and Susan E. Mackinnon, M.D. Department of Surgery, Washington University School of Medicine, St. Louis, Missouri. Annu. Rev. Med. 1995. 46:1-16

"Muscle balance must be restored with specific exercises. Otherwise, the already strong and overused muscles get stronger, and the weak and underused muscles remain weak. Individuals get good at using the overused muscles and must be trained specifically to recruit and strengthen the weak underused muscles." Philip E. Higgs, M.D. and Susan E. Mackinnon, M.D. Department of Surgery, Washington University School of Medicine, St. Louis, Missouri. Annu. Rev. Med. 1995. 46:1-16

"All of the extrinsic hand muscles become involved in a power grip, in proportion to the strength of the grip."........ "Strong agonist-antagonist interactions are needed between the flexors and extensors of the hand and fingers to produce forceful hand-grip. Powerful flexion of the distal phalanges requires strong activity also of the finger extensors." Janet G. Travell, M.D. and David G. Simons, M.D. Myofascial Pain and Dysfunction-The Trigger Point Manual. Volume1 Upper Extremities, Ch:35, pg. 501. Copyright 1983.

Jeff Anliker, LMT, is a Therapist and Inventor of Therapeutic Exercise Products that are utilized by Corporations, Consumers and Medical Facilities around the world for the prevention and rehabilitation of repetitive strain injuries. repetitive-strain.com

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