The Truth About Carpal Tunnel Syndrome

When it comes to carpal tunnel syndrome, there is a lot more going on than swelling in the carpal tunnel. Read the rest of the article to learn what other issues can mimic and compound the issue. Remember, pain doesn't exist in a vacuum, and neither does carpal tunnel syndrome.

Carpal Tunnel Syndrome in a Nutshell

In a nutshell, the syndrome is two different issues, one caused by another. The ultimate issue is that the median nerve is impinged as it travels though the carpal tunnel. 

The nerve impingement is the result of a preceding issue, which is inflammation and swelling of the tendons and tendon sheaths that pass through the carpal tunnel.

The reason that the tendons and their sheaths are swollen and inflamed is the same story you may already know. Repetitive stress to the tendons as they are overused on a daily or near daily basis is the main contributing factor. Ergonomics may be an additional factor.

Nerve Impingement in the Arm

Now, let's broaden our focus. To look at the condition from a holistic perspective, we simply need to continue following the trail of factors that contribute to the dysfunction. 

Specifically, we need to look at the overall movement pattern that the repetitive stress is part of. 

The muscles of immediate interest are the muscles of the carpal tunnel, located on the palmar side of your forearm.

If this group of muscles is being overused, then they are likely holding excess tension. That tension can in turn impinge the nerves of the hand in two additional places, the pronator teres muscle and the cubital tunnel. 

Pronator teres syndrome can closely mimic carpal tunnel syndrome, so it's crucial to consider when addressing the condition.

Impingement in the Shoulder and Neck

Further up the chain, there are several places in the shoulder and neck where the nerves of the arm can be impinged. Under pec minor, under the clavicle, between some neck muscles called the scalenes, and in the spine itself.

In my practice, the vast majority of people have a forward posture in their head and shoulders. This often indicates shortened pecs and scalenes, among other muscles. If those muscles are short, then they may be impinging the nerves of the arm, also.

Multiple Crush Phenomenon

So when you have symptoms of nerve impingement in the wrist, you may also have nerve impingement in the arm, shoulder, and/or neck.

When a nerve is impinged in more than one location, it is called multiple crush phenomenon. As you may imagine, each additional impingement compounds the previous level of impingement.

In a nutshell, multiple crush can make a minor case of carpal tunnel syndrome seem like a severe one. It may even make it appear that you have it even when you don't.

This may sound scary, but most of these locations of potential nerve impingement are easily addressed with manual therapy like massage and stretching.

Specifically, the scalenes, pec minor, bicipital aponeurosis, cubital tunnel, and pronator teres are all muscles that respond well to manual therapy. These areas are indicated by green dots in the above illustration.

The areas indicated by the yellow dots are places where nerves are impinged by bone, cartilage, or swelling within a confined space. Massage can still benefit these conditions, but the strategies for treatment are quite different.

For example, in the case of acute carpal tunnel syndrome, it is best to avoid direct treatment of the tunnel itself. The strategy should instead focus on treating the muscles of the forearm, arm, shoulder, and neck. Only after the inflammation has subsided can massage and manual therapy be applied directly to the carpal tunnel.


The first takeaway here is to make sure that your health providers check all the different places that the nerves of the arm can be impinged. If you receive a diagnosis of carpal tunnel syndrome from a health provider who did not check the entire upper extremity and neck, get a second opinion.

The second takeaway is that if you have symptoms of nerve impingement in your arm or hand, get a massage therapist on your team who is experienced in addressing this type of issue. They will be able to address the soft tissue impingement while your other practitioners address the remaining factors contributing to the impingement.

Click here to get my quick reference sheet about nerve impingement in the upper extremity.

About the Author

My name is Lovelace Linares. I have been practicing massage in Atlanta since 2001. I taught all aspects of massage for nine years, five of which I directed the massage program at the Atlanta School of Massage.

I'm a bit unconventional in my thinking. I believe that self discovery is the purpose of life. Through it, we can all achieve our greatest potentiontial, both individually and as a society.

To that end, i believe that true relaxation comes from two things: (1) Alleviating pain that you are aware of and (2) addressing tension you are not aware of. Self-awareness is the key.

My practice is located inside Urban Body Studios on the scenic Atlanta Beltline. Orthopedics, Deep tissue, Swedish massage, neuromuscular therapy, Thai massage, and stretching are some of the techniques that I use in my practice.

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