The Double Crush Syndrome
Your spinal cord and the nerves in your neck may have a way greater impact in Carpal Tunnel Syndrome that a single problem in your wrist. In my experience, the phenomenon is known as the “Double Crush Syndrome” is much more common than pure Carpal Tunnel Syndrome.
Now that you know how nerves pass from the neck into the wrist, I’m sure that you can appreciate that impingement anywhere along the course of the nerve may produce the exact same sensation. The kicker is that many times the nerve has impinged in more than one place!
For example, let’s say that you have a problem with the C6 and C7 nerves where it exits the spine. That creates an initial degree of tension on what will become the Median Nerve, and then let’s add a bit of pressure around the elbow and then a little more pressure at the middle wrist.
It is the combination of these pressures that ultimately produce Carpal Tunnel Syndrome. Unfortunately, it is common for people, GPs, and even specialists to focus on only the last one: the wrist. It is my opinion that pressures higher to the source produce way more irritation than farther away.
I’m making up numbers to illustrate my point, but let’s say that 10% of the pressure comes from the wrist, 15% comes from the elbow but then 75% comes from the neck. That is the nature of “Double Crush” and the principle that I am illustrating, which is that when it comes to burning pain in the hands there is often way more than meets the eye!
More Tales of Insanity on Double Crush Syndrome
Many years ago, I was taking care of a gentleman experiencing hand pain due to Double Crush Syndrome. The challenge is that he was a WorkCover case that only approved him for “Carpal Tunnel Syndrome,” which is limited to the treatment of the wrist. Even after explaining the true nature of his problem to the case manager, WorkCover refused to cover his chiropractic care because they did not believe the neck issue was linked.
This is the crazy world we live in where common sense is trumped by policy … (It is also one of many reasons why I no longer participate in WorkCover cases or any program where the government or an insurance company makes the clinical decisions!)
Ultimately, my point is that when it comes to “Carpal Tunnel Syndrome,” it is essential to consider a global perspective that includes the neck in order to determine what’s really going on, But what would you say if I told you that there was still more? I’m going to deviate from the nerve side of the equation for a moment (don’t worry, we’ll come back) in order to address the impact that blood flow also has on producing a tingling, burning, and pain in the hands.
Thoracic Outlet Syndrome
Neck stretches are commonly recommended for Double Crush Syndrome and Thoracic Outlet Syndrome ... but let me ask the question: WHY are your muscles continually tight in the first place? Because THAT is actually a spine and nerve problem! Have you ever had your “foot or leg fall asleep?” When you prop your foot in a position that clamps down on the blood vessels - even just a little bit - you end up experiencing this altered sensation that affects the entire limb.
And when you go to move it again, you experience the “pins and needles sensation” as the blood flow returns. The same phenomenon can occur in your hands. It is called “Thoracic Outlet Syndrome” (TOS).
The thoracic outlet refers to the frontal opening between your chest and beck where the major vessels (Brachial Arteries) that supply blood to your upper limbs emerge. Before transmitting down the arm, the Brachial Arteries pass by the Brachial Plexus (nerves), your collar bone, your 1st Rib, and also between a series of muscles that are involved with stabilising your neck and shoulder called the Scalenes.
If these muscles are excessively tight - especially if you do something that makes them tighter like sleeping on thick pillows, moving your arm above your head, or sticking your head excessively far forwards (like texting or working on a computer) - they can impede the normal flow of blood to your hands, which produces a numb or “pins and needles” sensation.
The typical pattern for Thoracic Outlet Syndrome is that its the whole of your fingers or hands that feel numb-ish. Again, this is significantly different from the “pins and needles” distribution that occurs if the problem is from a peripheral or spinal nerve.
Thoracic Outlet Syndrome isn't just a Posture Problem
Poor posture is NOT a laziness problem. It is a neurological problem. Your brain is adapting to some type of stress by forcing your muscles to adapt. ... So let me ask the question: WHY is your brain continually using your muscles this way, making you sore and crooked? It is very likely the problem can be found in your upper cervical spine! In rare cases, it is possible that a rib or extension of bone from the cervical spine can be the source of irritation causing your muscles to tighten (which may require surgery in severe cases).
More commonly, the conservative approach to managing Thoracic Outlet Syndrome is to stretch your Scalene muscles. I agree, that stretching is an essential step to improving your condition. However, I want to go one step further to address the question, “Why are your muscles tight in the first place?”
People are often quick to blame poor posture as the cause of muscle tightness. I disagree. Poor posture is only the effect of a nervous system problem. (I promised you that we would come back to the nerve side of the equation. Well, here we are.). Your nerves are the electrical power supply for your muscles.
Therefore, if you develop poor posture it is causing your own nervous system in making structural adaptations for something deeper that is actually going on. Yes, the thousands of things that you do every day such as slouching, sticking your head too far forwards at your desk, sleeping wrong add up.
However, they are rarely the source of the problem. If they were, when you make the conscious effort to fix your posture, you wouldn’t immediately collapse back into your bad pattern, now would you? So what makes your posture go sour?
And how does this relate to scalene tightness, Thoracic Outlet Syndrome, Double Crush Syndrome, “Carpal Tunnel Syndrome” and all the other reasons that your hands can feel like “pins and needles?” The answer to this question may lie at the base of your skull at the level of your brainstem, which I will address in the final part of this article series.