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  • JH Backcountry Health

Carpal Tunnel Syndrome vs Thoracic Outlet Syndrome

People usually complain of carpal tunnel when they have numbness and tingling in their hands. When is it really Carpal Tunnel Syndrome versus Thoracic Outlet Syndrome or something else?

What is Carpal Tunnel Syndrome (CTS)?

Carpal Tunnel Syndrome is when the median nerve is compressed in the carpal tunnel under the flexor retinaculum (thick band of connective tissue running across the base of the wrist). Symptoms include numbness, tingling or burning sensation in the thumb, index, middle finger and half of the ring finger and may include weakness in the hand. CTS is often related to overuse, obesity, pregnancy, and inflammatory conditions.

What is Thoracic Outlet Syndrome (TOS)?

Thoracic Outlet Syndrome is when the neurovascular bundle (brachial plexus made up of the C5-T1 nerve roots) is compressed after the nerve roots exit the spine and before they divide into the nerves in the upper arm. Symptoms are numbness/tingling in the fingers (including the ring finger and pinky) and sometimes pain in the shoulder, arm or hand. TOS is often posture related, and we see and work on this frequently in our office, but can also be associated with trauma or abnormalities such as cervical ribs.

What to do about Carpal Tunnel Syndrome?

Yes, there is surgery, but please try conservative treatment first. Often when we see CTS in our office, the median nerve is not just compressed under the flexor retinaculum but also higher up in the forearm by the pronator teres muscle. Often some thoracic outlet compression is present as well. What we do is work through to create space for the nerve to slide along its pathway. We may start with the anterior and middle scalene muscles (which the nerve roots pass between after they exit the spine), then the pectorals (the brachial plexus can get compressed here), and down into the forearm where pronator teres is a common spot for compression, as well as the finger flexors (these tendons also run through the carpal tunnel so if they are enlarged, they use up space in the tunnel) and the flexor retinaculum itself.

At home, you can work on chin tucks, scalene stretches, snow angels, and forearm stretches as well as wear a carpal tunnel brace (we have them in our office if you need them).

Clearing up the irritating factors by changing work station ergonomics and getting a new computer mouse can help tremendously as well. If all this fails, a corticosteroid shot can help and then we do have excellent surgeons in town if needed.

My numbness/tingling doesn’t fit either pattern!

When your ring finger and pinky are affected, it is most often cubital tunnel syndrome affecting the ulnar nerve (I get this frequently if I try to sleep with my elbows bent). Compression in the cervical spine (neck) can also affect specific fingers; for example, the C6 nerve root will radiate to the thumb.

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