Getting a Grip On Carpal Tunnel Syndrome
If you are having discomfort in your hand and wrist, with grip weakness, numb or tingling fingers or maybe just waking up with numbness in one or two hands and feel the need to shake to get relief, you probably have Carpal tunnel syndrome CTS
What is carpal tunnel Syndrome
Carpal tunnel syndrome is a condition that causes numbness, tingling and other symptoms in the hand because of pressure on the Median nerve that runs through the carpal tunnel. The carpal tunnel is a narrow passageway that allows nerves and blood vessels to pass through the palm side of the wrist into the hand. The median nerve provides sensation to the thumb, index and middle fingers as well as power to the muscles around the base of the thumb. Thus altered sensation and / or weakness can occur.
Symptoms begin when the median nerve gets squeezed inside the carpal tunnel known as nerve entrapment. Any condition that decreases the size of the carpal tunnel or enlarges the tissues inside the tunnel to press on the nerve can produce these symptoms.
How do you get carpal tunnel syndrome?
There is no one common cause of carpal tunnel syndrome and it appears that most cases start for no clear reason. Carpal tunnel syndrome appears to most commonly involve women between the ages of 40 and 60 and often affects both wrists to some degree. Genetic factors may predispose some people.
This syndrome may be linked with occupations that require repeated use of the hands, such as typing on a computer keyboard, vibration or doing assembly work, however many people develop this condition regardless of the type of work they do.
Other possible causes include:
- A traumatic wrist injury may cause swelling and extra pressure within the carpal tunnel.
- A wrist fracture or dislocation if the bone pushes into the tunnel.
- Various types of arthritis can cause swelling and pressure in the carpal tunnel.
- Fractured wrist bones may later cause CTS if the healed fragments result in abnormal irritation on the flexor tendons.
- Pregnancy can cause fluid to be retained, leading to extra pressure in the carpal tunnel.
- Diabetics may report symptoms of CTS, which may be from a problem in the nerve itself or from actual pressure on the median nerve.
- People with low thyroid function are also more prone to problems of CTS.
How do you manage carpal tunnel syndrome once you have it?
Generally, treatment begins with a conservative approach and can include splinting, activity modification and exercises.
Importantly early diagnosis and treatment is important as ignoring the early signs of CTS can lead to a prolonged and disabling condition.
Use of anti-inflammatory medications or cortico-steroid injections may be suggested as a means of reducing any inflammation causing pressure on the nerve. There is good evidence to support the use of these medications
What does Physiotherapy involve
Physiotherapy involves a thorough assessment as although carpal tunnel syndrome is a common cause of these symptoms, other sources of nerve impingement can be found in your neck, shoulder or elbow. To get long-term relief, it is important to identify and treat the causes of the problem not just the symptoms. Our physiotherapists are trained in musculoskeletal assessment to arrive at a diagnosis and develop an appropriate treatment plan.
Physiotherapy will help to identify what activities or positions aggravate the symptoms and education to develop strategies to minimize the effect of these factors.
The standard treatment for mild cases of carpal tunnel is splinting and this is generally worn at night and/or during activities that aggravate the symptoms. The most appropriate splint will need to be assessed by your physiotherapist
Treatment usually involves a set of exercises called tendon and nerve gliding exercises. These exercises are designed to increase movement and mobility of the nerve and tendons through the carpal tunnel and upper limb. Exercises to strengthen the muscles around the wrist joint and forearm may also be added to your program. The addition of Kinesiotape to aid in the reduction of inflammation and local fluid retention may also be useful in symptom control.
Hands-on therapy including manual mobilization of the wrist bones, the tendons, and the nerve itself is incorporated to potentially reduce the pressure existing around the nerve which help improve CTS symptoms
Electrical modalities such as ultrasound can also aid in the reduction of local inflammation.
Our recommended Frequency of hand therapy for the conservative management of CTS is 1-2x/wk for 6 weeks, or as indicated by severity and progression aiming to meet the clinical goals within 2 months of therapy.
If these options are not successful or if more aggressive treatment is required, surgery to release the structures pressing on the nerve may be necessary.
The two main manners to decompress the median nerve by surgery are the open carpal tunnel release (OCTR) and the endoscopic carpal tunnel release (ECTR).
Physiotherapy is then often prescribed for rehabilitation post surgery.
Please speak with one of our Physiotherapists experienced in the management of Carpal Tunnel to help you on your way to relieving your symptoms.