Today we know about:
A. What is Carpal Tunnel Syndrome
B. What is Your Carpal Tunnel?
C. What’s the Cause of Carpal Tunnel Syndrome
D. How does this occur
E. What’re the Symptoms of Carpal Tunnel Syndrome
F. How is Carpal Tunnel Syndrome Diagnosed?
G. Carpal Tunnel Syndrome Treatment
**Carpal Tunnel Syndrome**
** What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is a painful disorder of the hand caused by
pressure on your median nerve as it runs through the carpal tunnel of
the wrist. Symptoms include numbness, pins and needles, and pain
(particularly at night). Anything that causes swelling inside the
wrist can cause carpal tunnel syndrome, including repetitive hand
movements, pregnancy and arthritis.
** What is Your Carpal Tunnel?
Your carpal tunnel protects vital structures such as the median nerve,
blood vessels and tendons as they pass to and from your hand. The palm
side of your wrist has a band of strong ligaments (flexor retinaculum)
that attach to the carpal (wrist) bones at either side. The rear of
the tunnel is a curved compilation of the wrist bones.
** What’s the Cause of Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome symptoms begin when the pressure inside the
tunnel becomes too high. This results in your median nerve becoming
compressed as it passes through the small tunnel.
The carpal tunnel pressure increase occurs when either of two things happens:
The tunnel space decreases, such as when the wrist swells eg after a
traumatic injury, partial subluxation of the carpal bones or fracture
When the contents of the tunnel (median nerve, blood vessels and
Both of these situations increase the pressure on the nerve, leading
to the carpal tunnel symptoms.
Other Common Causes of Carpal Tunnel Syndrome
Frequently, the median nerve is compressed elsewhere along its path –
not in the carpal tunnel – and replicates carpal tunnel symptoms. Most
often compression occurs in your neck but can occur anywhere along the
nerve path as it travels to your hand. This entrapment predisposes the
nerve to develop carpal tunnel symptoms.
** How does this occur?
Healthy nerves have a supply of fluid called axoplasmic fluid, which
provides the nerve with nutrients. Normally, a pressure of about 70
mmHg propels this fluid slowly along the length of the nerve. However,
if the nerve is slightly squashed (e.g. by a bulging neck disc) then
the flow of this fluid is interrupted. Your nerve will starve and you
may experience carpal tunnel symptoms.
It is important to confirm the site of your nerve compression. There
are many patients over the years who have had carpal tunnel surgery
performed without benefit because the carpal tunnel symptoms
originated from nerve compression elsewhere. This condition is known
as “double crush syndrome”.
Your nerves should freely travel along their pathways between your
spine and your fingers. Any interference of their slide mobility could
cause symptoms eg scar tissue, tight muscles. Your physiotherapist can
assess your neurodynamics for abnormalities.
* Hormonal Factors
Hormone imbalances can cause swelling of the hands and feet, as
evidenced by the condition’s prevalence in middle-aged or pregnant
* Gripping, Repetition and Microvibration
• Occupations associated with repetitive wrist flexion and extension
activities, vibratory tools, and gripping have a high incidence of
carpal tunnel syndrome.
** What’re the Symptoms of Carpal Tunnel Syndrome?
carpal tunnel syndrome
Carpal Tunnel Syndrome (CTS) sufferers will usually experience the
following symptoms in their hand or fingers:
hand pain or aching
pins and needles
numbness esp at night of with wrist flexing
weakness or cramping
The symptoms are usually worse at night and your grip will weaken as
the condition progresses. Eventually you will notice muscle atrophy of
the thenar (thumb) muscles and loss of hand function or clumsiness. If
this sounds like you, suspect carpal tunnel syndrome.
Shaking the wrist may ease symptoms temporarily.
** How is Carpal Tunnel Syndrome Diagnosed?
Your physiotherapist[HKP] or doctor will generally diagnose carpal
tunnel syndrome based on your symptoms. They use various tests such as
Phalen’s test, Tinel’s test or the wrist flexion/median nerve
compression test that compress the carpal tunnel. It is also important
to thoroughly examine your lower neck and upper back joints, plus your
nerve tissue mobility – neurodynamics.
Your doctor may refer you for nerve conduction studies or EMG studies
to quantify if your nerve electrical impulses are slowed by
compression of the carpal tunnel or further up the arm.
Ultrasound may reveal median nerve enlargement. X-ray may identify
coexisting pathologies. MRI, CT scans are not normally required.
** Carpal Tunnel Syndrome Treatment
Rest & Patient Education
Resting from the aggravating cause is important. Education and
awareness about what the symptoms and what positions or activities
potentially cause carpal tunnel syndrome is important.
• Night Wrist Splint
A nighttime wrist splint is beneficial to eliminate wrist bending and
therefore carpal tunnel symptoms. Your physiotherapist[HKP] may
recommend a splint.
Physiotherapy is beneficial for most carpal tunnel sufferers
especially in mild to moderate cases.
Our physiotherapy team [HKP] will address:
Carpal bone mobilisation and flexor retinaculum stretching to open
the carpal tunnel.
Nerve and tendon gliding exercises to ensure full unrestricted nerve
motion is available.
Muscle and soft tissue extensibility.
Cervicothoracic spine to correct any referral or double crush syndromes.
Grip and pinch, thumb abduction and forearm strengthening in later phases.
Comprehensive upper limb, wrist and hand ROM strengthening and
Posture, fine motor and hand dexterity exercises.
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