Carpal Tunnel Syndrome

What is it?

Carpal tunnel syndrome is a condition which results in pain and a pins & needles / numbness sensation in the wrist and hand caused by excessive pressure on one of the three main nerves  - median nerve. It is named after the bony tunnel which is formed by the carpal bones of the wrist through which the median nerve and other tendons pass on their way to the hand.

The median nerve supplies power and feeling to the palmar surface of the thumb, index, middle and half of the ring finger. Symptoms may occur in one or both hands at a time and are often worse at night and can lead to broken sleep. In severe cases a weakened grip and muscle wasting at the base of the thumb may be evident due to longstanding nerve compression.

Apart from the clinical signs, the main way to diagnose carpal tunnel syndrome is by undertaking a nerve conduction test which measures the speed of the electrical signals along the nerve to see whether they are slower than usual.

Causes

Approximately 1 in 1000 people will develop this condition every year and it affects women 3 times more than men. It can occur at any age but mainly affects those in their 40-50s and is especially common in pregnancy due to water retention.
 

The cause for carpal tunnel syndrome is uncertain although it is thought that in many cases it is due to inflammation of one or more of the wrist tendons which in turn swell and cause compression on the other structures within the tunnel including the median nerve.
 

Occupations which result in excessive use of the forearm flexor tendons i.e. manual workers and typists can increase the incidence of this type of condition. Arthritis or previous fractures affecting the wrist area can also lead to a reduction of the available space within the carpal tunnel leading to symptoms.

Treatment

Often people with mild to moderate carpal tunnel syndrome will benefit from Physiotherapy. In severe or recurrent cases treatment in the form of a steroid injection may be offered by a specialist or in some cases surgery to release the compression. Physiotherapy rehabilitation following surgery will optimise recovery time and reduce post-operative pain.
 

Following a thorough and detailed examination, Physiotherapy treatment may include the following.
 

• Electrotherapy i.e. ultrasound, to reduce pain and inflammation

• Acupuncture to reduce pain and normalise muscle tone

• Wrist joint and forearm soft tissue mobilisations to address any imbalances or restrictions

• Use of taping / strapping or splints to support and maintain good wrist position throughout the day and night

• Appropriate stretching and strengthening exercises to restore full function

• Addressing any lower neck or upper back vertebral restrictions which may be contributing to the overall condition.