When is Carpal Tunnel Not Carpal Tunnel?

[Music] [Music] all righty it's good to be here as a Friday afternoon and hopefully you're all getting close to being ready for a weekend here it's gonna be nice and sunny in the 70s I think so that's not very cool wherever you are in the world it might be a little bit different I mean this weekend we've got the rocket city adventure race on which is gonna be good fun on Sunday money's been raised for girls on the run North Alabama so that's something we've got to look forward to but what I want to cover today is a little bit about carpal tunnel and some sort of things that I've seen in my career and I saw yesterday something that's happened more than one occasion so people assume he got some pain kind of in the wrist going into the hand maybe some numbness that is carpal tunnel and or in fact some people just assume pain around the hand that's kind of more widespread is carpal tunnel but this may not always be the case and you know we can do a test a very simple test which we call a ten ELLs test where we tap over the carpal tunnel here and we can tap tap tap tap tap and try and reproduce somewhat numbness if the nerve is sensitized through there and that's all well and good but that doesn't always guarantee that that's the problem and there are investigations that they can do where they're looking at the the nerve conduction through the carpal tunnel to see is there any interruption that is a one way of showing it better but even then still just because it's relatively positive it doesn't mean that doing say a surgical carpal tunnel release is gonna give someone the relief that they want and so I've seen people before who've come in who've had surgery for their carpal tunnel and haven't gone relief I've seen someone hit me past who had shoulder surgery and they had mentioned about having some hand symptoms they were told I wish this carpal tunnel weekend when we do the shoulder surgery will release your carpal tunnel at the same time and they didn't get any relief from either they actually still have problems and as we go through this little Facebook live today you're going to kind of find out why that might be the case well this is backtrack a second and you might be listening to this even now or after the fact and thinking okay what is the carpal tunnel so what I'm gonna do switch screens here we're gonna do a screen share and I'm gonna switch to this hopefully you can see my screen here and what I'm gonna show you is what the carpal tunnel is like on that so you're looking at a hand we're looking here is the thumb let me see if it lets me click on one and try click on there we go so here's the thumb and here is the little pinky finger and then here is what we call the transverse carpal ligament and this basically forms the base of the carpal tunnel so then you can see several muscles up here that have tendons they see those yellow tendons there there's another hero tenth tendon there that make up some of the structures that go in the carpal tunnel and then here you see the median nerve so this basically is the structure that usually gives people a lot of discomfort within carpal tunnel pain so when I'm doing that tee nails test where I'm tapping I'll show you you open you can see that in the corner screen when I'm tapping over here we could work ten ailes tests and we maybe get some numbness develop in the in the hand that's suggesting that there is a sensitivity of that median nerve so when something when there's inflammation let's say inflammation of these tendons these flexor tendon flexor digitorum profundus basically that's a long name for one of the muscle groups and tendons that flex the the four thing is not the thumb but when that tendon becomes maybe inflamed it becomes enlarged you can get a reduction in space within that carpal tunnel I'm gonna just draw a little circle here around the carpal tunnel so you can kind of see it's that through there so those tendons are all passing through the passing through the carpal tunnel so those tendons are inflamed enlarged you can get a pressure occurring on the on the median nerve let's see we'll get back out of that toolbox so there's your median nerve again so those tenders next to it when they become enlarged either these ones here this one here they can cause prey to occur on their median nerve so that's the traditional carpal tunnel and we see it happen more more for pregnant women because there's more fluid on board so there's typically less space so women tend to have more problems with carpal tackle another condition that they have is it's called de Quervain which is a an issue involving the thumb because the tendons run within sheaves actually this is a tendon sheath of one of the muscles that's involved in de coeur missouri I just highlighted green so yes I went pregnant women tend to have more carpal tunnel problems than other people people who do exercises or hobbies or work where they're doing a lot of finger flexion and maybe they're overusing these these tendons here they tend to have more of a chance of developing carpal tunnel but you know the title of the the face book live today was when is carpal tunnel stand not carpal tunnel so we're talking about the median being the problem while the median nerve isn't just here at the head I mean you can see as it goes off the top right of my screen that it goes somewhere else I'm gonna go to a different tab it may take a second to get where we want it to but here's where the median nerve goes you can see the purple median nerve going all the way up to the shoulder and then basically is actually four nerve roots five nerve roots here that from the neck that make up the median nerve so it's not just only say the median nerve yes it's one structure as it gets down here the wrist but it's actually made up of nerve roots from five places in the neck if we go to this next screen you'll be able to see how the nerves come out of the neck so if I move the model around a little bit you'll see how there's space a little space we call the foramen where the nerve roots come out of and you can see here discs for example those discs they can bulge they can herniate create creating less space we can see these joints here there's no green join here I've circled not a circle II here so we've got the facet joint of the spine that facet joint can become arthritic he can become enlarged and that can can cause some some problems but basically when you have something that's not that mean to draw there when you have something going on at the nerve root level here be a disc bulge be a disc herniation bit some enlargement of the the facet joints may be some our ferritic changes or even just inflammation around that nerve root you can get symptoms that mimic carpal tunnel and I'm gonna switch back off of screenshare to to me so you get to where you are what's my sprain here we go so basically we can get carpal tunnel like symptoms that are actually coming from the neck and they'll still produce a positive 10 hours sign where we tap when we get numbness in the hand is the nerve is sensitized it's just sense of this that the problem is coming from up here so this person I saw the other day they thought that they had carpal tunnel in both hands they actually incidentally did have actually a thumb pain which I mentioned early de Quervain syndrome and that was actually their main main problem but they had numbness that they develop occasionally as I talk to them more as you become a parent that they had neck pain as well and so as I'm looking at the one thing okay this doesn't just sound like carpal tunnel the facts on both hands yes they have a repetitive hobbies and repetitive job where they using their hands loss those carpal tunnel could be the case but they also had neck pain and so I did tests on them and basically I tested him by a horse burnings test where you take him into extension and you turn and you bend him to sight now I pushed down and basically that's loading up the back of the neck here and it's pinching down the vertebrae it's pinching down on nerve roots and when I took him out of that test he was left with ten developing in his hands and basically if it was just pure carpal tunnel here you wouldn't expect the neck to reproduce there so basically it made me think okay what he thinks is carpal tunnel in both hands is likely actually coming from the neck so I did this Sperling's test on the other side extended rotated SIA bended and pushed down and he also got the same thing happened in the other hands well okay how do we test this further so I took him and I can't lay down there on it on the table on the treatment table I put a little towel row under his neck and I did a very simple little exercise where he just nodded and tucked so he's laying down if I go to the side here if I have a towel that's rolled up here as a pivot point and I am gently nodding and tucking I'm relatively flexing my neck where is the test that reproduced the discomfort reproduced a numbness extended and closed everything down this little exercise of nodding and tucking opened stuff up it opened up space around the nerve root well having created numbness we did the exercise and the numbness went away I didn't do anything to the hand and the wrist there was nothing I did to try and affect the carpal tunnel instead what I did was I did something to the neck and all of a sudden the tingling went away so I could basically create his pain with extension and compressive positions but I could then take his pain away with something of a gentle flexion so let's say that person that attended in an office of a physical therapist or an orthopedist and they had been just the focus of the examination had been the hand and it hadn't taken a step back and looked more globally they may have been treated for carpal tunnel they may have been able to reduce some of the sensitivity locally around the median nerve but I don't think that that would necessarily have fixed this person's problem and I've seen like I say at the beginning the video I've seen plenty of people over the years who've had carpal tunnel release surgery and haven't felt better from it and it's probably because it really wasn't carpal tunnel in the first place it was actually probably something that was originating from the neck interesting it I'm a person there and their thumb pain that they thought was carpal tunnel that was the way for the main problem was was not it was something called de Quervain's tenosynovitis which basically i make a thumb in my in my house here yes right so my thumb put it inside my grip and I pushed go down like this it's called a thing called Stein's test it was a sudden it created pain across the top of his thumb and it was pretty positive for that and that again was kind of an overused type injury like a carpal tunnel a true carpal tunnel would be so this person actually had two things one was a local hand problem this de Quervain's and the other was numbness occurring in the hand but that was actually coming more from the neck and one of the guess that what the hint of that was the fact that as I asked him more questions I don't know where my videos gone green that's weird let's go off of that and come back strange there was this green your anyway the the telltale of why of what of what was going on was that he had some neck pain he reported some neck pain along with his carpal tunnel type sim symptoms so anyway I honestly do not know why in my video has gone green that's very very strange so carpal tunnel isn't always carpal tunnel there are other things that can masquerade and that's the same in other other things within our and within our body we see different things masquerade but carpal tunnel could be actually more of a neck problem and not actually a real carpal tunnel so in this case it was very simple to differentiate that and hopefully we can take this person and help them to get better from it and to where it actually doesn't come back and and continue to bother them let's see does anyone have any questions who's still online I said I don't know why at my camera has gone green I don't know if it's green on your end as well it's very strange anyone have any questions about carpal tunnel or neck pain like I say this person they had what they thought was carpal tunnel and he actually was neck pain and this is not an uncommon thing for me to see I don't know why my camera is green right now this is green my end of its green your end you can tell me or you can ignore it but do you have any questions about carpal tunnel or neck pain or anything else I'll be happy to answer them right now while I am on screen all righty well if you have quickly what's this video after the fact and you have questions you're always welcome to message me and message me on Facebook message me via email or drop me a call I will be happy to chat so I'm gonna sign out and you'll have a good weekend [Music]

Channel: PhysioWorks, Sports and Wellness, Inc

Views: 10,439

Keywords: Huntsville, Huntsville alabama, Madison, Madison Alabama, physical therapy, physical therapy huntsville, physical therapy huntsville al, physiotherapy huntsville, physiotherapy huntsville al, sports injury, sports injury huntsville, orthopedics huntsville, carpal tunnel, carpal tunnel Huntsville, Neck Pain, radiculopathy, neck pain huntsville, radiculopathy huntsville

Id: aNVIKMCJDOs

Length: 16min 24sec (984 seconds)

Published: Tue Nov 06 2018