Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) is a common condition where the median nerve, which runs down our arm and into our hand, becomes compressed between structures in the wrist as it passes through the carpal tunnel.
The median nerve is the motor nerve supply for most of the flexor muscles in the forearm and one of the sensory nerve supplies for the hand. This is why compression of this nerve can lead to symptoms such as numbness and weakness in your hand.
CTS is a result of increased pressure within the carpal tunnel which leads to compression of the median nerve. This can occur through repetitive fine movements like typing or working with your hands (i.e. hair dressing or sewing).
However, CTS is often due to a multitude of causes and has various other risk factors, some of these are:
Genetics: people with smaller carpal tunnels are more prone to developing CTS, this may also be a reason why CTS is more prevalent in women.
Metabolic diseases: nerve damage can be a complication of conditions such as diabetes.
Inflammatory conditions: conditions such as rheumatoid arthritis can cause swelling within the carpal tunnel which may cause CTS.
Pregnancy: fluid retention during pregnancy is common and can cause CTS due to increased fluid within the carpal tunnel.
The most common symptoms of CTS are numbness, tingling and weakness of the affected hand in terms of gripping. Generally, CTS symptoms begin gradually and may progress to more constant symptoms; with weakness occurring later compared to numbness and tingling. These symptoms may also radiate upwards towards the elbow and shoulder.
The numbness/tingling felt is usually present in the fingertips and palm side of the thumb, index, middle finger, and half of the ring finger. This is due to the median nerve’s sensory distribution which is shown below.
Physiotherapists can diagnose CTS by taking a full history of your injury as well as asking about other factors such as hobbies and work life. Strength measurement, symptom provocation and neural examination is also included in a physiotherapy assessment for CTS.
Imaging such as ultrasound or MRI may be done to confirm the medial nerve compression. X-ray may also be done to rule out arthritis or fractures in the area.
Non-surgical treatment such as physiotherapy is recommended as the first line of treatment and is most effective for mild/moderate cases of CTS.
Physiotherapy treatment for CTS will often consist of:
Activity modification to prevent further aggravation of your symptoms.
Manual therapy to reduce compression and tension within the forearm/wrist.
Exercise to aid the movement of the median nerve within the wrist to decrease compression and strengthen the affected muscles.
Other therapies such as splinting, ultrasound therapy and transcutaneous electrical nerve stimulation (TENS) may also be used. Treatment will depend on your symptoms and their severity.
For more information, please call to book in for advice and management from your physiotherapist.
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