In my practice I commonly see patients who mistakenly believe they have, or have been mistakenly diagnosed with carpal tunnel syndrome. Now, don’t get me wrong, carpal tunnel syndrome is a common occurrence. However, while surgery to improve carpal tunnel syndrome can be effective when conservative treatments have not provided results, the surgery will not be effective if the diagnosis is wrong.
The problem arises in that most internet searches, and even the knowledge of many physicians, simply state that the median nerve passes through the carpal tunnel. While this is true, it does not paint the entire picture. The palmar cutaneous branch of the median nerve branches off before the carpal tunnel and does not pass through the tunnel. This means that the nerve that supplies sensation to the skin of the central palm DOES NOT pass through the carpal tunnel. So, if symptoms are felt along the path of the median nerve EXCLUDING the central palm, carpal tunnel is the likely diagnosis. However, if symptoms are felt along the path of the median nerve INCLUDING the central palm, the compression of the nerve is happening further up the arm (usually by the pronator teres muscle) or in the thoracic outlet, before the branching of the palmar cutaneous nerve.
In my experience, many of the patients who present believing that they have carpal tunnel syndrome are in fact suffering from thoracic outlet syndrome. I also believe that conservative treatments for either syndrome should always be the first line of defense, whether they be chiropractic manipulation, massage, physical therapy, and/or other forms of soft tissue treatments, myofascial release, or neuromuscular re-education. So, when the central palm is not included in a patient’s symptoms, practitioners should check the pronator teres, scalene muscles, pectoralis minor, and assess for thoracic outlet syndrome. Patients, in turn, should seek out health professionals who are skilled in treating the CAUSE of their symptoms, not the symptoms themselves with effective conservative treatments before considering surgery.