There are, however, 18 other possible entrapment sites of the median nerve, the most common of which is at the pronator teres muscle in your forearm which, when contracted, turns the palm down. As I type this article, my pronator teres muscles are under constant, low grade contraction, thereby placing a mild but constant pressure on my median nerve. How many of us type for hours a day? How many of us drive our cars or operate machinery where our hands are palm down? With this in mind, it is easy to comprehend why this median nerve entrapment, called Pronator Teres Syndrome (PTS) is actually much more common than CTS.
So how do you know when you have CTS versus all the other median nerve entrapments in the body, including PTS? It comes down to where you feel the symptoms. The median nerve sprouts from the spinal cord in the neck, travels down the arm, and before entering the carpal tunnel, splits into two branches. One branch passes through the carpal tunnel and supplies sensation to the thumb, index, middle and neighbouring half of the ring finger. The other branch passes over the carpal tunnel and supplies sensation to the palm of the hand. Therefore, if you have loss of sensation (pins and needles, numbness or tingling) in the fingers mentioned, but in not the palm of the hand, it is likely you have a case of true CTS. If you have loss of sensation in these fingers, as well as the palm of the hand, then the nerve is pinched prior to entering the carpal tunnel and further testing by a chiropractor or related professional is required to gain a definitive diagnosis.
Proper diagnosis is essential to ensure effective, efficient treatment. Treatment to the wrist, if the nerve is pinched at the elbow or neck, is not going to work. Incorrect diagnosis is one reason why surgery is often not curative. Another reason is that the surgery entails cutting of the skin and fascia to allow removal of scar tissue from the carpal ligament, but in doing so more scar tissue is formed as the body heals from the cutting. In an area that is already anatomically crammed, the scar tissue from the surgery is enough to continue to compress the nerve, even after the original scar tissue has been removed from the ligament.
A safer, more conservative form of treatment that has been shown to be highly effective at treating carpal tunnel syndrome and related nerve entrapments is Active Release Techniques (ART®). ART® is a hands-on treatment that targets scar tissue deposited on soft tissues placed under repetitive strain. When a muscle (eg. pronator teres) is held in a contracted position, it leads to decreased blood flow and hypoxia (decreased oxygen) in the muscle, and the body eventually forms thick fibrous tissue, called scar tissue, along the muscle fibres. If adhesions contact the nerve, you feel numbness, tingling and pins and needles. ART®, in conjunction with other modalities, such as cold laser therapy, ergonomic changes and proper exercises, can safely and effectively cure CTS, PTS and other nerve entrapments.
Dr. Erin Kempt- Sutherland is a Chiropractor and owner of Choice Chiropractic & Integrated Health Centre. To learn more about healthy choices for your body, visit