Understanding Carpal Tunnel Syndrome
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on August 14, 2024
Carpal tunnel syndrome (CTS) is a common condition affecting the hand and wrist, characterized by numbness, tingling, and pain due to compression of the median nerve within the carpal tunnel. This condition is prevalent among the general population, significantly impacting individuals' ability to perform daily activities and work-related tasks. Physiotherapy plays a vital role in managing CTS, offering non-surgical treatment options that can alleviate symptoms and improve function.
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What is carpal tunnel syndrome?
Carpal tunnel syndrome is a condition where the median nerve, which runs from the forearm into the palm, becomes compressed at the wrist. The carpal tunnel is a narrow passageway of ligaments and bones at the base of the hand that houses the median nerve and tendons. Compression of the median nerve can occur due to swelling, inflammation, or structural changes within the carpal tunnel, leading to symptoms of CTS. Acute CTS occurs suddenly and may result from direct trauma, while chronic CTS develops gradually over time due to repetitive strain.
Causes of carpal tunnel syndrome
Repetitive hand movements
Activities such as typing, sewing, and assembly line work can lead to repeated stress on the wrist, contributing to the development of CTS.
Underlying health conditions:
Diabetes: Elevated blood sugar levels can damage nerves, increasing the risk of CTS.
Thyroid disorders: Hypothyroidism can cause fluid retention and swelling, compressing the median nerve.
Rheumatoid arthritis: This autoimmune condition can cause inflammation of the joints, including the wrist, leading to CTS.
Pregnancy and hormonal changes: Fluid retention during pregnancy can increase pressure within the carpal tunnel.
Wrist injuries or trauma: Fractures or sprains can alter the anatomy of the wrist, causing nerve compression.
Occupational factors
Jobs requiring repetitive wrist movements, such as data entry or assembly line work, are at higher risk for CTS.
Signs and symptoms of carpal tunnel syndrome
Numbness and tingling: Commonly affects the thumb, index, and middle fingers, starting gradually and intermittently. It can progress to persistent sensations that extend to the palm and wrist, often described as "pins and needles".
Pain and burning sensations: Varies in intensity from a dull ache to a burning sensation that may radiate up the arm. Aggravated by repetitive hand movements, it can extend from the wrist to the shoulder, impacting daily activities.
Weakness in grip strength: Progression leads to decreased grip strength, affecting tasks like buttoning a shirt or holding objects. Severe cases may show muscle wasting (atrophy) in the hand muscles, especially at the base of the thumb.
Night-time symptoms: Symptoms worsen during sleep due to wrist flexion, increasing median nerve pressure. Patients often wake with discomfort, disrupting sleep and causing fatigue.
Progression of symptoms: Untreated cases can worsen from mild discomfort to constant numbness and pain. Increased nerve compression expands symptoms across the hand and arm, impairing function.
Differences in symptom presentation: Severity varies based on nerve compression duration, individual health, and aggravating activities. Symptoms may progress quickly or over years, impacting daily activities to varying degrees.
Risk factors of carpal tunnel syndrome
Occupational hazards: High-risk activities include prolonged computer use, assembly line work, and jobs involving vibrating tools.
Age and gender: CTS is more common in women and increases with age.
Genetic predisposition: Family history can increase the likelihood of developing CTS.
Obesity: Excess weight can increase pressure within the carpal tunnel.
Previous hand or wrist injuries: Prior injuries can predispose individuals to CTS.
Chronic health conditions: Conditions like diabetes and rheumatoid arthritis increase the risk.
Diagnosis of carpal tunnel syndrome
Physical examination techniques
Clinicians can perform a variety of tests to aid in diagnosing carpal tunnel syndrome. These tests may include:
Tinel's Sign: Tapping over the median nerve to elicit tingling.
Phalen's Maneuver: Holding the wrists in flexion to reproduce symptoms.
Compression Test: Applying pressure over the carpal tunnel to provoke symptoms.
Nerve Conduction Studies and Electromyography: Assess the function of the median nerve.
Imaging Tests:
X-rays: Rule out other conditions like arthritis or fractures.
Ultrasound: Visualizes nerve compression and tendon abnormalities.
MRI: Provides detailed images of the wrist structures.
Differential diagnosis
Rule out conditions with similar symptoms such as cervical radiculopathy and peripheral neuropathy.
Prevention Strategies for carpal tunnel syndrome
Ergonomic Adjustments:
Proper keyboard and mouse positioning.
Ergonomic tools and equipment.
Proper Posture and Hand Positioning: Techniques for work and daily activities.
Stretching and Strengthening Exercises: Exercises to maintain wrist flexibility and strength.
Breaks and Rest Periods: Importance of microbreaks during repetitive tasks.
Lifestyle Modifications: Healthy diet, regular exercise, and stress management to reduce the risk of CTS.
Treatment options for carpal tunnel syndrome
Conservative treatments
Wrist splinting: Keeps the wrist in a neutral position to reduce median nerve pressure, especially effective at night and during aggravating activities.
Anti-inflammatory medications (NSAIDs): Like ibuprofen, alleviate pain and inflammation, providing short-term relief during flare-ups.
Corticosteroid injections: Directly reduce inflammation in the carpal tunnel, offering temporary symptom relief for severe cases; caution is advised due to potential side effects with repeated use.
Lifestyle modifications: Includes ergonomic adjustments, activity modifications, and weight management to reduce wrist strain and prevent repetitive stress injuries.
Physical therapy
Nerve gliding exercises: These exercises aim to improve the mobility of the median nerve within the carpal tunnel. By gently moving the nerve through its range of motion, nerve gliding exercises can help reduce adhesions and inflammation, improving overall nerve function.
Stretching and strengthening exercises: Stretching exercises can help alleviate tightness in the wrist and forearm muscles, while strengthening exercises focus on improving the strength and stability of the wrist and hand. Together, these exercises enhance overall wrist and hand function and reduce symptoms.
Manual therapy techniques: Physical therapists may use manual therapy techniques such as soft tissue mobilization and joint mobilization to improve the flexibility and mobility of the wrist and hand. These techniques can help reduce pain, improve circulation, and enhance the overall function of the wrist and hand.
Ultrasound therapy: Ultrasound therapy uses sound waves to generate deep heat in the tissues, which can help reduce inflammation and pain in the wrist. This non-invasive treatment can be particularly effective in managing chronic inflammation associated with carpal tunnel syndrome.
Education: Educating patients on proper ergonomics and self-management techniques is a key component of physical therapy. Patients learn how to adjust their workstations, use ergonomic tools, and perform daily activities in a way that minimizes stress on the wrist and reduces the risk of symptom exacerbation.
Surgical interventions
Open carpal tunnel release: This traditional surgery involves a larger palm incision to cut the transverse carpal ligament, relieving median nerve pressure. It offers direct ligament visualization and is highly effective but requires a longer recovery due to the larger incision.
Endoscopic carpal tunnel release: A minimally invasive option involving small incisions and an endoscope to cut the transverse carpal ligament. This method generally leads to faster recovery and less postoperative pain but may have a slightly higher complication risk.
Mini-open release: This technique combines open and endoscopic methods with a smaller incision, allowing direct ligament visualization with minimal tissue disruption. It aims to provide effective relief with reduced recovery time and lower complication risks
Physiotherapy for carpal tunnel syndrome
Benefits of physiotherapy in managing symptoms
Physiotherapy plays a crucial role in managing the symptoms of carpal tunnel syndrome by providing non-invasive and effective treatment options. The main benefits include pain reduction, improved wrist and hand function, and prevention of symptom progression. Physiotherapists tailor treatment plans to each patient's specific needs, ensuring personalized care that addresses the root cause of the condition.
Specific techniques used
Manual therapy: This involves hands-on techniques such as soft tissue mobilization and joint mobilization. Soft tissue mobilization helps reduce muscle tension and improve blood flow, while joint mobilization enhances the mobility and flexibility of the wrist joint. These techniques can alleviate pain and improve the overall function of the hand and wrist.
Ultrasound therapy: Ultrasound therapy uses high-frequency sound waves to generate heat deep within the tissues. This heat helps reduce inflammation and promotes healing by increasing blood flow to the affected area. Ultrasound therapy can be particularly effective in reducing chronic inflammation associated with carpal tunnel syndrome.
Electrical stimulation: This technique involves applying mild electrical currents to the affected area to reduce pain and promote muscle relaxation. Electrical stimulation can help manage pain, improve nerve function, and reduce muscle spasms.
Exercise programs
Nerve gliding exercises: These exercises are designed to improve the mobility of the median nerve within the carpal tunnel. By gently moving the nerve through its range of motion, nerve gliding exercises can help reduce adhesions and inflammation, leading to improved nerve function.
Strengthening exercises for hand and wrist: Strengthening exercises focus on improving the strength and stability of the muscles in the hand and wrist. Stronger muscles can better support the wrist joint and reduce the strain on the median nerve.
Flexibility exercises: Flexibility exercises help maintain and improve the range of motion in the wrist and hand. These exercises can reduce stiffness and prevent the recurrence of symptoms by ensuring that the wrist remains flexible and mobile.
Education on proper ergonomics and self-management techniques: Physiotherapists educate patients on how to adjust their workstations, use ergonomic tools, and perform daily activities in a way that minimizes stress on the wrist. Proper ergonomics and self-management techniques are essential for preventing symptom exacerbation and promoting long-term health.
Timeline for improvement with physiotherapy
The timeline for improvement with physiotherapy can vary depending on the severity of the condition and the individual’s adherence to the treatment plan. Generally, patients may start to notice improvements in symptoms within a few weeks of starting physiotherapy. Consistent participation in therapy sessions and adherence to home exercise programs are key factors in achieving positive outcomes. Full recovery and optimal management of symptoms may take several months, particularly for chronic or severe cases.
Recovery and long-term management of carpal tunnel syndrome
Expected outcomes from different treatments
The expected outcomes from physiotherapy and other treatments for carpal tunnel syndrome include significant pain reduction, improved hand and wrist function, and enhanced quality of life. Conservative treatments, such as splinting and physical therapy, are often effective in managing symptoms, while surgical interventions may be necessary for more severe cases. Post-surgery, physiotherapy can aid in recovery and help restore function.
Strategies for preventing recurrence
Ongoing exercises: Continuing with prescribed exercises, even after symptoms improve, can help maintain wrist and hand strength and flexibility, reducing the risk of recurrence.
Ergonomic practices: Maintaining proper ergonomic practices at work and during daily activities is crucial. This includes using ergonomic tools, adjusting workstations, and practicing good posture.
Regular check-ups: Regular follow-up appointments with a healthcare provider can help monitor the condition and address any early signs of recurrence promptly.
Importance of follow-up care: Consistent follow-up care ensures that any changes in symptoms are addressed quickly and that the treatment plan remains effective.
Potential lifestyle changes for long-term management
Adopting a healthy lifestyle, including regular physical activity, weight management, and stress reduction, can contribute to the long-term management of carpal tunnel syndrome and overall well-being.
When to seek professional help
Seek medical evaluation if symptoms persist or worsen. A physiotherapist can provide an accurate diagnosis and develop a personalized treatment plan. Early intervention is key to preventing permanent nerve damage.
Conclusion
Carpal tunnel syndrome can significantly impact daily life, but early treatment and prevention are effective in managing symptoms. Consulting with a physiotherapist for personalized care is recommended for those experiencing CTS symptoms.
References:
Keith, M. W., Masear, V., Chung, K. C., Mauck, G., Andary, M., Barth, R., ... & Hayward, R. A. (2009). Diagnosis of carpal tunnel syndrome. The Journal of the American Academy of Orthopaedic Surgeons, 17(6), 389-396.
O'Connor, D., Marshall, S., & Massy-Westropp, N. (2012). Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database of Systematic Reviews, (1).
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Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.