What is Carpal Tunnel Syndrome (CTS)?

Carpal Tunnel Syndrome (CTS) is the compression of the median nerve in the carpal tunnel at the wrist, which can lead to severe dysfunction, and in many cases permanent disability.

The carpal tunnel is a structure in the wrist that is formed by the transverse ligament and carpal bones. (see diagram) The carpal tunnel protects the median nerve, tendons, and blood vessels as they extend through the wrist. The median nerve is responsible for sensing touch, position, coordination, and strength in the thumb and first two fingers.



What causes Carpal Tunnel Syndrome (CTS)?

The compression can be caused by inflammation in the canal, pressure by the carpal bones, tumor, or restrictions of the muscles and nerves. In the majority of cases, STRESS in the head, neck and shoulder causes a tightening of the connective tissue (fascia) which shortens and pulls up from the hands and wrist, causing pressure on the nerves and blood vessels. This can then create compression of the median nerve, as well as other nerves. It is the tension in the neck and upper arm that causes distress on the wrist which causes the SYMPTOMS of CTS. You have to treat from the neck (the cause) down if you are going to make a difference, which is what the CTExerciser does.


Tendonitis May Lead to Carpal Tunnel Syndrome

Tendonitis is an inflammation of a tendon. If the tendonitis is at the wrist, the swelling may lead to carpal tunnel syndrome.

	DeQuervain’s Disease is tendonitis at the thumb
	Epicondylitis/Tennis Elbow/Golfer’s Elbow/Cubital Tunnel is tendonitis at the elbow
	Shoulder Tendonitis affects the biceps and/or rotator cuff tendons
	Colles Fracture is a break of head of ulna & radius in wrist (associated with falls; bodies self-fuse and muscles shorten, lose wrist mobility)

What Causes Cumulative Trauma Dysfunction?

Cumulative Trauma Disorders are caused by many types of stresses, incidents, personal health and social factors accumulating daily over a period of time. Job design, work habits, and personal circumstances act together to perpetuate the risk of developing Cumulative Trauma Dysfunction. Any type of stress, whether it is physical, mental, or emotional, causes tension in our bodies that accumulates due to static sustained posture. Tension manifests, in a physical manner, in the myofascial system. (see ‘Fascia Tension and Cumulative Trauma Dysfunction’ below)


What is the Myofascial System?

The myofascial system is the most pervasive system in our bodies. It is a three-dimensional matrix that connects every cell to every other cell within our entire body, bones, muscles, organs, skin etc. (Diagram-Fascia Man) Perhaps the most important quality of the fascia tissue is that it records all physical, mental, emotional, and cognitive activity. The myofascial system is composed of collagen and elastin fibers that provide flexibility (elastin) and support for the entire musculoskeletal system, connects all structures to other structures, forms a protective conduit to keep external pressure off the neurovascular system, and holds memory. The collagen and elastin fibers make the conduit flexible and strong. In addition, the elastin gives muscles elasticity and flexibility, while the collagen provides stability. Collagen also supports the musculoskeletal skeletal structure. Performance and function of all body systems and movements, including the relationship between the connective tissue and muscle, depends on the balance within the myofascial system.


How Does the Myofascial System Work?

The term ‘myofascial system’ refers to the relationship between muscle and fascia tissue that works like a fulcrum and lever. The force vectors of the fascia tissue operate like a pulley system. Muscles act to move the joints within these pulley systems. The joint is the fulcrum, and the fascia is the rope. The muscles provide the force on the rope. In a pulley system, force is traded for distance.

Diagram - Pully Man 1
Diagram - Pully Man 2


Basic physics laws state that in a pulley system, a small amount of force at a distant point can be translated through a system of levers to move a large amount of resistance. The force is translated exponentially through the fulcrum to the opposite end of the system. Thus, the fulcrum bears the full force, thereby increasing the capacity for work at the distal point. So, if the hands are considered to be the distal point, the cervical spine, shoulders and elbows provide a series of fulcrums to provide energy (force or power to the hands). In order to do hand work, energy from the shoulders is required. The translation of force through the pulley system is optimal when you are balanced, in the neutral position.


Balance Through Neutral Positioning

The body is most relaxed and efficient when working from a neutral position, achieved when standing with arms at your sides, hips neutral and the spine aligned over the hips. Balance is sustained during movements (flexion and extension) when the skeletal structure is balanced allowing the extremities to move through the maximal range of motion. Imbalance of these muscle groups creates restrictions in the myofascial system impinging on the neurovascular system, resulting in fatigue of the myofascial system. Continued use of fatiguing muscles results in micro/macro injury. This may result in immediate dysfunction or repetitive injury which is recorded in the fascia memory as Cumulative Trauma Dysfunction. Operating on the "fight or flight" principle this results in a tightening of the fascia a shortening of specific muscle groups (usually the flexors) and, which if not interrupted perpetuates this dysfunction to disability. Static sustained posture in any position is the primary culprit. Stabilizing yourself in order to maintain balance provokes the work of your hands to cause tension in your shoulders. If you do not move to release the tension, then the tension accumulates in your memory cells, or fascia.

Fascia Tension and Cumulative Trauma Dysfunction

The reason that stress ultimately causes Cumulative Trauma Dysfunction is determined by the way the fascia system (Diagram-Fascia Man) reacts to tension. Fascia tissue aligns itself with the lines of tension in the body, which are determined by the organization of the pulley system (Diagram-Pully Men 1 & 2). Tension can traumatize the body if it is not released. The fascia system attempts to protect the body by contracting when trauma is inflicted; its response is to tighten. This triggers the collagen fibers to thicken in order to provide additional support to the tissue that is undergoing stress. However, if the stress to a specific part of the body is repeated, as is generally the case in work and play, then the collagen fibers of the fascia tissue become dominant over the elastic fibers that normally allow tissue to stretch and relax. The thickening of the collagen fibers compresses the neurovascular conduit and decreases the internal diameter. Therefore, the cells ability to remove toxic waste is reduced, and the cells are poisoned, eventually leading to death of the cell. So, reactions on a cellular level actually cause the symptoms of Cumulative Trauma Dysfunction that inhibit optimal physical performance.


Physical Affects of Cumulative Trauma Dysfunction

Over time, repetitive stress in a static sustained posture causes Cumulative Trauma Dysfunction, which results in loss of flexibility, impaired posture, inefficient movement, increase in energy requirements, decreased range of motion, and decreased strength and grasp. Though Cumulative Trauma Dysfunction is usually recognized by dysfunction in the hand, this disorder actually begins at the cervical nerve distribution (the upper-back at the point where the brachial plexus nerve separates into three bands, and those separate again into the radial, ulnar and median nerve. The pain is the body’s way of telling the brain that there is a problem, and the burning sensation is a warning signal for nerve injury, and swelling (edema) is the warning signal of vascular impairment. The numbness and the sudden loss of grip and inability to turn the hand palms up, or rotate the wrist to allow the forearms to turn palms-up (supination), is an indication of an imbalance in muscle groups. These symptoms can eventually cause permanent disabilities if they go unresolved.