Houston Methodist. Leading Medicine

Hand FAQ

Question:

I am an avid bowler on two different adult leagues. But my bowling average has gone way down since I developed carpal tunnel syndrome. I heard from another bowler that there's a way a therapist can bend my elbow and hand to get these painful symptoms to stop. What is it called and where can I get it?

Answer:

Carpal tunnel syndrome (CTS) causes pain, numbness, tingling, and weakness of the hand and wrist when the median nerve gets squeezed or pinched inside the carpal tunnel of the wrist. CTS is also referred to as nerve entrapment or compressive neuropathy. Any condition that decreases the size of the carpal tunnel or enlarges the tissues inside the tunnel can produce the symptoms of CTS. The carpal tunnel is an opening through the wrist to the hand that is formed by the bones of the wrist on one side and the transverse carpal ligament on the other. The median nerve passes through the carpal tunnel into the hand. It gives sensation to the thumb, index finger, long finger, and half of the ring finger. It also sends a nerve branch to control the thenar muscles of the thumb. The thenar muscles form the thick pad at the base of the thumb and let you touch the pad of the thumb to the tips of each finger on the same hand, a motion called opposition. This thumb to hand oppositional movement is extremely important for a bowler, since it is part of the hand position used to pick up the ball, hold it, and then release it successfully. Hand therapists such as specially trained physical and occupational therapists often treat patients with carpal tunnel syndrome. A wide variety of treatment techniques are used such as splinting, activity modification, and stretching of the soft tissues. The method of stretching or stressing the nerve that you are referring to may be the neurodynamic technique (NDT). The neurodynamic technique is a relatively new treatment method that has become very popular in the last 10 years. Neurodynamics was developed in Australia by a physical therapist by the name of David Butler. It is the study of how the nervous system slides and glides as we move. Nerves such as the median nerve involved in carpal tunnel syndrome can become pinched, obstructed, or bound down by scar tissue, swelling, or other soft tissues surrounding the nerve. The neurodynamic technique is a way of restoring the free flowing movement of nerve tissue as the joint moves. It is true the therapist takes the patient's hand, wrist, and arm through different positions and movements designed to stress the median nerve. Some patients do report moderate pain with this technique. But they also say that they get the desired results. They become pain free and are able to resume all normal activities once again. This technique does require additional specialty training for the hand therapist. If you are interested in pursuing this approach, ask the therapist if he or she has been trained in neurodynamic techniques. Joel E. Bialosky, PT, PhD, et al. A Randomized Sham-Controlled Trial of Neurodynamic Technique in the Treatment of Carpal Tunnel Syndrome. In Journal of Orthopaedic & Sports Physical Therapy. October 2009. Vol. 39. No. 10. Pp. 709-723.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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