Muscle Medicine: The Revolutionary Approach to Maintaining, Strengthening, and Repairing Your Muscles and Joints (25 page)

DR. JENNIFER SOLOMON ON CARPAL TUNNEL SYNDROME

Carpal tunnel syndrome is overdiagnosed. I have patients coming in—a lot of secretaries— and they have numbness and tingling in the fingers. They’re convinced they need carpal tunnel surgery. I do a nerve conduction study that measures how fast the nerve signal travels down the median nerve, and the results are normal. I send them to Rob and he works to release the pronator teres muscle, and their symptoms dramatically improve. Of course, sometimes the transverse carpal tunnel really is compressing the nerve, or there is a problem within the tunnel. Then they are surgical candidates. But surgery always has risks—scarring, infection, nerve or muscle damage. Some hand specialists do really well with these patients using wrists splints and a corticosteroid injection.

nective tissue is in its supple prime, and she had a relatively short history of repetitive stress. So it wasn’t surprising that the joint structure was only mildly damaged. We could solve her problem by addressing the tight muscles that were irritating the tendons and the muscle compressing the median nerve. (The muscle had become overstressed by Julie’s tendency to twist her left arm inward when she typed.) Martha, on the other hand, had everything working against her. When the connection between nerve and muscle is that frayed, surgery is the usual solution. Without it, nerve fibers can die, leaving muscles permanently disabled.

Other patients require a different selection of “tools” from the “toolbox.” Often, bad work habits and bad keyboard/mouse ergonomics need to be corrected (see the Self-Defense box on page 131). Wrist splints and braces used to be a popular way to try to take pressure off the carpal tunnel area. We, and most experts in the field, now agree that immobilizing the arm muscles at work all day is a bad idea. However, wearing splints to bed can work well for patients whose wrists naturally assume a stressful, flexed position.

Ulnar Nerve Entrapment/Cubital Tunnel Syndrome

Everyone has had the experience of banging their funny bone on the inside of the elbow. Not very funny at all. The ulnar nerve, which passes by the elbow close to the surface of the skin, triggers all that pain and tingling. The ulnar nerve is one of three major nerves that pass down the arm and through the wrist. Like the median nerve getting trapped in the carpal tunnel, the ulnar nerve can get compressed in a tunnel in the hand called the tunnel of Guyon. But it’s more likely to run into problems at the elbow by getting squeezed into a groove in the funny bone (ulna) known as the cubital tunnel, which can cause tingling and numbness in the fourth and little fingers. A very successful surgical procedure can reposition the ulnar nerve away from the cubital tunnel, but manual therapy to release tight muscles up and down the arm can often help resolve the problem. Often, a bottleneck at the joint is not the crux of the problem. The ulnar nerve can be compressed by tight muscles at a number of spots on the arm, but a commonly overlooked area is in the shoulder region at the subscapularis, where the nerve originates (as the medial cord of the brachial plexus).

Joint/Orthopedic

Sprained Wrist

A sprained wrist is the most common wrist injury and is often serious. We see it in elderly patients who try to break a fall with their outstretched arms and in athletes, who usually have some help being driven to the ground. Ligaments on either side of the wrist can sprain, and the area becomes tender and painful. A wrist splint or plaster cast may be necessary, and a severe ligament tear may require surgery.

Wrist Fracture

Without an X-ray, it’s often difficult to tell whether you’ve sprained a ligament or suffered a fracture of the ulna or radius bone in the forearm or the scaphoid bone of the wrist. The scaphoid fracture is more common and more serious. It may require a splint or a cast, and because the scaphoid-bone area has such a poor blood supply, surgical repair is a possible worst-case scenario. Women and seniors of both sexes should get a bone-density test if they’ve been diagnosed with a wrist fracture. Bone thinning, or osteoporosis, could be the underlying problem.

ELBOW/WRIST/HAND

The motions at the wrist are flexion, extension, adduction, and abduction (bend forward, bend back, bend to the pinkie side, and bend to the thumb side), as well as circumduction. The movements at the elbow are simple flexion and extension.

ANTERIOR (PALM SIDE) OF THE FOREARM

Purpose:
To target and remove any restrictions and restore a full range of motion to the three zones of the flexor group by manually releasing tight, short, and damaged muscles. This is a great treatment for anyone who does repetitive movements with their hands or arms: from tennis to carpentry to computing.

Starting out:
Sit on a stability ball or chair with your feet spread shoulders’ width apart. Your palm should be facing up and flexed so that the fingers point toward the ceiling. Use the hand opposite to the treatment side and place the thumb, fingertips, or a ball or stick on the muscle, with pressure angled in and up toward the elbow. The three treatment zones are the inside, middle, and outside aspects of the flexor group. Use whatever hand position works best for you.

How to do it:
Once contact is made, bring the back of the hand toward the floor until the fingers are angled toward the floor, then straighten the elbow. Keep the motion slow and controlled. Repeat with your other arm. Do two to three passes in each zone, starting each zone closer to the wrist and working toward the elbow. To generate more pressure, you can use a golf or tennis ball.

Troubleshooting:
The muscle should be relaxed when the pressure is applied. Don’t press too hard as it can irritate the muscles. Avoid letting the skin slide under the fingers by using constant, angled pressure. Be sure to extend both the wrist and elbow for a complete stretch—some of these muscles cross both joints.

POSTERIOR (KNUCKLE SIDE) OF THE FOREARM

Purpose:
To target and remove any restrictions and restore a full range of motion to the three zones of the extensor group by manually releasing tight, short, and damaged muscles.

Starting out:
Sit on a stability ball or chair with your feet spread shoulders’ width apart. The back of your hand should be facing up and extended so that the fingers point toward the ceiling. Use the hand opposite to the treatment side and place the thumb, fingers, or edge of the hand (the karate-chop side) on the muscle. Apply angled pressure toward the elbow. The three treatment zones are the top, middle, and bottom aspects of the extensor group. Use whatever treatment position works best for you.

How to do it:
Once contact is made, bring the palm of the treatment hand toward the floor, until the fingers are angled toward the floor. Keep the motion slow and controlled. Then extend the elbow so that the arm is straight. Repeat with your other arm. Do two to three passes in each zone, starting each zone closer to the elbow and working toward the wrist.

Troubleshooting:
The muscles should be relaxed when the pressure is first applied. Don’t press too hard as this can irritate the muscles. Avoid letting the skin slide under the fingers by using constant, angled pressure. Be sure to extend both the wrist and elbow for a complete stretch—some of the muscles cross both joints. When extending the elbow, it may be easier to use the fingers of the treatment hand instead of the thumb.