News: Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is the most common nerve compression condition of the upper limb, occurring in roughly 2.7% of the general population. It can lead to significant issues doing even the most basic of activities from writing to eating and working. 60% of people with CTS will have it in both hands, making life even more difficult. Carpal tunnel can often force people to change job if they are in a profession where they are required to perform repetitive tasks with their hands.

What is carpal tunnel syndrome?

Carpal tunnel syndrome is caused by compression of the median nerve as it passes through the wrist. This compression of the median nerve causes pain, weakness, numbness and tingling into the hand. The 8 bones of the wrist -called the carpals- form a C-shaped structure and the transverse ligament forms a tunnel. The median nerve as well as tendons from the flexor muscles of the forearm pass through this tunnel. If these tendons become inflamed or there is swelling in this enclosed space, the nerves and blood vessels get compressed causing pain, weakness and numbness and tingling or loss of sensation in the palm and fingers.

What causes carpal tunnel syndrome?

The most common cause is repetitive movements with the wrist and hand that cause the tendons passing through the carpal tunnel to become inflamed.  The inflamed tendons swell, reducing the space in the tunnel and compressing the median nerve.

Pregnancy and situations that cause fluid retention (e.g. menopause) can also cause reduced space in the tunnel.

Inflammatory conditions like rheumatoid arthritis can also inflame the tendons in the tunnel; metabolic conditions like diabetes can alter the tendons too.

Lastly, on rare occasions, direct trauma may lead to carpal tunnel syndrome.

What are the symptoms of carpal tunnel?

• Weakness in gripping objects, particularly smaller ones
• Shooting pain into the palm and thumb, index finger and ring finger
• Numbness, pins and needles or tingling in the palm and thumb, index finger and ring finger
• Pain, pins and needles, numbness or tingling at night that often wakes you up
• Reduced size of the muscles (atrophy) near the thumb in long-term severe cases
• Shiny and dry skin of the hand (due to reduced circulation)
• Stiffness and cramping of the hand
• Frequent dropping of objects or clumsiness in the hand

Do you have any of these symptoms? If the answer is yes, book in for an assessment to find out how we can help. BOOK HERE

Why it is important to get the right diagnosis and how is CTS diagnosed?

The symptoms of carpal tunnel commonly overlap with those of irritation of nerve roots in the neck, or compression of the median nerve or other nerves as they pass from the neck through the shoulder, elbow, forearm and hand. It is important to see a skilled practitioner for diagnosis for two reasons:

1. Undiagnosed nerve compression syndromes can lead to significant muscle loss, weakness and pain that can often make even the most basic tasks like brushing your teeth or eating with a knife and fork difficult;
2. There is no point doing lots of wrist and hand work if the pain is actually coming from you neck, elbow or other regions!

A thorough examination can often be enough to diagnose carpal tunnel syndrome but if the diagnosis is unclear you may need a nerve conduction study that checks how the nerve signal passes through your nerves and shows how the nerves are functioning.   Typically ultrasound or MRI may also be used to confirm the diagnosis alongside a nerve conduction study and look for changes to the amount of space in the tunnel.

How do you treat carpal tunnel syndrome?

Once your diagnosis of carpal tunnel syndrome has been confirmed, treatment may begin. Carpal tunnel syndrome can be treated very effectively and there are multiple options to pursue.  A management strategy may include some of the following options:

• Home exercise program including mobility and stretching exercises of the hand and wrist, nerve gliding exercises and hand and wrist strength exercises to build back up the loss in grip strength later on.
• Hands on treatment including stretching, mobilisation, and massage to the ligaments and muscles of the hand, wrist and forearm.
• Rest from aggravating activities e.g. activities that require gripping or highly repetitive movements of the wrist
• Splinting of the wrist and hand at night.
• Address predisposing factors e.g. diabetes, smoking, obesity, via improvement in lifestyle choices.

• Anti-inflammatory medications if appropriate (anti-inflammatory medications may not be appropriate during pregnancy or breast feeding)
• Alterations to activities e.g. hanging your hand off your bed at night may help to improve blood flow to the area; using a fork or other utensil with a thicker handle may make it easier to grip.
• Surgery – a carpal tunnel release cuts one of the ligaments travelling over the wrist to allow more room, thereby reducing the pressure on the tendons and nerves. It can be very effective and is one of the most commonly performed surgeries but, like all surgeries, there are risks involved.  The current wait time for carpal tunnel surgery in Australia is 5 months.  A 2020 study showed people who undertook a program of exercise, splinting and education on how to alter their activities had a significantly higher chance to remove themselves from the surgical wait list due to improvement in their condition. So, even if you decide to have surgery, I recommend trying the above interventions while you wait.

If you have wrist and hand problems, numbness and tingling in your fingers or a loss in hand strength come and see one of our experienced and qualified practitioners. 

Book your appointment

References

Dec, P. and Zyluk, A., 2018. Bilateral carpal tunnel syndrome – A review. Neurologia i Neurochirurgia Polska, 52(1), pp.79-83.

Brukner, P., Clarsen Ben, Cook, J., Cools, A., Crossley, K., Hutchinson, M., McCrory, P., Bahr, R. and Khan, K., n.d. Brukner & Khan’s clinical sports medicine.

Lewis, K. J., Coppieters, M. W., Ross, L., Hughes, I., Vicenzino, B., & Schmid, A. B. (2020). Group education, night splinting and home exercises reduce conversion to surgery for carpal tunnel syndrome: a multicentre randomised trial. Journal of Physiotherapy, 66(2), 97–104. https://doi.org/10.1016/j.jphys.2020.03.007

Padua, L., Aprile, I., Caliandro, P., Carboni, T., Meloni, A., Massi, S., Mazza, O., Mondelli, M., Morini, A., Murasecco, D., Romano, M., & Tonali, P. (2001). Symptoms and neurophysiological picture of carpal tunnel syndrome in pregnancy. Clinical Neurophysiology, 112(10), 1946–1951. https://doi.org/10.1016/s1388-2457(01)00637-x

Smith, D. (2012). American Academy of Orthopaedic Surgeons Clinical Practice Guideline on: The Treatment of Carpal Tunnel Syndrome. Yearbook of Plastic and Aesthetic Surgery, 2012, 82–84. https://doi.org/10.1016/j.yprs.2010.12.020

Atroshi, I. (1999). Prevalence of Carpal Tunnel Syndrome in a General Population. JAMA, 282(2), 153. https://doi.org/10.1001/jama.282.2.153

Pourmemari, M. H., Heliövaara, M., Viikari-Juntura, E., & Shiri, R. (2018). Carpal tunnel release: Lifetime prevalence, annual incidence, and risk factors. Muscle & Nerve, 58(4), 497–502. https://doi.org/10.1002/mus.26145

Page, M. J., O’Connor, D., Pitt, V., & Massy-Westropp, N. (2012). Exercise and mobilisation interventions for carpal tunnel syndrome. Cochrane Database of Systematic Reviews. Published. https://doi.org/10.1002/14651858.cd009899

Peters, S., Page, M. J., Coppieters, M. W., Ross, M., & Johnston, V. (2016). Rehabilitation following carpal tunnel release. Cochrane Database of Systematic Reviews. Published. https://doi.org/10.1002/14651858.cd004158.pub3