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Tunneling Through Pain

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Posted by on Friday, September 24, 2010, 5:32
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Tunneling Through Pain

When confronted with pain, numbness, tingling, stiffness, burning or swelling in the hands and fingers, the universal tendency nowadays is to immediately apply the label “carpal tunnel syndrome,” with very little consideration given to other possible causes.

Tunneling Through Pain

Tunneling Through Pain

Few people know that myofascial trigger points (tiny contraction knots) in the scalene muscles of the front of the neck are almost always involved in causing pain and other abnormal sensations in the hands.

This revelation comes from decades of research by Doctors Janet Travell and David Simons, authors of the widely acclaimed medical textbook, Myofascial Pain and Dysfunction: The Trigger Point Manual. According to Travell and Simons, the scalenes (seen below) are often the primary source of all the symptoms wrongly blamed on the carpal tunnel.Carpal Tunnel Syndrome

scalene trigger points and referred pain

Referred Pain

The displacement of pain from the neck to the hands is called pain referral. With severe symptoms, trigger points in as many as thirty-eight muscles of the neck, chest, upper back, shoulder, upper arm, forearm, and hand may be involved in causing referred symptoms in the wrist, hand and fingers.

Overworked muscles of the forearms are one of the more obvious places to look. When primary treatment is directly at locating and deactivating trigger points in these areas, improvement can come quickly.

Conventional Therapies

Unfortunately, trigger point therapy isn’t widely known yet in the healthcare community. There’s great resistance to changing, or even questioning, firmly established conventional treatments for carpal tunnel syndrome, although they frequently give far less than satisfactory results.

Even after surgery, cortisone shots, and physical therapy, symptoms often remain unchanged and sometimes are made worse. Prescription drugs, wrist supports, prescribed rest, and ergonomic improvements in the workplace have little effect on “carpal tunnel” when trigger points in overworked muscles are the true cause of the symptoms.

Nerve Compression

The medical rationale for carpal tunnel syndrome blames compression of the median nerve as it passes through the carpal tunnel in the wrist on its way to the fingers and hands. The median nerve supplies the radial side of the hand (the thumb, first finger, the web connecting them, and part of the second finger).

Compression of the median nerve can cause numbness, pain, and tingling in these areas when the carpal tunnel is swollen or otherwise restricted. These abnormal sensations are also often wrongly labeled “peripheral neuropathy,” which implies nerve disease.Carpal Tunnel Exercises After Surgery

Thoracic Outlet Syndrome

Although numbness and tingling in the hands are clearly the effects of nerve compression, the problem doesn’t often originate in the carpal tunnel. Doctors Travell and Simons explain that the critical nerve impingement actually occurs at the thoracic outlet. This is the opening under your collarbone through which the nerves and blood vessels pass on their way to the arm.

Nerve compressions occur at the thoracic outlet when trigger points in the scalene muscles keep the first rib pulled up against the collarbone. This squeezes the brachial plexus, the thick bundle of nerves that supply the arm and hand, which passes through this area. Pressure on these nerves due to scalene trigger points is often the only cause of numbness, tingling and weakness in the hands and fingers.

Swollen Hands

This same action by tight scalenes can also compress the subclavian vein at the thoracic outlet, impeding the return of blood and lymph from the arm and causing swelling in the wrist and hand. This in turn may be the real reason for any tightness in the carpal tunnel.

When this happens, carpal tunnel surgery may indeed relieve the symptoms in the hand to a degree, but it doesn’t treat the real cause. It’s the scalene muscles that need attention, not the carpal tunnel!


Trigger points should be at the top of the list during any examination for suspected carpal tunnel syndrome, thoracic outlet syndrome, or peripheral neuropathy. When healthcare practitioners have had adequate training and experience, trigger points are easy to locate and treat. In fact, there are ways to treat them yourself quite effectively.

To read the front cover, click to enlargeIn The Trigger Point Therapy Workbook, nationally certified massage therapist Clair Davies simplifies Travell and Simons’ extensive research into myofascial pain and makes it accessible to the layman. His innovative methods of self-applied trigger point massage will relieve carpal tunnel syndrome, aching pain, numbness, tingling, and burning in your hands when trigger points are the cause.

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