Carpal Tunnel Syndrome
Carpal Tunnel Syndrome is pain, numbness, and tingling, in the wrist and hand particularly in the thumb, index and middle finger. This syndrome affects approximately 3-6% of the general population. The carpal tunnel is a small passageway at the wrist that tendons and the median nerve run through as they travel into the hand. The tunnel is surrounded by bone and connective tissue so it does not easily stretch or expand, making structures within it susceptible to irritation which can cause the median nerve to be compressed. If left untreated and the condition worsens, symptoms may progress to include weakness in the hand.
Causes and Risk Factors
A combination of several of the following factors can increase the risk of developing carpal tunnel syndrome:
- Chronic stress on wrist/hand – typically affecting the dominant hand, often due to working posture or repetitive motions (eg. using computers for several hours a day, assembly-line workers, musicians, using vibrating power tools)
- Trauma to the wrist (eg. fracture, sprain) – can cause damage to the nerve or swelling to other structures that will narrow the carpal tunnel
- Pregnancy – hormonal changes can affect tendons and cause swelling
- Arthritis – bony growths into the tunnel narrow the space
- Congenital Predisposition – women and smaller individuals may have narrower carpal tunnels, reducing space for the nerve
- Diabetic or Metabolic Disorders – negatively affect the body’s nerves
The most common symptoms of carpal tunnel syndrome include:
- Gradual onset of pain, burning, tingling, numbness or itching in the palm, thumb and/or index and middle fingers
- Feeling of weakness and swelling in the hand, with difficulty grasping small items, making a fist and performing fine motor tasks
- Urge to shake out the hand to relieve the tingling sensations
In the early stages, symptoms will often be intermittent. However, as the condition worsens symptoms are more severe and begin to persist for longer periods of time. Pain and numbness tends to be worse at night for a lot of individuals.
It is advised to seek treatment from a professional as soon as carpal tunnel symptoms arise as the condition will not typically resolve on its own.
Medication: Over the counter anti-inflammatory drugs (eg. Ibuprofen) may provide short term relief from mild symptoms. Corticosteroid injections are a much stronger anti-inflammatory, and may also be a temporary option to help relieve pressure and symptoms for those with relatively mild symptoms.
Physiotherapy: Seeking help from a registered physiotherapist is one of the best options for treatment of carpal tunnel syndrome. Physiotherapy will include manual therapy on your wrist to improve the mobility of the joints and stretch tight muscles and tendons in the wrist and fingers, helping to remove any scar tissue buildup that may hinder recovery. The Physiotherapist will also incorporate nerve gliding techniques to help improve the mobility of the median nerve through the carpal tunnel. Ultrasound may be used over the carpal tunnel area to reduce inflammation which helps to relieve symptoms. Your physiotherapist may also suggest a brace or splint to immobilize the wrist while working or performing aggravating activities. They will provide education about activity modification to avoid aggravating positions, such as holding the wrist in a flexed (bent) position. Your physiotherapist will also prescribe specific stretching and strengthening exercises for the fingers, thumb, hand and arm to progress through later stages of recovery. They will provide education on proper posture while working to prevent relapse.
Surgery: With very severe cases of carpal tunnel syndrome where nonsurgical treatment does not provide any relief, surgery may be an option. The surgery typically consists of cutting the roof of the carpal tunnel, to provide more room for the tendons and median nerve and decrease compression. Full recovery back to original strength in the hand may take 6-12 months.
While carpal tunnel is a relatively common condition, it is often misdiagnosed, thus it is a good idea to seek treatment from a registered physiotherapist upon the onset of symptoms in order to have the best chance of full recovery and to prevent irreversible damage. Your physiotherapist will be able to recommend appropriate treatment options, whether that be manual therapy, bracing, or if necessary, surgical intervention.