Tunnel Syndromes Affecting the Hands and Feet: Types, Symptoms, and Treatment

Nerve compression syndromes are more common than most people would think. Many people brush them off as just stiffness or a bit of tingling. There are quite a few types as the syndromes can depend on which type of nerve is being compressed and which location the compression of the nerve occurs.

Carpal Tunnel Syndrome

This is the most well-known one. The median nerve allows for the sensation of the thumb, index, middle, and part of the ring finger. Compression of the median nerve occurs around the wrist at the carpal tunnel. This can occur from a fracture, a tumor, a cyst, or inflammation from overly used repetitive work around the wrist. Rheumatoid arthritis can also be a cause.

The symptoms are typically numbness, tingling and pain in the thumb and index and middle fingers. This can be worse at night. The pain can travel all the way up to the shoulder from the forearm. As the syndrome worsens, the effects can be a weak grip, and the ability to hold small objects can be lost. Over time the fine motor skills can be lost as well, and patients can lose the ability to determine if something is hot or cold by touch. The base of the thumb can also be affected by muscle wasting. The females in the population are more affected by this than the males.

Cubital Tunnel Syndrome

Cubital Tunnel Syndrome occurs when the ulnar nerve becomes entrapped in the tunnel on the inside of the elbow. This can occur as a result of repeated elbow flexion, injury, or even arthritis.

Cubital Tunnel Syndrome can cause pain and a weak grip in addition to tingling in the ulnar nerve’s distribution (the little and ring fingers). Symptoms typically worsen when the elbow is flexed.

Radial Tunnel Syndrome

Like Cubital Tunnel, Radial Tunnel Syndrome occurs when a nerve becomes entrapped in a tunnel in the arm. The radial nerve becomes entrapped in the tunnel located on the outside of the elbow. Radial Tunnel Syndrome is typically the result of inadequate strength or flexibility of the arm and wrist and can be exacerbated by the presence of a cyst or tumor.

Unlike symptoms of other nerve entrapment syndromes, Radial Tunnel Syndrome typically lacks the tingling and numbness. Pain is most notable and is exacerbated by the use of the elbow. Radial Tunnel Syndrome can cause weakness of the forearm and result in the inability to hold the wrist in the flexed position (wrist drop).

Tarsal Tunnel Syndrome

This condition is similar to Carpal Tunnel Syndrome, but affects the foot. Known as posterior tibial neuralgia, this condition is the result of compression of the posterior tibial nerve as it passes through the tarsal tunnel on the inside of the ankle. This compression can result from flat feet, ankle sprains, arthritis, diabetes, varicose veins, cysts, or bone spurs.

This condition presents numerous symptoms including pain, tingling, numbness, and a burning sensation in the foot. These symptoms can be frustrating during the amount of time needed to accurately diagnose the condition.

How These Conditions Are Diagnosed and Managed

Standard diagnosis of this condition begins with a physical exam of the foot. This is often supplemented with an X-ray, MRI, electromyography, or nerve conduction studies in order to confirm which nerve is affected and determine the severity of the diagnosis.

Because this condition is the result of nerve compression, the most effective treatment is to avoid or alter the movement that is actually causing this compression. Resting the affected nerve and splinting the foot will protect the nerve from further irritation. Physical therapy can introduce less irritating movement and can assist in the lagun tissue that surround and compress the nerve.

The Ayurvedic Approach

The focus with treatment at Kottakkal Ayurveda is to reduce the nerve compression through swelling and inflammation. This is actually the root cause of the pain that so many other treatment options focus on. Lepanam (where a medicated paste is applied), medicated bandaging, Pekichu, and Dhara (where a stream of medicated oil is poured) are all external therapies that use these medicated oils to help reduce swelling and discomfort in the affected limbs.

After acute inflammation has decreased, treatments such as Shashtika Pinda Swedam strengthen the muscles surrounding the joint. Other internal Ayurvedic medicines are used to help balance the doshic disturbance that is the root cause of the condition. The treatment of any nerve compression issue using Ayurveda should be done only with the supervision of qualified personnel, as the treatment along with the duration is determined by the state of the compression and the specific nerve involved.

Frequently Asked Questions

All tunnel syndromes share the same pathophysiology: chronic nerve entrapment and compression. Without proper management, the condition progresses and becomes increasingly difficult to treat. Early recognition of the condition and avoidance of the repetitive causative activities are very important for effective treatment. Ayurvedic therapies are an excellent and effective adjunct treatment modality aimed at reducing both the inflammation and the underlying cause of the imbalance of vata dosha. At Kottakkal Ayurveda, treatment is individualized for the specific vitiated dosha and impacted nerve.

About the Author

Dr Nasreen Thacham Poyil graduated from VPSV Ayurveda College, and is currently practicing at Kottakkal Ayurvedic Treatment Centre, Ajman. Her range of expertise is comprehensive and includes the treatment of musculoskeletal, dermatological, gastrointestinal, gynaecological, and neurological disorders.

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