Hello and welcome back again to the ThreeSpires Physiotherapy blog where we take a look at all things physiotherapy and health related. In the last blog post we looked at a pathology of the upper limb: golfer's elbow, so I thought that we might as well continue with examining problems of the upper limb in this blog post. In this article we will have a brief look at a fairly common problem affecting the hands which at its worst can be debilitating and require surgery: carpal tunnel syndrome. 

What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome describes a collection of symptoms in the hand and fingers caused by compression of the median nerve. Patients with Carpal Tunnel Syndrom will often experience pain, tingling and weakness of the fingers and thumb which is worst at night.

What Causes Carpal Tunnel Syndrome?

To understand what causes it, we need first to understand a bit of anatomy at the wrist and hand. The wrist is made up of the carpal bones which are just beyond the crease in your wrist that you can see whenever you bend your wrist. At this point all of the tendons that flex the wrist and fingers funnel together into a very narrow and compressed space called the carpal tunnel, across the top of these tendons passes that transverse carpal ligament. Running through this tunnel and amongst the finger flexors is the median nerve which supplies the thumb and first two fingers. For reasons that are still being researched sometimes the median nerve becomes compressed in this tunnel and this is what causes the pain, numbness and tingling that patients with carpal tunnel will describe. Some common causes of this compression are manual labour e.g. repetitive use of hammers, the use of vibrating machines and poor positioning of the wrist whilst using a mouse.

What are The Symptoms of Carpal Tunnel Syndrome?

As decsribed earlier the main symptoms are pain, tingling and weakness of the fingers and thumb of the hand, most usually at night. In the initial stages these symptoms will be relatively mild and only slightly troublesome for patients. However as things develop the pain and tingling occurs more frequently and more severely. If left untreated and in severe cases the compression of the nerve causes loss of muscle mass of the thumb and thenar eminence. 

Who Gets Carpal Tunnel Syndrome?

Well, anyone can get Carpal Tunnel Syndrome but some groups are more at risk than others. It is more common in women and more common in older people. Carpal Tunnel is also more common in pregnancy and in people who work with their hands. This includes manual labourers, plumbers, electricians and also office workers who do a lot of typing and repetitive tasks. 

What are The Tests For Carpal Tunnel Syndrome?

There are several physical tests for carpal tunnel that can be used in conjunction with the patient's history to confirm a diagnosis of carpal tunnel. The two most commonly used are Phalen's and Tinel's. Phalen's Test for Carpal Tunnel Syndrome involves holding the wrist bent for approximately 1minute and Tinel's Test involves striking the sight of the median nerve at the wrist. If these tests are positive and symptoms particularly severe then nerve conduction tests prior to accepting surgery can be useful to fully confirm a diagnosis of Carpal Tunnel Syndrom.

Medical Warning:

Please be aware that this article about Carpal Tunnel Syndrome does not replace the need to seek medical help if you are experiencing pins and needles, pain or weakness in your hands. It is extremely important that you get your symptoms assessed by a professional rather than relying upon self-diagnosis as numbness, tingling and pain in the hands can be signs of several other conditions which need ruling out first.

What are The Treatments For Carpal Tunnel Syndrome?

The treatment for Carpal Tunnel Syndrome depends upon severity of symptoms, in general for those with mild symptoms conservative management is the first line of treatment. Some treatment options for Carpal Tunnel Syndrome are listed below:

1. Wrist Positioning: avoiding the aggravating positioning of your wrist can be enormously effective for mild symptoms and can simply involve trying to keep the wrist straighter in general.

2. Night Positioning: again avoiding allowing the wrist to be in a bent position all night can be very effective in managing the mild symptoms of Carpal Tunnel Syndrome.

3. Wrist Braces:for patients who are struggling to effectively manage their Carpal Tunnel Syndrome wrist braces that help keep the wrist in a neutral position can be effective. These can either (or both) be used at night or in the day.

4. Activity modification: sometimes there is a particular activity or piece of work that is particularly aggaravting for someone's Carpal Tunnel Syndrome and in these cases often the best approach is to modify this activity. For example if typing in an office it might mean getting a wrist support for your mouse or modifying the position of the mouse. If cycling is an issue then changing the hand position or handlebar height can help

5. Medication: this involves the use of pain relief and anti-inflammatories to manage the symptoms of Carpal Tunnel Syndrome and can be effective.

6. Stretching: making sure that your wrist, elbow, shoulders and neck have good mobility can sometimes help with reducing any nerve compression with Carpal Tunnel Syndrome.

7. Acupuncture: can be helpful and relieve pain in some patients with Carpal Tunnel Syndrome but is very variable in its effects.

8. Massage: soft tissue techniques can help stretch out affected araes and provide reliefe in some patients with Carpal Tunnel Syndrome.

9. Surgery: For those with more severe symptoms or those who have had no relief with other methods, surgery is the next step. This involves a surgical release (cutting) of the transverse carpal ligament in order to decompress the nerve. Results are usually excellent and rehab involves a period of physiotherapy to strengthen the wrist, hand and stretch tissues out.

Okay, I think that should do for one blog post on Carpal Tunnel Syndrome. I hope that you ahve found it useful and if you would like anymore information about Carpal Tunnel Syndrome then please get in touch.I hope that you have enjoyed reading this blog post. For anyone reading this blog who hasn't come across our site before: we are a home visit physiotherapy service, based in Lichfield but serving anywhere within a 20 minute drive including areas such as Sutton Coldfield, Tamworth, Cannock, Burton and Rugeley. We offer a wide range of services including paediatric physiotherapy, post-operative rehabilitation, neurological physiotherapy and neck and back pain relief. If you need further information or would like to book an appointment we can be contacted on 0788 428 1623 or via enquiries@threespiresphysiotherapy.co.uk