October 24, 2011

Where is all the Carpal?

So, going on my 16th year in massage therapy, I have to ask: Has anyone out there in practice-land ever seen a real case of carpal tunnel syndrome?

Please, I wish to be enlightened. I’ve been beating the flexors for years, and this condition seems as elusive as Sasquatch. Every time I think I see a CTS coming in, I find something else entirely. Not that I’m complaining, it just seems with so much CTS surgery out there, I should have, by this time, seen at least one.

What do I find? Well, most of it is on the TRP charts by Travell & Simons, but enough is different I’ll run it by you.

Mostly, I find screaming, adhesed flexors. Flexors so stressed from computer work, driving and video games that they feel like steel bedsprings in wet cement. And heck, wringing them out with some myo-fascial release combined with pronation and supination seems to open them up. Then they seem to respond to active stretching while under compression. Then 20 minutes of ice. Overnight, some sporty stretch tape helps draw lymph from the flexors up through the elbow. Does this work for other massage therapists?

Then I track down parasthesia. For funny feelings on the back of the hand, I flush triceps up into the armpit, followed by Trigger Point Release and Passive Range of Motion. The ants-on-the-hand seems to clear up as soon as I do the TRP.

For the rubber-band around the wrist feeling, I go for massive TRPs in the infraspinatus and teres-ses.

Definitely sideline and definitely slow and easy with lots of Swedish warm-up. I swear the back of the arm rotator TRPs are like Roman Candles.

For the stigmata feeling in the center of the palm, I look to the subscapularis. But on most adults it might take two or three sessions of sideline Swedish and light probing to get near it without killing the client. Once I can get my pinkies in there, I’ll go for light TRP compression. If they are excited by the results, I’ll venture into soft, slow range of motion.

Latissimus, egad, seem to do the last three fingers, while pectoris major does the first three. If I can get permission to get near the pec. minor with just the lightest, touch, it works just dandy in opening the entire thoracic outlet.

Massage for the scalenes, of course, eliminates distal finger tingles.

Now looking back at that list, where exactly is the need to rub the carpal tunnel? Heck, I am a massage therapist, so I always rub them anyways. But come on; is there any real carpal out there?


Unknown said...

Great list, I also find the omohyoid to be spastic causing pain in the anterior shoulder brachioradialis
and paraesthesia in the lateral tip of the forefinger.

Anonymous said...

Dear Unknown: Trippy good tip! I'm running to my ref books now! I know there are more stealth TRPs out there...let's round 'em up! hugs, Sue Peterson