The carpal tunnel is a narrow passageway on the palm side of your wrist – it is made up of bones on one side and ligaments on the other. The median nerve, which controls sensation and movement in the thumb and first three fingers, runs through this passageway along with tendons to the fingers and thumb. When these structures are pinched or compressed in this passageway, it causes numbness, tingling, weakness or pain in the hand – this is called carpal tunnel syndrome. At first, symptoms of carpal tunnel syndrome come and go, but as the condition worsens, symptoms may become constant. Pain may radiate up the arm all the way to the shoulder. Over time, if untreated, carpal tunnel syndrome can cause the muscles on the thumb side of your hand to waste away (atrophy).
There usually isn’t one definitive cause of carpal tunnel syndrome. Because the carpal tunnel is narrow and rigid, anytime there is swelling or inflammation in the area, the median nerve can be compressed and cause pain. Symptoms may be present in one or both hands (usually symptoms develop in the dominant hand first). Women are three times more likely than men to get carpal tunnel syndrome. Other conditions can also increase your risk of developing carpal tunnel syndrome include:
⦁ Diabetes, gout, hypothyroidism, and rheumatoid arthritis ·
⦁ Sprain or fracture of the wrist
Carpal tunnel develops slowly. At first, you’re most likely to notice it at night or
when you first wake up in the morning. The feeling is similar to the “pins-andneedles” sensation you get when your hand falls asleep. During the day, you may notice pain or tingling when holding things, like a phone or a book, or when driving. Shaking or moving your fingers usually helps. As carpal tunnel syndrome progresses, you may begin to notice weakness in your thumb and first two fingers, and it may be difficult to make a fist or grasp objects. You may find yourself dropping things, or you may have trouble doing things like holding a utensil or buttoning your shirt. Carpal tunnel syndrome can also cause a feeling of numbness in the hands. Some people feel like their fingers are swollen, even though no swelling is present, or they may have trouble distinguishing between hot and cold. There are several tests to confirm if you have carpal tunnel syndrome. The Tinel test involves tapping on the median nerve to see if it causes tingling in the fingers. In the Phalen test, you have to press the backs of your hands together for a minute to see if this causes numbness or tingling. To confirm the diagnosis, a nerve conduction study can be performed. In this test, electrodes are placed on the hands and wrists, and small electric shocks are applied to measure how quickly the median nerve transmits impulses. Another test, called electromyography, uses a fine needle inserted into a muscle to measure electrical activity and assess damage to the median nerve.
A few conditions have symptoms that can mimic carpal tunnel syndrome which should be eliminated namely:
⦁ Injury to a muscle, ligament, or tendon
⦁ Arthritis of the thumb or wrist
⦁ Nerve problems such as diabetic neuropathy
Underlying causes such as diabetes or arthritis will need treatment. Resting the hand and wrist and wearing a brace to limit movement may be advised. Night use is important to prevent the wrist from curling during sleep, which can make your symptoms flare up. Non-steroidal antiinflammatory drugs such as ibuprofen and cold compresses can reduce pain.
When carpal tunnel symptoms are more severe, corticosteroids or steroids can temporarily reduce inflammation around the median nerve and ease your symptoms. As a last resort surgery involves cutting the ligament overlying the top of the carpal tunnel to relieve pressure. The healed ligament will allow more space in the carpal tunnel. Pain and weakness usually resolve within two months after surgery, but it may take six months to a year. There may be some swelling and stiffness right after surgery, which can be relieved by elevating your hand over your heart and moving your fingers frequently. Physiotherapy treatment involves stretching and strengthening exercises to help prevent pain, numbness, and weakness. You may also have to alter the ways to perform tasks so that the median nerve doesn’t become inflamed again, causing your symptoms to return. Mobilisation of the wrist, elbow and upper spine as well as dry needling can improve carpal tunnel syndrome. The physiotherapist will also address the following:
⦁ Good posture
⦁ Ergonomic tools and workstations – refer to our tips on correct desk set up!
⦁ Stretching hands and wrists regularly
⦁ Taking frequent rest breaks to shake arms and legs, lean back and change position throughout the work day.