What is Carpal Tunnel Syndrome?
By Laurence APAM
Carpal Tunnel Syndrome is a common condition involving persistent pain, tingling and numbness in the hand. It is the result of compression of one of the major nerves in the hand/wrist, the median nerve.
What is the Carpal Tunnel?
The carpal tunnel is an area where various tendons, blood vessels and nerves run through in order to allow the hand to function. The median nerve is the only nerve that passes through the carpal tunnel, and is significantly affected with carpal tunnel syndrome. The flexor retinaculum and bones of the wrist (carpals) make the boundaries of the carpal tunnel. The two other major nerve branches of the hand, the ulnar and radial nerve, do not pass through the tunnel.
Who gets Carpal Tunnel Syndrome?
Approximately 5% of the population have carpal tunnel syndrome and 1 in 10 will develop it at some point in their life. It is most prevalent between ages 45-59 or 75-84 year olds and females are more at risk than males.
What causes Carpal Tunnel Syndrome?
As described above, the main cause of carpal tunnel syndrome is the compression of the median nerve. Therefore, anything that increases the pressure within the carpal tunnel can contribute to the cause of this syndrome. Often the exact cause is unknown (idiopathic) and multifactorial. The following may contribute to the cause of carpal tunnel syndrome.
· Tendon inflammation
· Hormonal changes – e.g. hypothyroidism, menopause and pregnancy
· Diabetes Mellitus
· Repetitive manual activity
· Auto-immune disorders such as rheumatoid arthritis
· Acute trauma to the wrist
What are the Symptoms of Carpal Tunnel Syndrome?
In the initial phases of carpal tunnel syndrome you will experience intermittent and nocturnal neural symptoms of paraesthesias (tingling) and numbness. As the condition progresses, this will become more frequent and occur during daylight hours. As well as neural symptoms, pain is often present and in severe cases will radiate proximally to the forearm, upper arm and even shoulder. In cases of true carpal tunnel syndrome you will not experience any neural symptoms above the wrist. Most commonly you will experience numbness in only the palmer surface of your first 3 fingers. However, as the condition worsens, other nerves can become sensitised, leading to the entire hand becoming numb. It is likely that you will begin to lose strength of your hand and finger muscles.
Can your Physiotherapist diagnose Carpal Tunnel Syndrome?
They certainly can. Diagnosis of carpal tunnel varies depending on your health practitioner’s preference. The most important diagnostic factor is clinical assessment, which includes an accurate history of your condition. Following this, it is debatable whether nerve conduction studies are necessary or not. Often nerve conduction studies will confirm that you have carpal tunnel and give you information regarding the degree of the condition. E.g. determining degree of demyelination and axonal loss that has occurred. However, in many cases it is not necessary and is better for ruling out conditions, as appose to diagnosing them.
How do you treat Carpal Tunnel Syndrome?
Education of the condition – assist you in knowing what activities to avoid and how you can reduce the amount of stress on the median nerve. E.g. limit wrist movement and reduction of heavy lifting in the initial phases.
Local corticosteroid injections – commonly used to treat carpal tunnel in order to reduce oedema and improve the space through the carpal tunnel. This treatment is likely to only provide short to moderate term relief.
Musculoskeletal manipulation – This includes massage, exercise and mobilisation of the wrist joint. Your physio will be knowledgeable in this area, and provide you with non-surgical treatment options.
Splinting – This is designed to reduce mechanical stress within the carpal tunnel and reduce irritation of the median nerve.
Surgical intervention – Carpal tunnel release is often performed when conservative (non-surgical) treatment has failed to improve the condition after 3-6 months.