Issue link: https://www.massageandbodyworkdigital.com/i/68013
WORKING WITH WRIST AND CARPAL BONES Wrists are amazing structures. They mediate the relationship between our stable, larger- boned arms and the highly mobile, sensitive dexterity of our hands. Additionally, key structures pass through the wrists from arms to hands: tendons, nerves, and vessels. Here are two effective techniques for working with the wrist, both drawing on the myofascial work as taught in Advanced- Trainings.com's Advanced Myofascial Techniques workshop and DVD series. Carpus is the name of the boney structure formed by the two rows of small carpal bones. Wherever these bones meet each other, they have slippery hyaline cartilage and fluid- filled synovial joints between them. They are also secured by a complex system of strong interlocking ligaments (Image 1). In other words, the carpal bones are built to both move against one another and to provide stability. By combining these two qualities, the integrated structure of the carpus provides a stable but adaptable base for the varied movements of the hand, fingers, and thumb. Problems can occur when either mobility is lost (hypomobility) or when stability is lost (hypermobility). Hypomobility issues can arise from several causes, including past injuries that have self-splinted as they healed; surgeries; arthritic conditions; and/or adaptations to heavy or repetitive work. Generally speaking, hypermobility issues are usually the result of injury or congenital conditions. Typically, bodyworkers will see more clients with issues related to lack of mobility than clients with too much mobility, and so it is here that we will focus.1 Lost carpal mobility can play a large part in the numbness and pain of carpal tunnel compression symptoms. Together with the bowstring-like flexor retinaculum, the bowed arch of the carpus forms the carpal tunnel—the space through which the tendons, vessels, and nerves of the hand pass. The distal row of the carpus and the carpal tunnel, in cross section. The flexor retinaculum, on the palm side, is labeled FR. The capitate bone (C) is prone to being fixed anteriorly (or volar, toward the palm) and so contributing to carpal tunnel narrowing. Structurally, it is all too easy for the contents of this tunnel to become crowded and unhappy. Although there are many things that can contribute to carpal tunnel narrowing, an immobile capitate bone is often a prime factor (Image 2). If the capitate is unable to move dorsally with wrist extension, the carpal tunnel flattens and neurovascular compression symptoms of pain, weakness, and numbness can occur, especially in the median nerve distribution area of the thumb pad and the ends of fingers 2–3.2 visit massageandbodywork.com to access your digital magazine 123