Chapter 3: Carpal Tunnel Syndrome: A Comprehensive Guide for Massage Therapists 1 CE Hour
By: Jimmy Gialelis, LMT Learning objectives Identify anatomical structures involved with carpal tunnel syndrome and similar conditions. Delineate “true” carpal tunnel syndrome from other similar conditions. The carpal tunnel region contains eight bones articulated in tight proximity; cartilaginous structures, called articular discs , help bind these bones. The average wrist circumference that encompasses the carpal tunnel region is seven inches for the average female body stature and eight inches for the average male body stature. Wrist circumference less than six inches for females and less than seven inches for males make one more susceptible to experience carpal tunnel syndrome. There are numerous joint classifications used to describe the articulations of the carpal bones. Most synovial joint spaces witnessed in this region are gliding joint surfaces, also called “plane joint surfaces.” Since there is no rotation of the bones in this area, the joints are considered nonaxial. The sliding movement is like rubbing one’s hands together for warmth in a straight-line fashion. Of note to manual therapists, the joint articulating the trapezium bone to the first metacarpal bone is a saddle joint. This is a modified ellipsoid joint due to the convex/concave shapes joining together. Because this joint provides rotational movement in two planes, it is considered a biaxial joint. The eight bones can easily be listed by their location in their respective rows, proximal or distal, and by directional placement, medial versus lateral. Medial to lateral: Proximal row ● Scaphoid. ● Lunate. ● Triquetrum. ● Pisiform. Medial to lateral: Distal row
Recognize research that indicates the effectiveness of massage therapy for carpal tunnel syndrome patients. Perform bodywork techniques designed to reduce the signs and the symptoms of carpal tunnel syndrome. ● The ulnar column, aligned with the ulnar nerve and ulna bone, contains the triquetrum, pisiform, and hamate bones. The pisiform bone is referred to as a sesamoid bone , meaning it is a bone without a direct articulation with another bone. In this case, the pisiform bone is embedded into the tendon of flexor carpi ulnaris muscle. An injury to this tendon can result in a deviation in the positioning of the pisiform bone, leading to ulnar nerve compression. Figure 1: Carpal Bones
ANATOMY OF THE REGION
Interestingly, the carpal bones were named for unique features possessed by each bone. Here are the eight listed below with associated name etymologies: ● Scaphoid: Boat shaped with a scaffold like tubercle on its lateral edge. ● Lunate: Half-moon (lunar) shaped. ● Triquetral: Pyramidal design with an oval facet on the palmar edge. ● Pisiform: Pea-shaped design with an oval facet on the dorsal edge. ● Trapezium: Quadrangular with a concave-convex articular distal surface. ● Trapezoid: Resembles as trapezoid shape. ● Capitate: Resembles a baseball cap design with its round head. ● Hamate: Wedge-shaped bone with a hook at its proximal base. Figure 2: Nerves Involved in CTS
● Trapezium. ● Trapezoid. ● Capitate. ● Hamate.
Medical school students use a variety of mnemonics (acronym phrases to recall lists) to memorize the eight carpal bones. These include:
“So Long to Pinky, Here Comes the Thumb.” “She Looks Too Pretty, Try to Catch Her. ”
Another good mnemonic includes recalling that the carpals are located within the manus region, whereas the tarsals are located within the pes region: “Drive a CAR with your carpals and walk on TAR with your tarsals.” Another easy way to learn the locations of the carpal bones is to divide the bones into functional zones in relation to nearby nerves and bones: ● The radial column, aligned with the radial nerve and radius bone, contains the scaphoid, trapezium, and trapezoid bones. ● The median column, aligned with the median nerve, is bounded by the lunate and capitate bones.
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