Massage Matters

Mindful musings on massage, muscles, and moxie

The Knot Whisperer Rides!

The Knot Whisperer Rides!

Friday, December 30, 2016

Avoiding (Carpal) Tunnel Vision

"It's fine for you to explore other options, but if you're not better in six weeks, you should have the surgery or you'll permanently damage the median nerve."

That’s what the hand surgeon told me on after diagnosing me with carpal tunnel in January of 2016.

The words “permanent damage” might make most people agree to surgery for carpal tunnel right on the spot. There are at least a couple of reasons, however, why I was reluctant to jump on the surgery bandwagon.

When I fell off a ladder in September 2015 and sustained a buckle fracture to that same wrist (along with a broken metatarsal in the opposite foot—but that’s another story), I felt no hesitation in undergoing surgery. Not repairing the splinter of bone jutting off my left radius was unthinkable to me, and though I am no fan of surgery, we moved forward quickly to surgically insert a metal plate over the bone. I had really only just recovered from that surgery when I started experiencing numbness in my middle and index fingers and thumb. But after having experienced pretty severe postsurgical pain, weeks of occupational therapy, and six weeks away from work, I was none too eager to have another surgery.

In addition, from my training as a massage therapist, I remembered that a tight muscle in the chest or neck area could cause numbness in those same fingers. I wasn’t convinced, in other words, that I even had carpal tunnel issues.

But neither my internist nor the doctor of osteopathy who I consulted for additional opinions gave much credence to my theory that the numbness might be caused by something other than carpal tunnel syndrome, both of them suggesting that I should have the carpal tunnel surgery—this even after the Tinel’s and Phalen’s sign tests used to help diagnose carpal tunnel were negative. The doctor of osteopathy responded to my lack of pain upon her administration of these tests by saying, “Good—that means it’s not very bad yet.” (What, then, is the point of the tests, I wondered.) She also told me that the numbness I was experiencing couldn’t be due to the tight scalene muscles in my neck because, if that were the cause, I’d have numbness or pain all the way down my arm, which I didn’t.

She speculated that my carpal tunnel was caused by scar tissue in the wrist area from the surgery I’d had the previous autumn. “The surgeon can clean that all out,” she told me. It was only afterward that it occurred to me that if she was right that the scar tissue from surgery had caused my problem, wouldn’t having surgery to clean out the scar tissue only cause more scar tissue?

In short, rather than being more convinced to have the surgery after seeing the doctor of osteopathy, I felt even less inclined to do so. Instead, I kept reading about nerves and carpal tunnel syndrome, trying to learn more, and everything I read made me all the more skeptical that surgery was the right way to go for me.

For one thing, I only had some numbness in my fingers. I had zero pain, no loss of grip strength, no aching in my forearm or elbow, and no stiffness in my fingers—all symptoms of carpal tunnel. I only had the numbness—so why would I undergo surgery, with all of the usual risks that any surgery involves (anesthesia complications, infection, etc.), along with the particular risks of carpal tunnel surgery? The fact of the matter, of course, is that many people undergo carpal tunnel surgery with no complications or problems at all and experience tremendous relief from it.

However, small percentages of people, following surgery for carpal tunnel, do have problems, including damage to the median nerve, scar tissue, permanent weakness in the hand, persistence of the symptoms even after surgery, or a recurrence of the symptoms at some time in the future. Again, the percentages of people suffering such problems are small, but why would I want to take those risks when I had no pain and no loss of function?

Furthermore, the reading I’d done about nerve damage at various reputable medical sites made it clear that nerves regenerate. The caveat is that nerve regeneration doesn’t always mean return of function to the area the nerve serves, though I believe this tends to be a problem more common to instances where the nerve is severed (versus a nerve that is compressed—as is the case with carpal tunnel syndrome). At any rate, the Center for Nerve Injury and Paralysis at Washington University says, “Most often, symptoms that result from compression of a nerve can be reversed, even in long-standing cases.

Still, I wasn’t entirely sure what I should do instead of surgery. Then a friend of friend suggested a chiropractic physician who practices active release technique, or ART. According to the ART website, this technique is “a patented, state of the art soft tissue system/movement-based massage technique that treats problems with muscles, tendons, ligaments, fascia, and nerves.

Dr.Ryan Verchota, who practices in Chicago, was the first medical professional I talked to who didn’t think I needed surgery, as well as the first to give credence to my suspicion that my chronically tight neck muscles might be involved in the numbness I was experiencing in my fingers. He proposed a treatment plan that would address what he diagnosed as a “double crush,” which is to say, pressure on the nerve at both the carpal tunnel and the neck muscles. Dr. Verchota informed me that the pressure at more than one site along a nerve’s pathway can be additive. Pressure at one site alone may not cause any symptoms yet compression at more than one site simultaneously can “add up” and cause the presenting symptoms of carpal tunnel syndrome. When I disclosed that I’d been told by one doctor that the neck muscles couldn’t be involved as I didn’t have symptoms of pain and/or numbness the entire length of my arm, he discounted that assessment, saying that it was indeed possible for an impingement on the nerve at the neck or shoulder to be experienced only in the fingers.

I also learned from Dr. Verchota that there is a difference between carpal tunnel syndrome and carpal tunnellike symptoms, both of which may present with the exact same symptoms of pain and/or numbness. In the case of carpal tunnel syndrome, however, there is direct pressure and nerve entrapment in the wrist, whereas carpal tunnellike symptoms can be due to pressure on the median nerve anywhere from the neck down to the fingers. Clearly, therefore, it is important that a practitioner be able to differentiate one from the other in order to offer the treatment options best suited for the individual. 

Dr. Verchota used a few hands-on techniques in his treatment, including ART on my neck, shoulders, forearm, and hand. Essentially, he would find a tight spot in one of those muscles, press on it with his thumb, and then either move or have me move the muscle away from the point of pressure he was applying. A technique called nerve flossing was used in conjunction with the ART. Nerve flossing is a procedure that promotes sliding and gliding of a nerve through all of the tissues in the body along its pathway. In this case, the median nerve was stretched and moved through the neck, shoulder, forearm, wrist, and fingers—all likely places for a double crush to occur.

He also used the Graston technique on my surgical scar, as well as on the area above the scar. Graston technique involves dragging specially designed stainless steel tools along areas where there is scar tissue or other types of muscle adhesions. I also began wearing, at night, a wrist brace that holds the wrist in a neutral position and so prevents the nerve from being further compressed—figuring that anything that might help was worth trying.

Now, breaking up scar tissue is one of the things that massage can do, and while I had massaged the area along and around the scar during occupational therapy, I had ceased doing so once that therapy was over, mistakenly assuming I was “cured.” While the end of my scar closest to my wrist seemed to be hard and dense, I thought I was just feeling the metal plate.

Dr. Verchota’s work made me realize I could and should be continuing to take an active role in my own healing process. I began doing myofascial work with my thumb along the scar—that is, pressing my thumb firmly against the skin and moving the thumb toward my wrist, creating a sensation of gently pulling on the skin and on the “sticky” spots (i.e., the adhered tissue) just below the surface.
Soon, though, it became apparent that I was also pulling the skin of my thumb away from the nail! Dr. Verchota suggested that I could probably do much the same work with a gua sha tool, available relatively inexpensively online. Gua sha, a traditional Chinese medical treatment, and Graston technique both involve scraping the skin with a tool. Their intentions and techniques are, however, different. For one thing, gua sha is ued to improve blood circulation, while Graston technique is used to break up adhesions in the muscle and promote mobilization of fascia (connective tissue). A 2014 review of research presented in the Journal of MultidisciplinaryHealthcare discusses evidence of a correlation between freely moving fascia and reduction in pain and symptomology, which opens up promising possibilities for treatment.

I am not trained as a practitioner in either gua sha or the Graston technique, however, and so am no expert. My suspicion, though, is that, once I had purchased my inexpensive jade gua sha tool, I was using it more like a Graston tool and as a substitute for the pressure of my thumb, rather than as a tool for improving blood circulation. For maybe a minute a day, I gently but firmly pressed and dragged the tool along the scar. More than that would likely have only increased the inflammation in that area. And my intent was only to make sure the scar tissue received a little attention every day, between my weekly appointments with Dr. Verchota.

For the first month or so, I noticed almost no difference in the numbness in my fingers—though my neck muscles were feeling better than they had in months. I questioned whether I had made the right decision: maybe I should have the surgery? But Dr. Verchota counseled patience. He firmly believed the work we were doing would eventually produce results.

And then, very slowly, I began to notice the numbness receding from my thumb and index finger. Eventually, the numbness was growing noticeably less in my middle finger as well, the first place I’d felt the numbness and where the numbness was most pronounced. And finally, after three or four months of Dr. Verchota’s treatments, the wrist brace, and my own work on my wrist, there was no numbness in my fingers.

I don’t know whether any of these three things alone would have done the trick or whether it was their combination that eliminated my numbness. And I can’t know for sure whether it was only scar tissue from my wrist surgery that had caused the problem or whether my tight neck muscles were also a contributing factor.

What I do know is that it was worth it to me to investigate other avenues for resolving the problem before pursuing something as invasive as surgery, with all of its inherent risks. The route I took to get out of my carpal tunnel problem cost less money, caused less harm, provided me an opportunity to learn more about the human body in general and my own body in particular, validated my belief in the efficacy of alternative and complementary medicines, and afforded me a personalized and rewarding relationship with a medicial professional whose raison d’ĂȘtre is not about finding the quickest fix or the one fix that fits all.

I have nothing against surgery per se—witness, for example, my readiness to go that route when my radius was splintered. But I do think it’s important to do your research first and not just accept that surgery is the only solution. Not everyone experiencing one or more symptoms of carpal tunnel syndrome would necessarily find relief following the route I did. But that doesn’t mean there isn’t another nonsurgical route that might be just right for them.