Carpal tunnel syndrome

CARPAL 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.

What are the symptoms of carpal tunnel syndrome?

Numbness or pins and needles around the thumb, index and middle fingers are the most commonly reported symptoms of carpal tunnel syndrome. This may be associated with wrist discomfort. The pins and needles are especially noticeable at night as they can cause you to wake up.

Other common symptoms of carpal tunnel syndrome include:

wrist pain, particularly at night
weakness of the hand and thumb
difficulty grasping objects
pain radiating up into the arm.

What causes carpal 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.

How do I know if I have carpal tunnel?

If you have the signs and symptoms of carpal tunnel syndrome, you can have the diagnosis confirmed by a health professional.

A diagnosis of carpal tunnel syndrome can be made by your GP, physiotherapist or hand therapist. They will complete a clinical assessment and a couple of simple tests in the clinic. Occasionally, a nerve conduction study is required.

How can physiotherapy help with carpal tunnel?

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.

Tendon gliding exercises

These four 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

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.

It’s important to note that not all physiotherapists are specialised in the area of hand therapy. For the best treatment outcome, find a physio who specialises in this area.

How effective is physiotherapy for carpal tunnel?

Physiotherapy gets the best results for carpal tunnel syndrome when treatment is started early (within the first three months) and when the symptoms are still mild.

Splinting for 3–6 weeks, even if it’s only at night, is strongly recommended.

In more severe and long-standing cases, with constant numbness or weakness in the small thumb muscles, surgical release will be required to improve symptoms.

It is important not to leave the condition untreated as permanent nerve and muscle damage can occur.

What can I do at home?

Try to avoid any positions or movements that make your symptoms worse, particularly repetitive tasks in poor wrist positions or static postures
Wearing a splint that holds the wrist in a neutral or slightly bent forward position at night is usually effective in reducing symptoms, and can also be worn during the day to help reduce your symptoms. Take care to avoid a splint that holds your wrist back, which is the case for most store bought splints, as this wrist position may increase your symptoms
Reduce hand swelling if it is a factor by keeping the hand elevated or by wearing a compression glove
Follow the exercise advice of your physiotherapist

How long until I feel better?

In mild cases, correct splint wear will usually have an immediate effect in reducing your symptoms, especially at night. If you do not get relief of your symptoms with physiotherapy, self-management and splinting as mentioned above, then your physiotherapist or GP will refer you on for a surgical opinion.

CARPAL TUNNEL SYNDROME

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