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What is Carpal Tunnel Syndrome?
The small bones in our wrist form one side of a tunnel and a ligament (or retinaculum to more specific) forms the other side. In this tunnel, called the Carpel Tunnel sit many tendons which are used for gripping and bending the wrist into flexion. The median nerve also sits in this tunnel. There is only a certain amount of space in the tunnel. If the tendons get irritated by overuse they will naturally swell and increase the pressure within the tunnel and compress the median nerve. Other reasons why pressure within the tunnel can increase can be the effects of pregnancy.
Symptoms include burning wrist pain on the palm side with numbness and pins and needles in the distribution of the Median Nerve. That is the thumb, index finger, middle finger and thumb side of the ring finger. Nocturnal pins and needles are common. Pain can radiate to the forearm, elbow and shoulder. Diagnosis is achieved through history taking and holding the wrist in prolonged flexion to reproduce symptoms. Tinsel’s sign can also help reach a diagnosis. This test comprises of repetitively tapping over the wrist on the palm side where the Median Nerve passes to reproduce symptoms.
Mild cases can be treated effectively with anti-inflammatories and physiotherapy. A Physiotherapist will release the tension from the muscles and tendons that flex the wrist and fingers and provide stretches for a patient to do. Additionally, a physiotherapist will provide a splint which keeps the wrist in a neutral position for the irritated Median Nerve to settle. For more severe cases simple surgery to create more space in the tunnel can be done.
The problem
- The carpal tunnel is a narrow passageway on the palm-side of the wrist through which the median nerve passes
- Increased pressure in the carpal tunnel can cause median nerve compression, resulting in numbness, tingling, pain, and weakness in the hand
- Increased pressure in the carpal tunnel is often associated with a repetitive use injury. Carpal Tunnel Syndrome can also occur secondary to another health condition. It is also possible for the carpal tunnel to be smaller than average.
Interesting facts
- Women are more likely than men to develop carpal tunnel syndrome
- Individuals with a family history of Carpal Tunnel Syndrome may have an increased risk for developing Carpal Tunnel Syndrome
- Carpal Tunnel Syndrome can occur more frequently in individuals with rheumatoid arthritis, diabetes, thyroid disorders, or pregnancy
What you can expect/look out for
- Numbness and/or tingling in the affected hand, especially in the thumb, index, middle or ring fingers, but not in the little finger
- Pain radiating from the palm-side of the wrist into the hand and arm
- A sense of weakness in the hand or a tendency to drop things
- Symptoms may occur more frequently when using your hands, especially to grip objects
Hints for self-management
- Avoid aggravating activities
- Avoid sleeping on your hands/wrists
- An over the counter wrist splint can help keep the wrist in a neutral position and maintain the maximum amount of space in the carpal tunnel
- Practice good posture at work and good technique when engaging in activities that involve repetitive movements of the wrist and hand
Management options
- Wrist splinting
- A corticosteroid injection may relieve pain and help reduce inflammation in the carpal tunnel
- Physiotherapy for nerve glides, carpal mobilizations, and an assessment of biomechanics and ergonomics that may be contributing to the condition
- Surgery, which involves cutting the transverse ligament and relieving the pressure in the carpal tunnel. This approach is usually only taken when conservative measures have failed or when symptoms are more severe
More information
- The carpal tunnel is formed by carpal bones on three sides with the broad transverse ligament forming the “roof” of the tunnel
- The median nerve is a mixed nerve. It carries motor signals to some of the muscles in the hand, as well as sensory signals from the thumb, index, middle, and a portion of the ring fingers
- In addition to the median nerve, nine tendons that function to flex the fingers also pass through the carpal tunnel
- At Sydney Physiotherapy Solutions our highly qualified physiotherapists specialise in the assessment, treatment and prevention of neuromusculoskeletal injuries.
Contact us today – 9252 5770
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