What is carpel tunnel syndrome?
The carpal tunnel is a narrow passageway on the palm side of the wrist. The floor of this tunnel is formed by the bones of the wrist and a strong ligament creates the roof. An important nerve called the median nerve runs through the carpal tunnel and gives feeling to the skin of the thumb, index finger, middle finger and half of the ring finger. This nerve also gives movement to some of the muscles around the thumb. Carpal tunnel syndrome occurs when there is pressure on the median nerve from a variety of causes.
Signs and symptoms of carpel tunnel syndrome
- Pins and needles or numbness around the thumb, index and middle fingers. The pins and needles are especially noticeable at night as they can cause you to wake up.
- Wrist pain, particularly at night
- Weakness of the hand and thumb
- Difficulty grasping objects
- Pain radiating up into the arm.
What causes carpel tunnel syndrome?
Carpal tunnel syndrome is caused by compression of the median nerve within the carpal tunnel.
This can be caused by a narrowing of the tunnel, enlargement of the tunnel contents or general swelling in the area. This occurs fairly commonly as people age, during pregnancy and in conjunction with conditions such as:
- wrist arthritis
- wrist fracture
- thickened tendons
- tendon inflammation
- hand trauma causing swelling.
Treatment for carpel tunnel syndrome
Accurate diagnosis is crucial in the selection of the best treatment for carpal tunnel syndrome. Your physiotherapist will be able to accurately assess and differentiate the source of your symptoms. Once your physiotherapist has established the source of your pain and neural symptoms, they will discuss the best management of your condition and a plan to return you to being symptom free.
Physiotherapy management may include
- Splinting. Splints that hold the wrist in a neutral position or a slight forward bend will aim to maximise the amount of room in the carpal tunnel and relieve pressure on the median nerve. Splints that hold the wrist in the extended (arched backwards) position can make the symptoms worse as the carpal tunnel space is reduced in this position. In more severe cases, a full resting wrist and finger splint may be required.
- Ergonomic advice. Symptoms can be reduced by avoiding certain common wrist positions and activities that increase the pressure in the tunnel.
- Range of movement exercises. Gentle movements of your fingers give a gliding motion between the different tendons and the nerve to reduce swelling of the little adhesions that can form in the area due to swelling.
- Swelling management. Compression gloves and other techniques to reduce swelling may be required, depending on the cause of your symptoms.
- Nerve glides. Gentle movements of your arm and neck are thought to improve the movement of the median nerve and assist with the healing of the nerve after compression at the carpal tunnel. Gentle movement of the nerve may increase blood flow to the nerve, which helps the nerve heal and improve your symptoms.
- Strengthening. You may need to strengthen your hand after you have recovered from the symptoms of carpal tunnel syndrome.
Surgery is required for a small percentage of people with carpal tunnel syndrome. If there is loss of sensation or inability to contract the muscles supplied by the median nerve, then referral to a surgeon is necessary. A variety of other treatments, such as scar management, desensitising and special exercises, may be required after surgery.