Carpal Tunnel Syndrome

Carpal tunnel syndrome: 

Facts: 

1. Carpal tunnel syndrome is caused by irritation of the median nerve at the wrist. 
2. Any condition that exerts pressure on the median nerve can cause carpal tunnel syndrome. 
3. Symptoms of carpal tunnel syndrome include numbness and tingling of the hand. 
4. Diagnosis of carpal tunnel syndrome is suspected based on symptoms, supported by physical examination signs, and confirmed by nerve conduction testing. 
5. Treatment of carpal tunnel syndrome depends on the severity of symptoms and the underlying cause. 

What is carpal tunnel syndrome? 

The wrist is surrounded by a band of fibrous tissue that normally functions as a support for the joint. The tight space between this fibrous band and the wrist bone is called the carpal tunnel. The median nerve passes through the carpal tunnel to receive sensations from the thumb, index, and middle fingers of the hand. Any condition that causes swelling or a change in position of the tissue within the carpal tunnel can squeeze and irritate the median nerve. Irritation of the median nerve in this manner causes tingling and numbness of the thumb, index, and the middle fingers -- a condition known as "carpal tunnel syndrome." 

What are carpal tunnel syndrome symptoms? 

People with carpal tunnel syndrome initially feel numbness and tingling of the hand in the distribution of the median nerve (the thumb, index, middle, and thumb side of the ring fingers). These sensations are often more pronounced at night and can awaken people from sleep. The reason symptoms are worse at night may be related to the flexed-wrist sleeping position and/or fluid accumulating around the wrist and hand while lying flat. Carpal tunnel syndrome may be a temporary condition that completely resolves or it can persist and progress. 

As the disease progresses, patients can develop a burning sensation, and/or cramping and weakness of the hand. Decreased grip strength can lead to frequent dropping of objects from the hand. Occasionally, sharp shooting pains can be felt in the forearm. Chronic carpal tunnel syndrome can also lead to wasting (atrophy) of the hand muscles, particularly those near the base of the thumb in the palm of the hand. 

How a physio can help? 

Determining the cause and contributing factors is important in the management. Reducing inflammation associated with a fracture or an injured tendon will help reduce pressure in the carpal tunnel. If symptoms are related to vibration then modifying work practices to avoid prolonged exposure is important. Similarly avoiding prolonged positioning of the wrist in a flexed or extended position is important. Splints, different equipment, different grips may all be useful to change and support the wrist mechanics. 
Wear a splint: 
A specific carpal tunnel splint that helps to keep the wrist in a neutral position helps minimise the pressure in the carpal tunnel. Initially the splint may need to be worn for long periods to allow symptoms to settle. As symptoms settle the splint is worn for shorter periods. 
Rest: 
Rest from aggravating activities is important, it helps settle inflammation and alleviates symptoms. 

Exercise Program: 

Your physiotherapist will give you stretches and exercises that help to mobilise the median nerve, help strengthen the muscles around the wrist and stretches to stretch the structures around the wrist to help settle and alleviate symptoms and to prevent recurrences. 

Surgery? 

In cases that are left untreated, serious cases, or cases that don’t respond to treatment, surgery is sometimes needed. Surgery involves decompression of the nerve. Most people do well after such surgery.