A young, female tennis pro was diagnosed with Carpal Tunnel Syndrome (CTS) by a hand specialist. Symptoms were pain and weakness in the hand and tingling in the wrist with weight bearing activities. Surgery was recommended to alleviate symptoms. She was referred to 360 NMT by her tennis coach to explore alternative treatment options.
Evaluation, clinical reasoning & treatment strategizing
Postural assessment revealed weakness in scapular stabilizing muscles and posterior cervical muscles. The Tinel’s sign (tapping at the elbow over the nerve pathway to elicit a sensation of “pins and needles”) was negative, indicating there was no nerve entrapment at the elbow. She had greatly reduced forearm supination (forearm rotation to be palm up), suggesting tightness in the forearm pronators. The pronator teres muscle is known to bifurcate to allow passage of the median nerve. If tight, this muscle could entrap the nerve and contribute to her wrist pain.
NMT was utilized to remove any trigger point driven symptoms and reduce entrapment of the median nerve throughout its full pathway in the upper extremity. The pronator teres muscle, forearm flexors and hand muscles (flexor pollicis brevis, adductor pollicis, abductor pollicis brevis, opponens pollicis) were treated. We progressed treatment up the arm to include the biceps, chest and neck muscles. Some shoulder muscles can refer pain symptoms to the wrist, so we also explored the rotator cuff.
Outcomes and follow-up
Over the course of four months, Neuromuscular Therapy, combined with corrective postural exercises, prevented a carpal tunnel surgery. In this case, many symptoms in the patient’s wrist and forearm were sourced from trigger points that most likely had formed from overuse activities. This case demonstrates the importance and value of treating the soft-tissue components of the body prior to any surgical decision.