We’re pleased to publish this guest post from our friend, Katie Adams. She’s a career therapist in the Boston area and knows.her.stuff. You can read more about her in the bio at the end of this post.
Thank you, lax ligaments, for allowing me to get away with doing massage for 19 years without much pain. Over the past two, however, I have chased nerve-like symptoms up and down my arm while continuing to practice full time. I’d only cancel clients when the pain was enough to cause me to panic, haphazardly putting out the fire with chiropractic, massage, trigger point dry needling, some strengthening and stretching.
My thumb and first two fingers were tingling a lot when I went to my annual physical this past October. My PCP kindly reminded me that I was complaining about forearm and wrist pain at my last annual physical. Duh! Something always hurts when you are a bodyworker, right?
“I just don’t know where it’s coming from,” I said. “The pain jumps around between my neck, shoulder, biceps, forearm and thumb. But, come to think of it, I have been dropping things a lot lately. I just assumed I was clumsy.”
Full disclosure, I knew I had a positive Tinel’s Sign and Phelen’s Maneuver, so I begrudgingly made an appointment to see a neurologist.
I wanted to see a “soft-tissue friendly” doctor, so I made an appointment with a wonderful woman who is a neurologist and physiatrist. She remarked about my fear of the painful EMG test, “You have had a tingling hand for over a year? Trust me you have already felt more pain than this test will elicit!”
Well, it was a rather unpleasant experience, but not that painful – quite interesting, actually. An electromyogram (EMG) measures the electrical activity of muscles at rest and during contraction. A nerve conduction study measures how well and how fast the nerves can send electrical signals. My neurologist taped electrodes to my skin and put small shocks through my upper extremity nerves. Using a thin-needle electrode, she then stuck various muscles and asked me to move, listening to what sounded like loud static. Results: muscle damage (also called wasting) in my abductor pollicis muscle and significantly slowed median nerve impulses in the carpal tunnel. Diagnosis: moderate-severe Carpal Tunnel Syndrome (CTS).
Normally, if symptoms are caught early, conservative treatment for CTS inclusive of rest, PT and a cortisone shot to the wrist is prescribed. However, mine being a moderate-severe diagnosis with muscle and nerve damage, is a surgical case.
According to WebMd.com “Endoscopic surgery uses a thin, flexible tube with a camera attached (endoscope). The endoscope is guided through a small incision in the wrist (single-portal technique) or at the wrist and palm (two-portal technique). The endoscope lets the doctor see structures in the wrist, such as the transverse carpal ligament, without opening the entire area with a large incision.”
There are two main types of CTS Surgery: Open or Endoscopic. The hand surgeon that I consulted with specializes in the endoscopic procedures. He really seemed to understand my anxiety about my hand. “It’s more than the ability to support myself, I said, “It’s my connection to the world. My sense of touch is highly attuned – far more than any of my other senses. What if I lost it?”
No one can look into a crystal ball and know the outcome of any surgical procedure. But, according to the hand literature, my surgeon told me four things:
- Anyone with my level of nerve impairment (proven electrically) is best treated with a carpal tunnel release. Surgery can immediately halt further progression of nerve fiber loss and damage, provide symptomatic relief and prevent further loss of function.
- The damage thus far is not going to reverse by itself. Steroid injection can temporarily improve pain or tingling. But, there will be ongoing nerve loss with time, even while pursuing conservative measures, possibly progressing to ultimate total numbness and weakness in the hand.
- In the short term, less invasive endoscopic technique has been shown to be less painful and allow quicker return to function for the patient.
- At a certain point post-operatively, all carpal tunnel surgical patients should function equally (which is to say quite well). The hand ligament will heal over, but with roughly 30% more space for tendons and nerve to coexist within the tunnel.
My take away: there is no guarantee that conservative treatment will take pressure off my carpal tunnel. I could spend a year trying non-invasive therapies, but with the moderate-severe diagnosis, it’s a gamble for sure. While spending time treating the symptoms, I could lose time for the nerve to viably recover. With the possibility of more permanent nerve damage, I decided to pursue surgery.
As I left the surgeon’s office, my brain slammed with self-defeating thoughts:
“You are so stubborn, you could have prevented this if you’d taken better care of yourself.”
“You have been slouching for years over the massage table. You could have worked with better ergonomics.”
“What were you thinking digging in the garden and making rock walls for all those years while you did massage?”
“You were completely stupid trying to do sand bag carries and pull-ups at the gym followed by 5 massages back to back without rest.”
“I should have given up gluten and sugar…” (isn’t that ultimately what everyone blames these days?!)
I’ve often called myself a dinosaur in the massage world. I’m either seriously old, or I’ve survived the 7-year average burn-out rate multiple times.
Reflecting back upon the 18,500+ massage hours I have done in my career, I realized that I have been given the rare gift of a second chance with this surgery. I can prevent career extinction.
It’s easy to assume people just want a quick fix when they have surgeries. As massage therapists, we usually try to help our clients avoid them at all costs. I never realized, however, how hard it is to actually make the decision to have an elective surgery. It is an exhausting and emotional process. But making the decision can be a true ‘light at the end of the ‘tunnel,’ bringing hope for longer lasting relief. Remember this the next time one of your clients comes in and has made this very personal decision.
To my massage colleagues I say, do not be afraid of injury or extinction! The “Age of Dinosaurs” was the Mesozoic Era, which got divided into three periods: the Triassic, Jurassic and Cretaceous (albeit 145-66 million years ago). I figure that I’m just entering my own post-surgical, ‘Jurassic’ massage era. I wonder if the Jurassic Park Discovery Center at Universal Studios in Orlando needs a new exhibit!
Katie Adams has been practicing NMT in the greater Boston area for a long time. She founded the group practice 360 NeuroMuscular Therapy in Needham, MA which is uniquely focused on rehabilitation of soft-tissue dysfunction associated with medically diagnosed injury and myofascial pain syndrome. She is on the faculty of Myopain Seminars in Bethesda, MD, and also a regular speaker at medical conferences, including for the last five years, the New England Baptist Shoulder & Sports Symposium. Katie holds a BA from Ithaca College, and achieved national NMT certification in 1996 after graduating from the Massage Institute of New England. She is an active member of the American Massage Therapy Association, the National Association of Trigger Point Therapists and the International Myopain Society. Katie is always eager to confer with fellow or budding Massage Dinosaurs! Kadams@360nmt.com | @katieadams360 | #massagedinosaur