Carpal Tunnel Syndrome

CARPAL TUNNEL SYNDROME

 

 

 

INTRODUCTION:-

The median nerve is one of the nerves which supplies the hand. It passes through the wrist in a narrow channel called the carpal tunnel along with the flexor digitorum superficialis and flexor pollicis longus tendons. Inflammation of the muscles, tendons or a fracture of the wrist can reduce the space in the carpel tunnel and so cause pressure on the nerve leading to pain, paresthesias, and muscle weakness in the forearm and hand.

 carpaltunnelsyndrome2

Symptoms of carpel tunnel syndrome

  • A dull ache in the wrist and forearm with pain radiating in to the fingers.
  • A burning wrist pain with numbness or loss of feeling in the thumb, index finger and middle finger which the median nerve supplies.
  • Pain which is worse at night. because many people sleep with bent wrists which further compresses the carpal tunnel
  • Positive result for Tinels sign (symptoms reproduced when tapping the volar aspect of the wrist (inside).
  •  Difficulty gripping and making a fist, dropping objects, and  weakness are symptoms of progression.
  • In early stages of CTS individuals often mistakenly blame the tingling and numbness on restricted blood circulation and they believe their hands are simply “falling asleep”.
  • In chronic cases, there may be wasting of the thenar muscles (the body of muscles which are connected to the thumb).  Unless numbness or paresthesias are among the predominant symptoms, it is unlikely the symptoms are primarily caused by carpal tunnel syndrome.

Causes

  •  Idiopathic
  • Common activities that have been identified as contributing to repetitive stress induced carpal tunnel syndrome include:
  • Use of power tools
  • Typing on a computer keyboard or typewriter
  • Construction work such as handling many bricks, stone and/or lumber
  • Excessive play of percussion instruments
  • Often people suffering from carpal tunnel syndrome can have multiple contributing factors which are aggravated by vigorous hand activities and repetitive stress trauma to the hand.
  • Work related- Occupational risk factors of repetitive tasks, force, posture, and vibration
  • Many cases of carpal tunnel syndrome are provoked by repetitive grasping and manipulating activities, and the exposure can be cumulative. job tasks involving highly repetitive manual acts or necessitating wrist bending or other stressful wrist postures.
  • Traumatic- Fractures of one of the arm bones, particularly a Colles’ fracture.  Dislocation of one of the carpal bones of the wrist.   Strong blunt trauma to the wrist or lower forearm, incurred for example by using arm extremity to cushion a fall or protecting oneself from falling heavy objects.   Hematoma forming inside the wrist, because of internal hemorrhaging.  Deformities from abnormal healing of old bone fractures.
  • Non traumatic- Inflammation of the thin mucinous membrane around the tendons. Part of the process of inflammation is swelling, and this compresses the  nerve. Swelling of this membrane is the final common pathway for most cases of carpal tunnel, whether caused idiopathically, through exposure, or  medically.
  • With pregnancy and hypothyroidism fluid is retained in tissues, which swells the tenosynovium.
  • Acromegaly, a disorder of growth hormones, compresses the nerve by the abnormal growth of bones around the hand and wrist.
  • Tumors (usually benign), such as a ganglion or a lipoma, can protrude into the carpal tunnel, reducing the amount of space.
  •  Double crush syndrome, where there is compression or irritation of nerve branches contributing to the median nerve in the neck or anywhere above the  wrist. This then increases the sensitivity of the nerve to compression in the wrist

 

Clinical assessment by history taking and physical examination can frequently diagnose CTS.

  •  Phalen’s maneuver is performed by flexing the wrist gently as far as possible, then holding this position and awaiting symptoms.[13] A positive test is one  that results in numbness in the median nerve distribution when holding the wrist in acute flexion position within 60 seconds. The quicker the numbness  starts, the more advanced the condition.
  •  Tinel’s sign, a classic, though less specific test, is a way to detect irritated nerves. Tinel’s is performed by lightly tapping (percussing) the area over the  nerve to elicit a sensation of tingling or “pins and needles” in the nerve distribution

Prevention

The most effective way to prevent carpal tunnel syndrome is :-

  • To take frequent breaks from repetitive movement such as computer keyboard usage
  • Reduce your force and relax your grip. Most people use more force than needed to perform many tasks involving the hands. If your work involves a cash  register, for instance, hit the keys softly.
  • For prolonged handwriting, use a big pen with an oversized, soft grip adapter and free-flowing ink. This way you won’t have to grip the pen tightly or  press as hard on the paper.
  • Take frequent breaks. Every 15 to 20 minutes give your hands and wrists a break by gently stretching and bending them.
  • Alternate tasks when possible. If you use equipment that vibrates or that requires you to exert a great amount of force, taking breaks is even more important.
  • Watch your form. Avoid bending your wrist all the way up or down. A relaxed middle position is best. If you use a keyboard, keep it at elbow height or slightly lower
  •  Improve your posture. Incorrect posture can cause your shoulders to roll forward. When your shoulders are in this position, your neck and shoulder muscles are shortened, compressing nerves in your neck. This can affect your wrists, fingers and hands.
  • Keep your hands warm. You’re more likely to develop hand pain and stiffness if you work in a cold environment. If you can’t control the temperature at work, put on fingerless gloves that keep your hands and wrists warm.

Carpel Tunnel Syndrome Treatment

What can the athlete do about it?

Rest and wear a heat retainer or wrist support with a splint to prevent movement.

Visit Physioline for treatment and rehabilitation

 

Physioline management

We treat any possible underlying disease or condition,

  •  Electrotherapy
  •  Manual therapy
  •  Nerve tissue mobilisation
  •  Ergonomics
  •  Massage therapy
  •  Prioritizing hand activities
  • Splints:-A wrist splint or carpel tunnel support will help immobilise the wrist and allow it to rest.
  • Strengthening