Carpal tunnel syndrome (CTS)
What is Carpal Tunnel?
The carpal tunnel is a narrow canal in the wrist. Similarly to a tunnel you could travel through by car, this part of the wrist allows the median nerve and tendons to connect the hand and forearm.*
The carpal tunnel consists of:
- Carpal bones which form the bottom and the sides of the tunnel, similar to a children's slide in shape
- Transverse carpal ligament is at the top of the tunnel - it is a strong and slightly flexible tissue that holds the tunnel together
Inside this tunnel sit:
- Median Nerve which provides innervation to muscles that flex your fingers and also is responsible for feeling in your first 4 fingers on the palm side and tips of the first 3 fingers on the top of your hand
- Tendons that connect muscles in the forearm to the bones in the hand and allow the fingers and thumb to bend.
What is Carpal Tunnel Syndrome?
Carpal Tunnel syndrome is a condition affecting hand caused by pressure on the median nerve in the wrist area. The main symptoms of carpal tunnel are:
- tingling or pins and needless affecting especially the thumb, index finger, middle finger and half of the ring finger
- pain or burning sensation
- difficulties in handling small objects, gripping, writing
- difficulties in performing precise small movements like buttoning up a shirt or applying makeup
- dropping things
- weakness that can lead to permanent muscle wastage in the thumb in more severe cases (if left untreated for long)
Many people experience these symptoms especially at night. This is because of few factors: the chances are your wrists at night are in a curled in / flexed position which causes more pressure on the affected area. The other reason is muscle inactivity at night - during the day as you move the muscle action works as a pump redistributing fluid around the arm; at night this "pump" stops working and fluid can stagnate in the carpal tunnel area causing more pressure over the median nerve making the symptoms worse.
What is the most common cause of Carpal Tunnel Syndrome?
There are several reasons for this condition to occur. Usually your anatomy and genetics play a role - some of us are born with narrower carpal tunnels than others. If there is an additional factor causing irritation in the area you might get a flare up and experience symptoms.
The most common of these factors are:
Repetitive small and frequent movements with the hands, especially with wrist in incorrect position, e.g. typing or using phone for long time
- High force repetitive movements like for example hammering or prolonged exposure to vibrations on the wrist as in some construction work - drilling, using jack hammer, etc
- Frequent and prolonged grasping and holding - working in the kitchen, construction, carpentry
Some joint or bone diseases, e.g. arthritis (osteoarthritis or rheumatoid arthritis)
Hormonal or metabolic changes causing increased water retention, e.g. menopause, pregnancy, thyroid issues
Changes in blood sugar levels as seen with type 2 diabetes
Injuries of the wrist - strains, sprains, dislocations, fractures
How can Carpal Tunnel be diagnosed?
In addition to taking the history and general physical examination there are specific tests that can help to diagnose the carpal tunnel. Two test most commonly used during the physical examination are Tinel's sign and Phalen's test; the evidence however shows they are not always sensitive enough to diagnose the condition accurately and the gold standard for carpal tunnel diagnosis seems to be median nerve conduction study.
How can Carpal Tunnel be treated?
In many cases the CTS can be successfully treated conservatively without the need for surgery. Having a consultation with physiotherapist or occupational therapist specialising in Hand therapy is usually a good first step. They can assess you and suggest a plan to improve your condition. Sometimes an application of steroid injection in conjunction with the hand therapy helps as well. If after few sessions your progress is not optimal and your symptoms persist an orthopaedic review is usually recommended.
The Hand Therapy experts in our clinic have successfully treated many clients with the carpal tunnel syndrome both conservatively and after the Carpal tunnel release surgery.
The treatment techniques we offer include a combination of:
- myofascial release / soft tissue techniques on your forearm and wrist but also your neck and shoulder area as these are often related to the CTS symptoms
- wrist and elbow mobilisation
- median nerve gliding exercises
- ergonomic advise
- sensory re-education if indicated
- splinting for night
If you are after CTS surgery we would usually also add:
- oedema management
- scar work once the scar is closed and ready
- range of movement and strengthening exercises
Can Carpal Tunnel be prevented?
In many cases the symptoms of carpal tunnel syndrome can be indeed prevented. Correct posture, especially of your upper body, will play a big role in keeping the flare ups at bay, especially if your work involves a lot of repetitive hand and wrist movements. Taking regular breaks, doing few gentle stretches and nerve gliding exercises will make a big difference as well as having your work station set up correctly regardless if you are working in the office or on a building site.