We often think of Dry Needling therapy as targeting muscle trigger points in taut bands. But what about Dry Needling therapy for conditions that are indirectly caused by muscle tension?
One of these conditions is Carpal Tunnel Syndrome. As part of our Dry Needling Advanced course we’ll be covering how to treat this common condition using Dry Needling therapy.
Carpal tunnel syndrome is a condition that affects the median nerve. Many authors suggest that the nerve is compressed at the wrist. However, in my experience this is not the only area that it may be compressed.
Due to the course of this important nerve that supplies sensation to the skin of the palmar side of the thumb, the index and middle finger, half the ring finger, and the nail bed of these fingers, it can easily & commonly be compressed as it passes through the forearm.
The lateral part of the palm is supplied by the palmar cutaneous branch of the median nerve, which leaves the nerve proximal to the wrist creases. This palmar cutaneous branch travels in a separate fascial groove adjacent to the flexor carpi radialis and then superficial to the flexor retinaculum. It is therefore spared in carpal tunnel syndrome.
The ulnar nerve (palmar & dorsal cutaneous branches) supplies the sensation to the skin on the medial or ulnar side of the hand including the little finger and the ulnar side of the ring finger.
Carpal Tunnel – an alternative mechanism of injury
If we undertake to accept the established aetiology that mechanical compression of a nerve through a small tunnel may cause paresthesia, which of course is implicit in the recognised explanation of carpal tunnel syndrome, we should be equally accepting of the possibility that tension in the flexors of the hand & wrist may also cause compression of neural structures within the forearm.
This mechanism of compression would explain why many patients who are diagnosed with carpal tunnel syndrome also complain of paresthesia in areas not affected by the median nerve as it passes through the carpal tunnel.
Although carpal tunnel syndrome is characterised by compression of the median nerve at the wrist, it may also become compressed along its course within the forearm due to excess loading of the flexors of the wrist and fingers as well as pronator teres, resulting in subsequent muscle tension. This is quite possible as many of the forearm flexor muscles are vulnerable to increased tension due to overuse.
It is also quite feasible that the ulnar nerve may also be compressed along its course deep to the flexor carpi ulnaris and therefore give rise to cutaneous paresthesia over the ulnar distribution of the hand & ulnar side fingers.
The following muscles are strongly associated with carpal tunnel syndrome:
- Pronator Teres
- Flexor digitorum superficiailis
- Flexor digitorum profundus
- Flexor carpi ulnaris
- Flexor pollicis longus
Dry needling therapy targeting trigger point zones within these muscles may be helpful in the treatment of carpal tunnel syndrome.
Unlike the treatment aimed at specific trigger point zones to affect their particular referral patterns, here, we aim to treat taut bands that may be contributing to compression of the median nerve above the wrist and the ulnar nerve deep to the flexor carpi ulnaris.
Dr Wayne W Mahmoud
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