CARPAL TUNNEL SYNDROME
Symptoms include numbness, pins and needles, and pain (particularly at night). Anything that causes swelling inside the wrist can cause carpal tunnel syndrome, including repetitive hand movements, pregnancy and arthritis.
Carpal Tunnel Syndrome symptoms begin when the pressure inside the tunnel becomes too high. This results in your median nerve becoming compressed as it passes through the small tunnel.
The carpal tunnel pressure increase occurs when either of two things happens:
- The tunnel space decreases, such as when the wrist swells eg after a traumatic injury, partial subluxation of the carpal bones or fracture or tenosynovitis.
- When the contents of the tunnel (median nerve, blood vessels and tendons) enlarge.
Both of these situations increase the pressure on the nerve, leading to the carpal tunnel symptoms.
Carpal Tunnel Syndrome (CTS) sufferers will usually experience the following symptoms in their hand or fingers:
- hand pain or aching
- pins and needles
- numbness especially at night with wrist flexing
- weakness or cramping
- perceived swelling
The symptoms are usually worse at night and your grip will weaken as the condition progresses. Eventually you will notice muscle atrophy of the thenar (thumb) muscles and loss of hand function or clumsiness. If this sounds like you, suspect carpal tunnel syndrome.
Your physiotherapist or doctor will generally diagnose carpal tunnel syndrome based on your symptoms. They use various tests such as Phalen’s test, Tinel’s test or the wrist flexion/median nerve compression test that compress the carpal tunnel. It is also important to thoroughly examine your lower neck and upper back joints, plus your nerve tissue mobility – neurodynamics.
Your doctor may refer you for nerve conduction studies or EMG studies to quantify if your nerve electrical impulses are slowed by compression within the carpal tunnel or further up the arm.
Ultrasound may reveal median nerve enlargement. X-ray may identify coexisting pathologies. MRI, CT scans are not normally required.
1) Rest & Patient Education
- Resting from the aggravating cause is important.
- Education and awareness about what the symptoms and what positions or activities potentially cause carpal tunnel syndrome is important.
2) Night Wrist Splint
- A night-time wrist splint is beneficial to eliminate wrist bending and therefore carpal tunnel symptoms.
Physiotherapy is beneficial for most carpal tunnel sufferers especially in mild to moderate cases.
Your physiotherapist will address:
- Carpal bone mobilisation and flexor retinaculum stretching to open the carpal tunnel
- Nerve and tendon gliding exercises to ensure full unrestricted nerve motion is available
- Muscle and soft tissue extensibility
- Grip and pinch, thumb abduction and forearm strengthening in later phases.
- Comprehensive upper limb, wrist and hand ROM strengthening and endurance exercises.
- Posture, fine motor and hand dexterity exercises