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What Causes The Painful And Disabling Symptoms Associated With sTS And RSI's?

CARPAL TUNNEL SYNDROME:

Repetitive and/or static wrist and finger flexion can cause the flexor muscles which 'close' the hand to develop more strength than the wrist and finger extensor muscles that 'open' the hand. This can often lead to a "muscle imbalance" of the wrist and hand because of the lack of activities that require direct stimulation of the extensor muscles; such as opening a door or holding onto the steering wheel of a car with the backside of the hands.

The stronger flexor muscles can pull the finger (MP, PIP, DIP), metacarpal, carpal, and wrist joints out of their correct functional position and out of alignment. This imbalance then causes the carpal bones to shift towards the carpal tunnel from the sides and from above, and the overlapping Thenar and Hypothenar muscles and Palmaris Longus fascia, which are positioned directly over the carpal ligament, compress the carpal tunnel from beneath. (Referring to when the hand is in the pronated "functional" position as compared to the supinated "anatomical" position).

Performing repetitive wrist and finger flexion causes inflammation of the flexor tendons due to friction within the severely compressed carpal tunnel; ultimately aggravating the existing symptoms, and leading to possible irreversible damage of the underlying tendons, blood vessels and nerves.

REPETITIVE STRAIN INJURIES:

Muscle imbalances can occur throughout the entire body between any agonist and its antagonist. (A single opposing muscle or group of muscles: i.e. Biceps / Triceps, Pectorals / Latissimus Dorsi, flexors / extensors, etc.)

Performing tasks that require constant use of a muscle or group of muscles in a unidirectional movement pattern or even multi-plane movement pattern can cause a specific muscle or group of muscles to become overused, resulting in them becoming stronger, tighter, shorter and more restrictive than the opposing muscle or group of muscles that are being underused. These type of muscle imbalances often result in two types of injuries:

1) Tissue-to-Tissue Approximation Injury: This type of injury occurs when a muscle or group of muscles is used in an excessive manner, resulting in the muscle(s) to become stronger, short, tighter, thicker, etc. Many people call this "overuse", which it is, but it really should be called "over exercising". This constant "overuse" or "over exercising" causes the muscle(s) to become stronger, shorter, tighter and more restrictive. The muscle(s) become so overdeveloped in comparison to the opposing muscle(s) (that is/are too weak to offer any type of stability or counter-resistance), that they (agonist) begin to compress and impinge the soft tissue structures beneath them, resulting in poor circulation, compressed nerves, and the irritation and inflammation of the impinged tendons. (i.e. Shoulder impingement syndrome, Thoracic Outlet Syndrome, Medial Epicondylitis, Carpal Tunnel Syndrome, etc.)

To eliminate this type of injury, the strong, short, restrictive muscle(s) (agonists) need to be stretched and elongated to relieve pressure to the underlying nerves, blood vessels and tendons while simultaneously increasing the strength of the opposing muscle(s) (antagonists) in order to maintain the muscle(s) length created from stretching the agonists, as well as to create structural balance between the agonist and antagonist muscle(s), thus creating a strength ratio with more equality. Creating a more balanced strength ratio between a muscle or group of muscles is necessary for structural integrity of muscles/ joints, and structural integrity is a must in order to prevent and rehabilitate injuries and to function at an optimal level.

A) Tissue-to-Tissue Approximation + Trauma: This type of injury occurs when a muscle group is already strong and powerful, but is subjected to direct trauma that causes micro tears to occur in the involved tissues. Because the involved muscle(s) are constantly in use, the area of injury tends to overdevelop scar tissue, creating a nodule or adhesion on the affected muscle(s). (i.e. Trigger Finger)

2) Tensile Strain Injury: This type of injury occurs due to a weak muscle or group of muscles that are under a tensile strain due to the opposing muscle group (antagonist) overpowering the agonist. The weak muscle(s) (agonist) cannot counteract the "pull" from the opposing muscle group and are always under stress as they try and maintain structural equality / integrity around the joint that they are crossing. Over time, the constant stress that these muscles are subjected to causes micro-tears in the muscle fibers, leading to irritation and inflammation of the affected muscles / tendons. (i.e. Tendonitis, lateral epicondylitis, etc.)

To eliminate this type of injury, strengthening and shortening the weak, underdeveloped muscles will help maintain the opposing antagonist muscle(s) appropriate length, create equality of both length and strength surrounding the joint, eliminate existing micro tears and allow the joint to perform in its correct functional pattern / range of motion (ROM).

A) Tensile Strain + Trauma: The subcategory of Tensile Strain Injury is that a weak muscle or group of muscles may not even hurt although a muscle imbalance already exists, but when subjected to direct trauma, causes micro-tears or more acute tearing of the involved tissues, resulting in pain, inflammation, etc. (i.e. Lateral Epicondylitis)

REFERENCE MATERIALS:

• The flexor muscles of the forearm have a large effect on carpal tunnel pressure by acting on and within the carpal tunnel (Keir et al., 1995) .
• Static fingertip loading (gripping/flexing finger tips against an object) has also been shown to increase carpal tunnel pressure (Rempel et al., 1994) .
• "The theory we propose explains pain, paresthesia, and muscular tenderness on the basis of multilevel nerve compression caused by postural abnormalities and muscle imbalance." Philip E. Higgs, M.D. and Susan E. Mackinnon, M.D. Department of Surgery, Washington University School of Medicine, St. Louis, Missouri. Annu. Rev. Med. 1995. 46:1-16
• "If certain muscle groups are underused, opposing muscle groups will be overused. Muscles in either a lengthened or shortened position will be at a mechanical disadvantage and weak. The overused group will hypertrophy, and the underused group will continue to be weak. This combination produces a self perpetuating condition that maintains the abnormal posture and muscle imbalance." Philip E. Higgs, M.D. and Susan E. Mackinnon, M.D. Department of Surgery, Washington University School of Medicine, St. Louis, Missouri. Annu. Rev. Med. 1995. 46:1-16