Carpal tunnel syndrome is a common hand injury that can affect anyone and at any time. The ‘Carpal Tunnel’ refers to a gap in the wrist bones (carpals) which provides protection and allows for tendons, blood vessels and nerves to travel into the hand from the forearm. This tunnel, located at the front of the wrist, is bounded by the carpal bones (forming the floor of the tunnel) and tissue known as the flexor retinaculum (which forms the roof of the tunnel). Through this small space, 9 flexor tendons and 1 nerve pass through;
- Median nerve
- Flexor digitorum superficialis
- Flexor pollicis longus
- Flexor digitorum profundas
Causes of Carpal Tunnel Syndrome
As mentioned above, the space within the tunnel itself is rather snug. So that the median nerve can function effectively, pressure and available space within the tunnel must be balanced. Pressure within the tunnel increases when either the available space within the tunnel decreases, or the volume of its contents increases. When pressure becomes too high, the median nerve is compressed (entrapment neuropathy), and symptoms then follow. Common causes include;
- A genetic predisposition
- Repetitive wrist movements (e.g. typing, machine work)
- Autoimmune disorders (e.g. rheumatoid arthritis)
- Altered neurodynamics (e.g. due to scar tissue, muscle tightness)
Signs and Symptoms
- Carpal tunnel syndrome often develops gradually and progressively worsens. It usually begins as tingling and numbness in the median nerve distribution and as the disorder progresses, the pain may change to a burning sensation.
- Symptoms are also most often felt median nerve distribution of the hand (palmar aspect of the thumb, index, middle and half of the ring finger), but the pain can also radiate to the forearm, elbow, or shoulder.
- Swelling in the fingers.
- Night pain which can disturb sleep.
- Thumb weakness and reduced grip strength as it progresses (e.g. turning a key, opening a jar).
- Loss of hand function and clumsiness.
- Pain is worsened by use of the hand (e.g. gripping objects, repetitive flexion, and extension of the wrist).
- Pain is often eased by shaking and flicking of the hand.
For most cases, conservative management via positioning and appropriate exercises has shown to have a favorable outcome. Initially, a physiotherapist will provide education on activity modifications that should be implemented to avoid worsening of symptoms. It is recommended to reduce repetitive wrist activities such as gripping, flexing, and extending the wrist, and ensure proper hand ergonomics when typing on the computer for example. Often, simple changes in how you position and use your hand can be very beneficial in controlling more mild cases.
If symptoms are a bit more severe, your physiotherapist may prescribe a splint for you to wear. Wearing a splint during the day will ensure the wrist stays in a neutral position and minimizes motion at the wrist which reduces the space within the carpal tunnel. If night pain is an issue, a night splint can be worn in order to avoid the wrist being placed in positions that will aggravate symptoms (without you even being aware of it). If a night splint isn’t for you, try sleeping with your hands in a prayer position between your legs or under your pillow.
A physiotherapist can also help to relieve pain and optimize function by a range of manual therapy techniques including soft tissue massage, mobilization, nerve gliding and ultrasound.
Most importantly, a physiotherapist will prescribe a range of stretching and strengthening exercises designed to relieve symptoms and strengthen the supportive structures of the carpal tunnel.
If after conservative management, the condition is still very persistent and severe, surgical intervention may be considered. This minor procedure is often performed by an orthopedic or hand surgeon and aims to open more space within the tunnel to release the median nerve.
If you or a family member would like to learn more about physiotherapy for Carpal Tunnel Syndrome, the physiotherapists at Back In Motion Como would love to help!
Phone Number: 9313 3414