Carpal Tunnel Syndrome a real pain in the neck?

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Often in school when we are thought the nervous system our instructors will use pretty pictures from text books.  Blue represents the L5 dermatological distribution or pink is where the median nerve travels. Although these pictures give great insight towards mapping out the nervous system they can at times be diagnostically useless. This is because they are based on the belief every nerve carries out the exact same pattern in every person. In addition, it is wrong to believe every nerve which obtains a pathology will present with similar symptoms consistently.




The nervous system is one of the most complex systems the body has to offer. Studies have shown Ulnar Nerve abnormalities in patients with Carpal Tunnel Syndrome (CTS), which is a condition involving the Median Nerve.[1] Furthermore, studies have also demonstrated a decrease in pressure of the Guyon's canal (a common site for Ulnar nerve entrapment) after Carpal Tunnel surgeries have been performed.[2]

This gives premise to the concept that nerves in one area may very well affect nerves in another area. It seems the nervous system may work as a whole and not in just different subsets of entities.  When considering this concept it doesn't surprise me that CTS has been shown to also relate to neck disorders. [3,4].




A recent study in JOSPT evaluated this relationship further. The article attempted to analyze if forward head posture (FHP) and cervical range of motion (CROM) is related to CTS or median nerve abnormalities. Subjects with CTS were compared with healthy controls. In addition, subjects were paired based on age, occupation and hand dominance. Occupations consisted of desk worker, housewife, cleaning lady and teachers.

Results indicated a significant correlation to both a reduction in CROM and increased FHP in the group with CTS. CROM differences ranged from 12-18 degrees less in those with CTS. Furthermore FHP ranged with a difference 8-9 degrees in those with CTS.

Although this correlation is an interesting finding it can not create a cause and effect relationship. The study also found these findings to not be related to pain or symptoms of CTS.

In summary, one cannot say CTS is caused by postural abnormalities of the neck. The authors suggest these findings may be due to the CTS itself. A similar example is when patients will often have an antalgic posture when herniating a disc in their back. This purposes the concept that we should explore the option of treating the neck in patients with CTS. Furthermore, if postural corrections are made in patients with FHP will this decrease the prevalence of CTS? Only one case study to date has assessed a multimodal approach to treating a patient with CTS [5]. Hopefully, the following study will promote more research into this relationship.

Ginanneschi, F., Milani, P., & Rossi, A. (2008). Anomalies of ulnar nerve conduction in different carpal tunnel syndrome stages Muscle & Nerve, 38 (3), 1155-1160 DOI: 10.1002/mus.21070

Mondelli M, Ginanneschi F, & Rossi A (2009). Evidence of improvement in distal conduction of ulnar nerve sensory fibers after carpal tunnel release. Neurosurgery, 65 (4) PMID: 19834374

Chow CS, Hung LK, Chiu CP, Lai KL, Lam LN, Ng ML, Tam KC, Wong KC, & Ho PC (2005). Is symptomatology useful in distinguishing between carpal tunnel syndrome and cervical spondylosis? Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand, 10 (1), 1-5 PMID: 16106494

Reading, I. (2003). Anatomic Distribution of Sensory Symptoms in the Hand and Their Relation to Neck Pain, Psychosocial Variables, and Occupational Activities American Journal of Epidemiology, 157 (6), 524-530 DOI: 10.1093/aje/kwf225

Valente R, & Gibson H (1994). Chiropractic manipulation in carpal tunnel syndrome. Journal of manipulative and physiological therapeutics, 17 (4), 246-9 PMID: 8046280

De-la-Llave-Rincón, A. (2009). Increased Forward Head Posture and Restricted Cervical Range of Motion in Patients With Carpal Tunnel Syndrome Journal of Orthopaedic and Sports Physical Therapy DOI: 10.2519/jospt.2009.3058