Carpal Tunnel Syndrome (CTS) is a common condition that affects millions of people worldwide, particularly those who perform repetitive hand movements. It occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes compressed at the wrist. This can result in numbness, tingling, weakness, and pain. Ultimately, these can affect your ability to perform daily tasks including grasping, eating, typing and more.
Where is the carpal tunnel?
The carpal tunnel is a narrow passageway located on the palm side of your wrist, surrounded by bones and ligaments. Within this tunnel, several tendons and the median nerve run through, controlling sensation in the thumb, index, and middle fingers. When the tunnel becomes constricted or inflamed, pressure on the median nerve increases, leading to the symptoms associated with CTS.
How do I know if I have carpal tunnel syndrome?
The symptoms of CTS typically develop gradually and can range from mild to severe. Common signs include:
- Numbness or tingling: This often affects the thumb, index, middle, and sometimes the ring fingers, particularly when holding objects or during activities that involve repetitive hand movements, such as typing or writing
- Pain: A dull ache or sharp pain may occur in the wrist or hand, often extending up the arm
- Weakness: People with CTS may experience difficulty gripping objects, as their hand muscles may weaken over time
- Worsening symptoms at night: CTS symptoms tend to be more pronounced at night, often disrupting sleep
What makes someone vulnerable to it?
There are several factors that can contribute to the development of CTS. While certain individuals may have a genetic predisposition to a smaller carpal tunnel, other common causes include:
- Repetitive hand movements: Jobs that involve prolonged typing, using a mouse, assembly line work, or playing musical instruments are the most at risk
- Injury or trauma: Wrist fractures or dislocations can cause swelling in the carpal tunnel, increasing pressure on the median nerve
- Inflammatory conditions: Conditions like rheumatoid arthritis, diabetes, and thyroid dysfunction can contribute to CTS by affecting nerve function or causing inflammation around the wrist
- Pregnancy: Hormonal changes during pregnancy can cause fluid retention, which increases pressure on the carpal tunnel. Additionally, mothers are also at risk post-partum due to holding and nursing their baby
- Obesity: Excess weight can also put additional pressure on the wrists, increasing the risk of developing CTS
How is it diagnosed?
Diagnosis typically involves:
- Medical history: The pattern of symptoms is usually very distinctive in CTS, a simple history will tell your practitioner a lot
- Physical exam: The practitioner will ask about your symptoms and may perform tests to evaluate the strength and sensation in your fingers and wrist. Often, holding certain positions and tapping the median nerve is enough to reproduce symptoms in CTS
- Ultrasound: An ultrasound will create an image of the wrist to show whether the nerves and tendons are inflamed and being compressed
- Nerve conduction studies: These tests measure the electrical activity of the median nerve and assess how well the signals are traveling through the carpal tunnel
- Electromyography (EMG): This test measures the electrical activity of muscles and can help pinpoint nerve damage.
How do we treat carpal tunnel syndrome with physiotherapy?
The treatment for CTS depends on the severity of the condition. In mild cases, conservative approaches like physiotherapy are often effective, while more severe cases may require consultation with a surgeon.
Physiotherapy treatments include:
- Manual therapy techniques: Soft tissue techniques, mobilizations, and more are used to decrease pain and symptoms, and increase mobility
- Nerve gliding exercises: These exercises gently slide the nerve back and forth in the body, restoring normal mobility and decreasing pain, swelling, and inflammation
- Ergonomic adjustments: If your job or daily activities contribute to CTS, your physiotherapist will show you how to adjust your working conditions. For example, a desk job can use a more ergonomic keyboard and mouse to can reduce strain on the wrists.
- Wrist splinting: Your physiotherapist can recommend a splint for you to wear. Wearing a splint at night or during activities can help keep your wrist in a neutral position, reducing pressure on the median nerve.
Other treatments may include:
Your physiotherapist will collaborate with the other members of your health care team to determine other treatment options. These may be used alongside physiotherapy or if physiotherapy alone is not effective.
- Steroid injections: Corticosteroid injections can reduce inflammation and relieve pain and swelling in the carpal tunnel
- Anti-inflammatory medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can reduce pain and inflammation.
- Referral to a surgeon: If conservative measures do not improve symptoms, surgery may be required. The most common procedure for CTS is called carpal tunnel release surgery. This involves cutting the ligament that forms the roof of the carpal tunnel, which helps relieve pressure on the median nerve
Looking for help with wrist pain and hand pain?
Look for PhysioNow! Our expert clinicians offer Physiotherapy, Massage Therapy, Manual Osteopathy and more. Get your hand pain and wrist pain treated today! PhysioNow has 10 locations across the west GTA including Burlington, Oakville, Mississauga, and Etobicoke. Book with PhysioNow today for your first assessment and treatment. Feel free to reach out at P: 289-724-0528 or Email: applewood@physionow.ca
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