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Carpal Tunnel Syndrome

posted Oct 6, 2015, 4:51 PM by Rebecca Smith
Carpal tunnel syndrome is a condition of the hand where excessive pressure is placed on the median nerve, hence
resulting in hand (and sometimes arm) symptoms. These symptoms can include pain, numbness, pins and needles, and weakness, especially on the palm side of the hand excluding the little finger.

The carpal tunnel essentially is a narrow passageway in the wrist. This passageway is made up from the bones, ligaments and fascia of the wrist. It is this tunnel where the median nerve travels through, as it travels from the arm and into the hand. Sharing this tunnel with the median nerve are also various tendons. If the tunnel reduces its diameter and/or the tendons take up more room of the tunnel, then the median nerve is compressed, hence causing excessive pressure on the nerve.

Causes of the tunnel itself narrowing include arthritis and wrist fractures, while causes of the tendons taking up more of the tunnel include overuse injuries, poor ergonomics of the hand and general muscle tightness. Other causes of carpal tunnel syndrome are pregnancy, which results in excessive fluid being built up in the carpal tunnel (hence leaving less room for the median nerve), and simply people just having a smaller carpal tunnel by genetics.

Although anyone can develop carpal tunnel syndrome, it is most likely to develop in women, those aged between 40-60 years, pregnant women (as per reasons listed before), those who experience rapid weight gain, and people who are involved in daily strenuous manual work. It has also been found that people who use hand operated machinery on a regular basis, especially if the machinery causes vibrations in the hand, are at a higher risk of developing the condition.

While corticosteroid injections and surgery are sometimes necessary for treating carpal tunnel syndrome, the following is going to be focused on conservative treatment by physiotherapists, which is the first pathway taken for managing this condition.

Initial treatment of carpal tunnel syndrome consists of resting the hand as much as possible, and wearing a wrist splint at night. By wearing a splint, the wrist is kept in a neutral position throughout the night to prevent bending movements causing further compression to the nerve. Evidence shows that wearing a wrist splint during the day provides no further benefits compared to just wearing it at night.

If after a few weeks symptoms are still present, then other treatments are considered to provide additional relief. Stretches, massage and dry needling will help to relieve the tendon swelling, and may even help remove excess fluid from the tunnel. At this point, a heat pack may also be trialled to see whether the person responds well to heat therapy. Median nerve glides are also beneficial for treating symptoms as it stretches the median nerve so that there is less tension placed on it, as well as providing a glide to the nerve as it travels through the tunnel. Think of this as “flossing” the median nerve. Joint mobilisations can also be utilised in order to loosen up the carpal bones so that the tunnel space is not as restricted. Strength exercises of the hand may also be provided but this is only as symptoms significantly improve, making it a lower priority in the entire course of carpal tunnel syndrome management.

If you have been experiencing pain or other symptoms in your hands, then book yourself an appointment with Arron or myself, and let physiotherapy help you.



Robert

Physiotherapist Narellan

Difference Physiotherapy Narellan & Camden

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