Carpal tunnel syndrome is a wrist and hand pain syndrome which may, in select instances, come from purely structural narrowing of the canal which houses the median nerve. However, there are also other more logical anatomical explanations for some cases, as well as the possibility of a purely psychologically induced pain syndrome being responsible for enacting the pain.
Medical science considers this a mostly idiopathic condition, which is no surprise since most cases do not actually involve any neurological compression at all. Many theories have been proposed regarding the nature and mechanism of carpal tunnel nerve impingement, but doctors can not seem to agree on an exact universal causation of CTS symptoms when classic structural issues are absent.
This dialog explores the alternative possible explanations for carpal tunnel expressions related to anatomical or mindbody causes.
The carpal tunnel is an area in the wrist through which the 9 flexor tendons and the medial nerve pass. In CTS, the theory is that the nerve somehow gets compressed by a narrowing of this canal. Most patients do not demonstrate any verifiable compression, although the median nerve may indeed be proven as being involved in the painful expression.
Doctors will typically diagnose CTS despite no evidence of compression, based on symptoms alone. This is a huge mistake, as other structural and nonstructural conditions can cause the exact same discomfort even though the causative processes are different.
CTS is another recently popularized diagnosis that was almost unheard of just a few decades ago. Now, the condition has become a full blown epidemic, as well as one of the more profitable pain syndromes to treat. This might help explain the ever increasing incidence of diagnosis.
Numbness, tingling and pain in the hand and wrist are the most common symptoms of CTS. These symptoms are often worse when moving the hand and may be especially bad when the wrist is bent at a severe angle. Many patients find pain worse at night, since they can not control their hand position when trying to sleep.
Some patients also report other neurological symptoms, such as weakness, numbness or tingling in the hand or fingers upon movement or simply all the time. It is possible for a person with severe CTS symptoms to lose function in the hand or individual fingers, although this is rare.
The usual treatment routine for the CTS diagnosis follows a progressive path, with ever more drastic approaches being utilized if conservative measures fail:
OTC medication and use of an orthotic wrist brace are usually the first steps in CTS therapy.
Physical therapy and prescription pain management drugs will be given if symptoms continue or escalate.
Surgery is reserved for severe cases where symptoms prevent normal functionality. Carpal tunnel releases are invasive procedures that demonstrate only acceptable results for pain relief. There are many doctors who might push a patient into surgery early in the treatment process. The operation is simple to perform and profitable, so many doctors have created a real niche performing specialized CTS surgery.
It is unfortunate that CTS is rarely actually caused by a physical restriction in the carpal tunnel. Therefore, treatment is often unsuccessful or creates the opportunity for substitute symptoms to occur.
A great number of patients do find relief from surgery short term, but suffer a relapse of pain in the same location, in the other wrist, or a related location soon after. This is a good indicator of a symptom imperative at work in the subconscious mind.
Some cases of CTS are caused by a purely psychological process. The real causative process in most of these instances is oxygen deprivation of the wrist tendons and/or medial nerve.
This condition is clinically identical to traditional CTS, but is almost never recognized as stemming from a mindbody source. This helps explain why so many carpal tunnel treatments do not resolve pain long-term. The expression in the wrist was simply part of a larger psychoemotional syndrome, so treatment could only be effective through placebo effect. Eventually, pain returns.
Knowledge therapy has worked wonders for some CTS patients, establishing a definite link between painful symptoms and unresolved emotional issues. Being that the patients can change their perception of the source of pain from physical to emotional, recurrent pain syndromes are rare in patients cured through this particular path of treatment.
We have heard all sorts of nonsense when it comes to CTS. Some doctors blame the epidemic on the boom in computer usage. We think these doctors have never heard of a typewriter. People were typing in office pools for 12 hours straight and there was no CTS to be diagnosed or treated.
Other doctors blame assembly-type work or any other activity involving extensive manipulation of the hands and wrists. People have been working with their hands for millions of years. Why would this tiny area suddenly become such a problem?
The reality of carpal tunnel syndrome is that it is one of the in vogue pain syndromes of our time. It is also ridiculously easy for doctors to use this condition to milk the insurance system. This might be one of the reasons for the common nocebo effect given to patients from a scary sounding diagnosis.
I used to have some horrible tendonitis as a pre-teen and teen. It was always in my wrists and hands. I play drums and attributed the pain to that activity. It made sense at the time. This is before the popularization of the CTS diagnosis. Who knows what type of nightmarish treatment I may have endured had I complained about this pain syndrome today?
Well, my wrist tendonitis eventually disappeared. I was about 16 when it finally ended. My doctor thought that my wrists “finally developed enough strength to keep drumming without pain.” That’s funny, since I had been playing hours a day for 12 years already!
What’s even funnier was that the same year my tendonitis ended, my back pain began. This is obviously a classic case of symptom substitution and escalation based upon the increased need to create a more effective distraction for my repressed emotional issues.
Looking back, my CTS-type symptoms were one of the precursor conditions for my decades long struggle with back pain. It just proves that some patients are prone to many forms of psychogenic pain and the mind will often escalate the pain until it has achieved the desired goal of controlling a person’s conscious thoughts. For me, it controlled (and almost ruined) my life.