An article in the The Journal of Orthopaedic and Sports Physical Therapy (JOSPT) recently discussed a possible new hallmark of carpal tunnel syndrome – a stiff neck. Carpal Tunnel Syndrome (CTS) is a condition in which a nerve in the wrist is compressed, causing symptoms of numbness, tingling, and weakness in the hand. It can cause considerable pain and debility in the hand and many patients complain of it waking them at night or causing them to drop objects. Carpal Tunnel Syndrome is most commonly thought to be caused by compression of the median nerve within the “carpal tunnel” in the wrist. Or so we think. In the JOSPT article, neck mobility was assessed in women with CTS and a second healthy group. The research showed that women with CTS had less neck mobility, essentially a stiff neck, compared to the healthy counterparts. The research also discussed previous studies that also found the presence of abnormal posture, arthritis, spinal stenosis, and pain in the neck and shoulder in individuals with CTS. Apparently, CTS and conditions of the neck hang out well together like peas and carrots. Hmmm. One of my patients made a relevant comment this week, “You mean one part of the body is connected to another?!”
The carpal tunnel is a space within the wrist. In this space lies a nerve, the median nerve to be exact, as well as 9 tendons. If you can correctly comment below the names of the 9 tendons, you get a cookie, or maybe one of those mashed potato cupcakes. During cadaver dissection, nerves look like little white strings. The median nerve arrives from the brachial plexus, a bundle of nerves in the neck and shoulder region that look like a complicated braid. The brachial plexus arrives from nerves that shoot off from the neck. When you pull one side of a string, does it make the other side of the string move? I’m simplifying something that is much more complex than that, but can you see how movement of the neck might affect a string or strings that come from it?
Physical therapists are trained to assess adjoining joints to get a more global picture of what might be contributing to a condition. In a physical therapy evaluation of a patient with CTS, I screen range of motion and strength in the joints all the way up from the wrist and hand to the neck. I also assess mobility of the median nerve along its entire course from the hand to the neck, in what I like to call “flossing.” Whatever impairments I find, treatments are incorporated to address them. If CTS is not managed well with conservative treatments of physical therapy, splinting, and injections, then surgery may be suggested. If you have or think you have CTS, be sure someone takes a look at your neck.
Although this study points out that a stiff neck may be a common feature in CTS, more research needs to be done to see if this may indicate it contributes to CTS or if CTS contributes to neck pain and associated conditions. We don’t fully understand our body’s nervous system. I have a feeling it’s more than just peas and carrots.
Is all this talk of vegetables making you hungry? Try this out.
- De-La-Llave-Rincon, et al. (2011). Women With Carpal Tunnel Syndrome Show Restricted Cervical Range of Motion. JOSPT, 41(5): 305-310. [↩]