Carpal Tunnel Syndrome
Updated: Feb 27, 2019
In this week’s blog we are focusing on carpal tunnel syndrome (CTS). CTS is one of the most common conditions that affects the wrists and hands, it is a nerve compression syndrome and is generally accompanied by pain, pins & needles, numbness, and a loss of strength in the hand and fingers.
The carpal tunnel is a narrow passageway, at the wrist, where the tendons, ligaments and nerves run from the forearm to the hand. It is comprised of the carpal bones which make up the bottom of the tunnel and the transverse carpal ligament which seals everything in at the top. Inside the tunnel there are 9 tendons and the median nerve. This nerve is responsible for the sensation in the thumb, forefinger, middle finger and half of the ring finger. The 9 tendons that run through it are those involved in wrist and finger flexion.
What happens to the structures to create the problem and how does it commonly occur?
There are many different causes of carpal tunnel syndrome. Essentially anything that reduces the amount of space for the tendons and nerve to run can cause compression. This can be from something growing into the carpal tunnel (i.e. bone spurs, ganglions) or the structures running through the space getting bigger (i.e. inflamed tendons).
Trauma to the area can cause inflammation which results in swelling in the tunnel, thereby shrinking the amount of available space and compressing the median nerve against the transverse carpal ligament. This results in a block on the messages that go to and from the hand leading to the feeling of numbness in the hand and fingers. Other causes involve arthritis which may cause bony overgrowths or inflammation like trauma and congenitally people can be born with a smaller carpal tunnel.
The most common cause that we see at CBD Wellness Centre is from an overuse injury to the area, such as repetitive hand movements or sustained risky wrist postures that are common in people who use their hands a lot for work (i.e. typists, desk workers, builders).
Any time the hand or wrist is moved away from a neutral position the pressure in the carpal tunnel begins to increase. The further we move into wrist flexion or extension the greater the pressure becomes, thus people who suffer from CTS can normal reproduce their symptoms by holding the hands in end range wrist flexion or extension.
If this position is coupled with a repetitive activity (e.g. typing), or an activity with a lot of vibration (e.g. drilling) the use of the hand creates more blood flow into the muscles and tendons causing them to increase in size. In this example we now have a reduced tunnel size due to the position of the hand, and larger tendons due to them being used which can ultimately result in compression on the median nerve.
What are the signs and symptoms of CTS?
Some common signs and symptoms of carpal tunnel syndrome involve a sensation of numbness and tingling or pins and needles that affect the thumb, forefinger, middle finger and half of the ring finger.
Pain that can vary from a dull, aching sensation, through to a burning feeling, or a sharp, piercing or shooting pain that starts at the wrist and extends into the limbs mentioned before. This pain may also feel like it is travelling up the arm and into the shoulder and may feel like it is relieved by shaking out the hands.
Lastly you may also experience a feeling of weakness in your hands and that you don’t have any grip strength making it difficult to hold small objects or clench your fist.
Can CTS be Treated?
Yes. CTS is a very common problem due to the amount of use our hands get. Conservative treatment is always preferred over surgical treatment and has a lot of benefits.
Initially the best form of treatment, especially where overuse is the cause, is to rest the wrist by avoiding anything that aggravates the pain for at least 2 weeks. Splinting, for a short period, may also be beneficial but should be used sparingly so that the muscles don’t become deconditioned.
During the resting period Physiotherapy, Chiropractic and Remedial massage can be very effective in relieving pain by releasing the muscles of the forearm and wrist, mobilising the joints and nerves and reducing inflammation. Once out of this painful period it is important to engage in an exercise program focusing on restoring normal range of movement and strength to the wrist and hand, to maximise function and minimise the chance of recurrence in the future.
Preventing the onset of CTS is much easier than treating it, so here’s 3 Tips to help minimise the risk of CTS occurring:
1. Warm up your fingers, wrists and forearms with stretching exercises before work
2. Making sure your desk or work area is correctly adjusted to maintain a neutral wrist position.
3. If you are going to be engaging in an activity that requires repetitive use of the hands, ensure you take regular breaks.
So that’s a brief overview of how carpal tunnel syndrome occurs, If you have questions or comments feel free to e-mail us at firstname.lastname@example.org and we will be happy to answer them for you.
If you think you may already be suffering from carpal tunnel syndrome, then addressing it sooner rather than later is crucial. So, if you want relief now, call us on (08) 9486 8653 and we will arrange an appointment for you.