Tunnel syndromes (carpal, cubital)

Effective treatment of tunnel syndromes (carpal tunnel, cubital tunnel) in our centre! Unique simulators, 3-stage methodology, individual approach. We help even in difficult cases.

Kinesiology methods in the recovery of tunnel syndromes (carpal tunnel, cubital tunnel).¶

What is carpal tunnel syndrome and where does it occur?¶

Tunnel Syndrome: is a compression-ischaemic neuropathy resulting from compression of a peripheral nerve in anatomically narrow channels (tunnels). The nerves passing through the wrist (carpal tunnel) or elbow (cubital tunnel) are most commonly affected.

Where Tunnelling Syndrome occurs.¶

Main areas of manifestation:

Carpal Tunnel Syndrome - compression of the median nerve in the wrist, causes pain and numbness in the hand (I-IV fingers).
Cubital tunnel syndrome - compression of the ulnar nerve in the elbow area, causes weakness and impaired sensation (numbness) in fingers IV-V.

Median nerve and ulnar nerve

Both nerves originate from roots C5-T1 (cervical and first thoracic segments of the spinal cord).

Median Nerve: Passes from the armpit through the upper arm and forearm, then through the carpal tunnel (carpal tunnel) into the hand. Innervates the muscles of the thumb (thumb eminence). Responsible for sensitivity in the palm of the hand (on the side of the thumb, index, middle and half of the ring finger).

Elbow nerve Passes from the shoulder through the elbow (ulnar canal - ‘cubital tunnel’), then along the forearm into the hand. Innervates the muscles of the little finger and part of the hand (interosseous muscles). Responsible for the sensitivity of the little finger and half of the ring finger.

Major Causes¶

Tunnel syndromes, such as carpal tunnel (carpal tunnel) and cubital tunnel (elbow) syndromes, are most often caused by constant squeezing or overloading of nerves in narrow anatomical canals.

One of the most common causes is prolonged repetitive movements, such as working at a keyboard or mouse, playing musical instruments or monotonous manual labour.

These activities lead to chronic strain on the tendons and ligaments surrounding the nerve, causing the canal to narrow and the nerve to become compressed.

In addition, trauma (fractures, dislocations) or congenital features of bone and ligament structure can initially narrow the tunnel, increasing the risk of nerve compression even with small loads.

Another important cause is inflammation and oedema, which reduce the free space in the canal.

This can occur in tendonitis, arthritis or after trauma.

Endocrine disorders also play a major role - for example, in diabetes or hypothyroidism, the blood supply to the nerves is impaired, making them more vulnerable to compression.

In pregnant women, tunnel syndromes often develop due to fluid retention in the body, which increases pressure in the tissues and provokes swelling in the wrist or elbow.

If the problem is ignored, over time, permanent sensory disturbances and muscle weakness can occur, so it is important to pay attention to the first symptoms in time and adjust the load.

Types of tunnelling syndrome¶

Carpal (median nerve).
Cubital (ulnar nerve).
Tarsal canal syndrome (tibial nerve in the ankle).
Circular pronator syndrome (median nerve in the forearm).

Kinesiotherapy Implications for the body¶

From a kinesiotherapy point of view, untreated tunnel syndromes lead to serious functional disorders of the musculoskeletal system.

First of all, permanent nerve compression causes chronic pain syndrome and progressive muscle weakness, which significantly reduces the quality of life and performance.

Violation of nerve conduction worsens the microcirculation of blood and lymph in the affected area, leading to a deficit of tissue nutrition - this is manifested in the form of trophic changes in the skin, slow regeneration and increased vulnerability to injury.

Particularly dangerous are irreversible consequences in the form of muscle atrophy, when, due to prolonged denervation, entire muscle groups begin to shrink in volume and lose strength.

For example, in carpal tunnel syndrome, the thumb is often atrophied, which severely limits the grip function of the hand.

In addition, chronic overstretching of some muscles while weakening others leads to the formation of myofascial dysfunctions - painful seals in muscles and fascia that further limit joint mobility and create a vicious circle of pain and movement disorders.

Kinesiotherapy in such cases aims not only to relieve symptoms, but also to restore proper muscle balance and biomechanics of movement.

Denervation

Denervation is a pathological condition in which there is a cessation or significant reduction in nerve impulsation to muscles, organs, or other tissues due to damage, compression, or dysfunction of the innervating nerve.

The effects of denervation in kinesiology:

Muscle atrophy (decrease in muscle volume and strength due to lack of nerve stimulation).
Disturbance of tissue trophics (deterioration of cell nutrition, as the nervous system regulates metabolic processes).
Loss of reflexes and sensitivity (if sensory fibres are affected).
Fibrosis and replacement of muscle tissue with connective tissue (in case of prolonged denervation).

In the context of tunnel syndromes (carpal tunnel syndrome, cubital tunnel syndrome), denervation develops with chronic nerve compression, which without treatment leads to irreversible changes.

Important!

Kinesiotherapy helps to slow down this process by restoring microcirculation and preventing contractures.

Statistics and undetectable course¶

Tunnel syndromes are insidious in their early stages.

According to research, up to 50% of cases remain undetected - many patients ignore mild tingling in the fingers or occasional numbness in the hand for years, writing them off as fatigue or uncomfortable sleeping positions.

For example, an office worker may ignore discomfort in the wrist after a day's work, believing it to be a normal consequence of working at a computer.

However, it is these ‘harmless’ symptoms that often signal the initial stage of carpal tunnel or cubital syndrome.

About 10% of people deliberately do not consult a doctor, even when symptoms become regular. Reasons vary from fear of diagnosis to the belief that ‘it will go away on its own.’

For example, a musician who feels weakness in his fingers may tolerate it for a long time until he is unable to play an instrument.

Sixty per cent of office workers with more than 5 years' experience have early signs of carpal tunnel syndrome, but only a few start treatment in time.

Why are tunnel syndromes difficult to diagnose?¶

Mild symptoms - pain and numbness may come and go.
Lack of visual changes - no swelling or redness, which makes you less alert.
Similarity to other diseases (osteochondrosis, arthritis), especially in the elderly.
Habituation to discomfort - people adapt to mild pain until it becomes unbearable.

Example: A packer in a warehouse over the years notices that his fingers go numb at night, but attributes it to the strain. When the hand begins to ‘fail’ when lifting weights, it turns out that the nerve has already been seriously damaged.

Do not delay diagnosis

Early diagnosis is critical - simple tests (e.g. Tinel's or Phalen's test) can detect the problem at a stage when exercises and orthotics are still helping.

Tinel's Test: Method of Performance and Interpretation

The Tinel's test is a simple neurological test used to diagnose peripheral nerve irritation or compression in tunnel syndromes (e.g., carpal or cubital). It is based on the assessment of paresthesias (tingling at the tapping sites) when tapping along the course of the nerve.

Performance technique: The arm is relaxed, in a neutral position (palm up for carpal tunnel, slightly bent at the elbow for cubital tunnel).

Check the median nerve for carpal tunnel syndrome:
- Tap with fingertips or a neurological mallet over the carpal tunnel (2-3 cm above (from the wrist towards the elbow) the wrist crease on the palm side).
Check the ulnar nerve for cubital syndrome:
- Tapping the ulnar canal (posterior surface of the elbow joint - where the nerve runs in the groove between the medial epicondyle and the ulna).

The intensity of the tapping should be light but sufficiently palpable (not painful!).

Interpretation of results

Positive test:

Tingling, numbness, or ‘shooting’ in the area of nerve innervation (fingers in carpal tunnel syndrome, IV-V fingers in cubital syndrome). Indicates nerve irritation in the tapping area.

Negative test:

No symptoms - compression is unlikely.

Strategy for the treatment of tunnel syndromes from a kinesiotherapy perspective¶

Three-Step Approach to Rehabilitation (3+ months)¶

Tunnel Syndromes are not just a localised problem of a compressed nerve, but a complex disorder affecting the entire kinematic chain of the hand. When a nerve suffers years of compression, the body builds a whole system of compensatory changes - from muscle imbalances to restructuring of motor patterns.

This is why the classic ‘rest + anaesthesia’ often has only a temporary effect - without step-by-step restoration of microcirculation, elasticity of the nerve trunk and correct movement patterns, relapse is inevitable.

The three-stage strategy in kinesiotherapy is based on the principles of biomechanical tissue adaptation.

For the first 6 weeks, we fight not so much the symptoms as the pathological conditions in which the nerve has found itself - oedema, ischaemia and impaired gliding properties.

Then we gradually ‘retrain’ the muscles and joints to work without overloading vulnerable areas, and only at the final stage we consolidate the result through functional exercises.

This approach takes into account that it takes 3-6 months for a nerve to regenerate fully - this is how long it takes for Schwann cells to restore the myelin sheath and for the brain to restructure its motor programmes.

Schwann cells

Schwann cells are specialised cells in the peripheral nervous system that perform critical functions for nerve function and repair. They literally ‘wrap’ the long branches of neurons with their membranes, forming a myelin sheath - a kind of ‘insulation’ that speeds up the conduction of nerve impulses by 50-100 times.

In case of nerve damage (including compression in tunnel syndromes) Schwann cells activate regeneration:

Destroy damaged areas (phagocytosis);
Release growth factors (NGF, BDNF), stimulating axon growth;
Form ‘tunnels’ of extracellular matrix proteins, guiding regenerating nerve fibres.

Example: In carpal tunnel syndrome, chronic compression of the median nerve leads to demyelination - Schwann cells try to compensate for this, but without removing the compression the process becomes irreversible.

These cells are named in honour of the German physiologist Theodor Schwann (19th century), one of the founders of the cell theory.

Stage 1: Acute period (0-6 weeks)¶

Goal

Reduction of inflammation and decompression of the nerve.

In the first weeks it is important to reduce the pressure in the tunnel by reducing oedema. Kinesiotherapy uses:

Passive movements - maintain blood flow without stressing the nerve, preventing congestion.
Lymphatic drainage techniques - manual massage of the proximal arm stimulates the outflow of interstitial fluid.
Position therapy - wearing orthoses in a neutral position (wrist in 0-10° extension for carpal tunnel) reduces nocturnal nerve ischaemia.

Physiological rationale: Inflammatory mediators (prostaglandins, bradykinin) irritate nerve endings. Gentle treatment breaks the vicious circle ‘oedema-compression-ischaemia’.

Stage 2: Subacute period (6-12 weeks)¶

Goal

Restoration of nerve gliding properties and prevention of fibrosis.

Nerve mobilisation - median/lumbar nerve gliding techniques (flossing exercises) improve nerve adaptation to load.
Gradual strengthening of the antagonist muscles - isometric then concentric contractions of the wrist extensors balance the tone of the flexors.
Myofascial release - working on trigger points in the shoulder and scapular area eliminates compensatory overload.

Physiological process: Activation of protein synthesis by Schwann cells accelerates remyelination. Dosed load stimulates angiogenesis in the endoneurium.

Stage 3: Functional adaptation (3-6 months)¶

Goal

Return to full load with a new motor strategy.

Eccentric training - controlled lengthening of the forearm muscles during loading (e.g. slow lowering of a dumbbell) redistributes tension from the tunnel structures.
Neuromuscular control - proprioception exercises (balance on a rocking platform with hand support) reduce compensatory hypertonus.
Ergonomic Correction - teaching movement patterns without repetitive flexion/extension of the problem joint.

Physiologically, cortical representations in the motor area of the brain are remodelled (neuroplasticity) and new, safe motor stereotypes are formed. An increase in capillary density in the outer nerve sheath completes the regeneration.

Efficacy criteria

At each stage - reduction of Tinel's/Falen's symptoms, increase in strength (dynamometry) and endurance (repetitive movement test). If pain persists for >3 months, electroneuromyography is indicated to clarify the degree of denervation.

Why special simulators are effective in the treatment of tunnel syndromes¶

In our centre we use unique exercise equipment designed specifically for the delicate treatment of tunnel syndromes.

Their main advantage is the ability to dose the muscle groups involved in nerve decompression. For example, our variable resistance block system helps to restore the correct movement pattern in the wrist and elbow joints.

Effectiveness is built on three pillars: individuality of programmes, complexity of treatment and physiological.

We don't just design exercises for the arm - we analyse the entire kinematic chain. In 80% of patients with long-standing carpal tunnel syndrome there is shoulder girdle misalignment and in cubital syndrome there is cervical hyperlordosis, which increases nerve compression. Therefore, we include posture correction on anti-gravity simulators and neuromuscular activation of deep stabilisers in the programme.

A special feature of our approach is adaptation of training devices to the stage of the disease. In the acute period it can be passive modes with hydraulic resistance, in the subacute period - isokinetic training with feedback, and in the recovery phase - functional imitators of working movements (for example, for musicians or IT specialists). In parallel, we use nervous mobilisation techniques - the same exercise equipment, but in special positions that improve nerve gliding in the canal.

Result

Not just temporary relief of symptoms, but elimination of the biomechanical causes of compression. Our data shows that 92% of patients who complete the full course remain in remission for more than 3 years, because we work not only on the effects, but also on the source of the problem.

Why can't tunnel syndromes be treated for less than 3-4 months?¶

The physiology of nerve tissue requires long recovery times - unlike muscles, which adapt in weeks, nerves need a minimum of 12 weeks for structural remodelling. The myelin sheath regenerates at a rate of 1-2 mm/day, and in chronic compression (as in neglected tunnel syndromes) the process is even slower due to fibrosis of the perineurium.

Example: even with a perfect decompression of the median nerve in the wrist, it would take 35-50 days just for remyelination to restore conduction over a 5 cm area - and that's without taking into account time to correct muscle imbalances.

Perineurium

The Perineurium is a dense connective tissue sheath surrounding individual bundles of nerve fibres (fasciculi) within a peripheral nerve.

It consists of 3-15 layers of flattened cells (perineural fibrocytes)
Contains collagen fibres (mainly type I and III)
Has a basal membrane with laminin

Functions of the perineurium:

Mechanical protection of nerve fibres
Maintenance of intraneural pressure
Barrier function (haemato-neural barrier)
Providing sliding properties of the nerve

Pathology example: In carpal tunnel syndrome, perineurium thickening of the median nerve can be up to 300% of normal, requiring special mobilisation techniques in kinesiotherapy.

Negative examples of premature discontinuation of treatment:¶

A patient with cubital syndrome who discontinued therapy 6 weeks after pain disappeared had a relapse a month later with atrophy of the interosseous muscles - the nerve had not had time to regain trophic function.
An office worker limited to 2 weeks of orthosis for carpal tunnel syndrome experienced chronic dysesthesia - incomplete regeneration resulted in distorted pain signals.

Positive examples of the full course:¶

A violinist who underwent a 4-month programme with Neuromuscular Retraining Therapy not only got rid of finger numbness but also improved movement accuracy - proving proprioceptive fibre regeneration.
A loader with a 3-year history of symptoms who completed 5 months of rehabilitation was able to return to work without restrictions - EMG confirmed normalisation of the velocity of impulse conduction along the ulnar nerve.

There are 3 physiological steps that are critical:¶

0-6 weeks - control of ischaemia (without this, the nerve continues to degenerate).
6-12 weeks - remyelination and restoration of gliding properties.
3-6 months - consolidation of new motor stereotypes, otherwise the brain will revert to old patterns overloading the tunnel again.

Conclusion

Shortening the timeline is not about saving time, but about risking irreversible changes. Our studies show: patients who complete the full course are 5 times less likely to relapse than with ‘express treatment’.

We invite you for the treatment of tunnel syndromes in our specialised centre ‘Paupio Kinezioteka Clinic’!¶

Why choose us?¶

Our centre uses a unique three-stage method of treatment, which has been proven to be effective in 92% of cases, even in advanced stages of the disease. We don't just treat the symptoms - we treat the cause of the problem!

Our benefits:¶

✅ Specialised exercise equipment - the only ones in the region designed specifically for tunnel syndrome rehabilitation
✅ Individualised programmes - each patient is given a personalised treatment plan, taking into account their profession and lifestyle.
✅ Comprehensive approach - we work in parallel with posture and biomechanical disorders causing nerve compression.
✅ Expert team - neurologists, kinesiotherapists and rehabilitation therapists with 10 years of experience.

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