CARPAL TUNNEL SYNDROME: CAUSES AND TREATMENTS
Carpal tunnel syndrome is a common condition that occurs when there is too much pressure on the median nerve in one or both wrists. It may include symptoms of; tingling, numbness and pain in the wrists, hands and fingers.
The term ‘carpal tunnel’ refers to a small corridor running to the wrist inside the forearm. It is comprised of the carpal bones at the top of the tunnel and the transverse carpal ligament on the underside of the tunnel. Tendons, blood vessels and the median nerve all occupy this small space and each structure contributes to the function of the hands and wrist (Figure 1).
The primary symptoms of Carpal Tunnel syndrome may include sensations of tingling, pain or numbness, and weakness, resulting in difficulty gripping objects and moving fingers. Pain, pins and needles and weakness is often concentrated in the thumb, index and middle finger and half of the ring finger as well as in the wrist itself. Symptoms are generally worse at night, and symptoms tend to be stronger on your dominant hand side.
Generally, anything that reduces the space in the carpal tunnel, or increases the volume in the tunnel or irritates the median nerve can result in carpal tunnel syndrome. Most commonly, inflammation from an underlying condition can lead to increased swelling in the wrist and sometimes reduced blood flow. Some of the causes include:
- Wrist fracture
- Rheumatoid arthritis in the wrist
- Flexor Tenosynovitis or flexor tendinitis
- Repetitive bending or sustained bending of the wrist
Carpal tunnel is diagnosed by these painful symptoms in conjunction with a number of non-invasive tests and a physical assessment done by a Hand Physiotherapist. Depending on symptoms and circumstance, an ultrasound may be advised in order to check for irregularities in the wrist. Unclear symptoms may require a nerve conduction study in order to determine precisely what problem is occurring.
Treatment for carpal tunnel may include using a wrist splint to enable the wrist to rest, thereby reducing the swelling in the tunnel. A splint will maintain the wrist in the best position to minimise the pressure within the tunnel. Your Hand Physiotherapist may also use manual treatments to reduce inflammation and swelling, improve movements in the hand and wrist and to maintain the strength of the hand and wrist.
Home exercises to help alleviate symptoms including: icing the hand and wrist, elevating the hand and wrist and gently exercising to try to restore some flexibility and strength may also be incorporated in the management for Carpal Tunnel Syndrome. If these methods are not effective, steroid injection of cortisone, diuretics and surgery may be considered in consultation with a Hand Surgeon.
Further discussion with your Hand Physiotherapist on how to manage symptoms and adapt your household and work activities to work around the condition and alleviate its symptoms can be very helpful.
About The Author: Sophie Halsall-McLennan is Physiotherapist from Australia who specialises in running clinical pilates in the Geelong region and is the owner of Fresh Start Physiotherapy. She has a Bachelor of Physiotherapy from Charles Sturt Physiotherapy, and over 12 years of clinical experience as a Physiotherapist and is registered with AHPRA. She is also a Lecturer at Deakin University.