CTS is being reclassified by some researchers as an axonopathy affecting the median nerve not simply compression of the median nerve as it passes through the carpal tunnel.
Again not all cases of CTS are the same. This clinical ambiguity has led to controversial theories such as the 'double crush' theory which supposes that the median nerve may become irritated at multiple sites (neck and/or elbow and/or wrist) which can lead to a sensitisation of the nerve.
The nature of this neck or cervical involvement is still under debate, but most likely represents a central sensitisation of the pain pathways, rather than overt nerve compression.
For clinicians and patients widening the scope of attention to both proximal (close to the body) and distal sites can give us a number of interesting treatment strategies. These often include gentle spinal and carpal manipulation, as well as median nerve mobilisation and postural advice.
Douglas Scown
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