Why They Get Confused & How to Tell the Difference

When hand pain, numbness, or tingling begins, many people assume Carpal Tunnel Syndrome (CTS) is to blame. Yet a large percentage of cases diagnosed as “carpal tunnel” actually originate much higher in the body—often in the neck, shoulder, or thorax.

A common imposter? Thoracic Outlet Syndrome (TOS).

Both conditions can create numbness, tingling, and weakness in the hand… but they are not the same problem, and they require different treatment strategies.

This is where skilled clinical assessment matters. At Body Kneads Integrative Healing, we use advanced orthopaedic testing, anatomical pattern recognition, and integrative manual therapy—including microcurrent through Dolphin MPS—to determine the true source of symptoms and treat the root cause, not just the site of pain.

Carpal Tunnel Syndrome: A Quick Definition

Carpal Tunnel Syndrome occurs when the median nerve becomes compressed as it travels through the carpal tunnel in the wrist.

Common symptoms include:

• Tingling or numbness in the thumb, 2nd and 3rd fingers
• Night pain
• Difficulty gripping or holding objects
• Weakness in thumb opposition or fine motor tasks

But Here’s the Critical Truth:  Carpal Tunnel Syndrome rarely develops in isolation. Most cases have contributing dysfunction in the neck, shoulder girdle, thoracic outlet region, scapular stabilizers and fascial networks of the upper quadrant.

If we only treat the wrist, we only prune the leaves—not fix the plant.

Thoracic Outlet Syndrome (TOS): What It Actually Is

TOS occurs when nerves and/or blood vessels become compressed as they travel from the neck and shoulder into the arm.

This compression most commonly happens beneath the clavicle due to fracture or shoulder separation or entrapment under the pectoralis minor and/or anterior and middle scalene muscles due to tightness and myofascial restriction.

Typical symptoms of TOS:

• Numbness/tingling typically into 3rd, 4th and 5th fingers
• Pain or heaviness down the arm, especially when working overhead
• Coldness or colour changes in the hand indicating vascular involvement
• Shoulder and neck tightness or fatigue
• Symptoms often occurring in bed due to postural changes exacerbating the tightness in the neck, shoulder and thorax

TOS sounds intimidating, but with proper care it is very manageable. Many cases resolve with postural retraining, integrative manual therapy, fascial release, and home exercise.

Why They Get Confused

CTS and TOS often become confused because they appear at first to share the common symptoms of hand numbness/tingling/weakness, forearm tightness and bedtime symptoms.

But HERE is the difference:

Feature	Carpal Tunnel	Thoracic Outlet
Location of problem	Wrist	Neck/shoulder/clavicle
Nerve affected	Median nerve only	Neurovascular Brachial Plexus branch(es)
Numbness pattern	Thumb/2nd/3rd fingers	3rd/4th/5th fingers
Aggravated by	Wrist compression, flexion	Overhead activity, posture
Often coexists with	Anterior tension in neck/shoulder/thorax	Anterior tension in neck/shoulder/thorax; Scapular weakness

Orthopaedic Testing Matters

We don’t “guess and massage.” We assess to understand.  

When it is assumed that the painful area is the source of the pain without proving it, much time is wasted and there is opportunity for the issue(s) to get worse.  Orthopaedic testing provide evidence to support clinical thinking as they have predictable and repeatable outcomes for them to be true.  Each pathology has its own key tests:

• CTS:  Phalen’s Test, Tinel’s Sign at the wrist and the Median nerve tension test (ULNTT)
• TOS: Adson’s Test, Roo’s Test (EAST) and the Costoclavicular Maneuver.

These tests help determine site of compression, whether symptoms are vascular or neurological, and which structures require treatment.

Why “Just Working the Wrist” Isn’t Enough

When a plant has yellowing, weak leaves, we don’t simply trim them.  We re-pot it, change the soil, improve the location, add some fertilizer and water, and yes, maybe trim a leaf or two at the end!  Restrictive fascia up the chain chokes flow down the chain: limiting blood flow, nerve conduction and lymphatic drainage.  Without addressing the root, you create a “toxic landfill” effect in the hand—stagnation, inflammation, and nerve irritation.

Hand symptoms are the same way.  If we only work on the wrist, we miss the important contributors.  There is a dynamic of muscles and fascia that need to be stretched and strengthened.  It is critical to release and stretch the anterior chain including the Pecs, Subscapularis, Serratus Anterior, Scalenes, SCM, Subclavius, Biceps and Coracobrachialis.  Then putting efforts to strengthen the posterior chain to maintain the new posture including Rhomboids, Mid Traps, Infraspinatus, Deep Cervical Stabilizers and Suboccipitals.

The Role of Integrative Orthopaedic Massage + Dolphin MPS Neurostim

This is where my approach truly shines. Each treatment begins with a precise orthopaedic assessment—never guesswork—because understanding the actual source of restriction is essential before applying any technique. Once identified, I focus on releasing fascial and muscular compression in the shoulder, neck, and thoracic regions that feed tension into the wrist and hand. The carpal tunnel area is then addressed gently, with attention to restoring healthy posture, scapular mobility, and balance across the upper body. Strengthening key stabilizing muscles ensures that new alignment patterns are maintained and that the improvements become long-term rather than temporary.

The addition of Dolphin MPS Neurostim elevates this process even further. By combining microcurrent stimulation with principles of acupuncture and neuromodulation, Dolphin MPS provides a neurologic “reset” that helps the body restore its own electrical balance. The result is faster nervous system calming, improved local circulation and lymphatic drainage, and tissue recovery that occurs at a cellular level. Clients experience less post-treatment soreness, a deeper sense of release, and results that last longer between sessions. This integration allows me to work more effectively and achieve greater structural change without overwhelming the tissue—making it a true game-changer in rehabilitative care.

What About Surgery?

Carpal tunnel surgery can be successful when the only problem is the wrist.  But when the neck, clavicle, fascial lines, and thoracic outlet are involved—and they often are—surgery does not fix the true issue.  This is why some patients continue to experience symptoms post-surgery.

Final Thoughts

Both Carpal Tunnel Syndrome and Thoracic Outlet Syndrome are highly treatable conditions that respond best to a comprehensive and individualized approach. 

Effective care begins with a detailed clinical assessment to identify the true source of the problem, followed by integrative manual therapy and targeted fascial release to restore balanced movement throughout the upper body. Supporting the nervous system, improving posture, strengthening key stabilizers, and incorporating microcurrent neuromodulation all work together to create longer-lasting relief and improved function. Most importantly, these conditions require a root-cause approach—not a quick fix focused only on symptoms. 

If your hands ache, tingle, or go numb, don’t wait for it to become chronic. Book an assessment so we can pinpoint exactly where the issue begins and design a treatment plan that restores comfort, circulation, and mobility from the neck to the fingertips.

Ready to Feel Your Hands Again?

📍 Serving Okotoks, High River, and Calgary region
📞 403-862-8679
🌐 www.Body-Kneads.ca

Integrative Orthopaedic Medical Massage & Dolphin MPS Neurostim for long-lasting change.