What is Carpal Tunnel Syndrome?
By Laurence Schubert 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
·
Obesity
·
Oedema/swelling
·
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?
If you have any questions about carpal tunnel
syndrome please contact us or book online for an appointment.
