Carpal Tunnel Syndrome

A form of nerve compression; carpal tunnel syndrome describes a painful condition affecting the hand and the wrist. The carpal tunnel itself refers to a channel in the wrist; the sides and base are formed of bones, and the top is ligament which helps to secure the structure together. Through the tunnel runs the median nerve which is a major nerve responsible for providing feeling and sensation to several of the fingers in the hand. The carpal tunnel is narrow, although there may be variation in size from person to person. Any type of obstruction within the carpal tunnel, (whether it is inflammation, bone, excess fluid or a tumour/cyst), is likely to come into contact with the median nerve causing compression or irritation, leading to adverse painful symptoms.

Symptoms

Typical symptoms include pain and aching in the thumb, index and middle fingers, and in some cases, this is accompanied by tingling and numbness. Another commonly described symptom is a weak grip or a weak thumb. Some may experience difficulty pinching anything together between the index finger and the thumb. Pain is a highly subjective sensation and as such may vary from person to person, depending on the extent of the nerve compression/irritation and on the individual themselves; symptoms may vary from mild to severe.

Causes

As previously noted, carpal tunnel is a result of irritation or compression to the median nerve. There are a number of possible causes for carpal tunnel syndrome, although often there is no one single identifiable cause.

• Injury/trauma to the wrist – a fracture of the wrist or other type of trauma can cause inflammation, increasing the chances of developing carpal tunnel syndrome.
• Mechanical Issues – repetitive strain involving the use of the wrists and hands can cause swelling to the tissue surrounding the median nerve. The use of vibratory tools in the workplace or of computers may be attributed as causative factors of carpal tunnel syndrome.
• Obesity – being overweight increases the likelihood of developing carpal tunnel symptoms.
• Hormonal changes due to pregnancy or the menopause can cause excessive fluid and inflammation.
• Tumour/Cyst – the formation of a tumour or cyst within the carpal tunnel can result in nerve compression.
• Gender – being female can make the carpal tunnel naturally narrower and more disposed to nerve compression.
• Pre-existing health conditions such as diabetes, rheumatoid arthritis, an underactive thyroid gland or an over-active pituitary gland can all increase the likelihood of developing carpal tunnel.

Diagnosis

In most cases, suspected Carpal Tunnel syndrome can be diagnosed by the GP or by a physiotherapist. This will include a detailed physical examination as well as discussing the subjective symptoms. During the examination, the practitioner will look for signs of swelling, pain upon palpation and levels of sensitivity. Accurate diagnosis is important as the symptoms of carpal tunnel syndrome often mimic those of other disorders of a similar nature. Depending on the underlying cause, there are various diagnostic tools which may be helpful; for example, if there is a fracture, X-Ray’s will help to highlight any evidence of trauma or any arthritis.

Nerve conduction tests can check how well the median nerve is working and how well it controls muscle movement.

Ultrasound can be useful for illustrating any changes in the size of the median nerve.  Tinel’s Test and Phalen’s Test are other methods of testing often used by practitioners.

Treatment

A Wrist Splint

This can help to keep the wrist in a straight position which reduces pressure on the compressed nerve. Some patients may benefit from wearing the splint at night as well as in the day until symptoms begin to settle.

Physiotherapy

Specific exercises involving the hand and the wrist are vital for the recovery process. A specialist physiotherapist will be able to devise a suitable exercise plan which targets the wrist, helping to relieve any inflammation and compression.

Pain Relief Medication

Over the counter pain relief medication, such as paracetamol and anti-inflammatories may be useful in relieving painful symptoms and inflammation. In more severe cases, a cortisone injection (steroid and anaesthetic medication) can provide good pain relief for several months.

Surgery

If all conservative treatment methods fail, then surgery may be recommended as a last resort. Surgery for carpal tunnel symptoms is typically either open release surgery or endoscopic; both usually involve cutting a ligament in order to relieve pressure on the median nerve.

Following surgery, rehabilitative physiotherapy and pain relief medication may be required.

Preventative Measures When Working From Home

For many, the outbreak of COVID-19 has meant working from home, where ergonomic chairs and desks may not be available. However, there are several easy adjustments which can be made to help prevent the development of carpal tunnel syndrome and other postural related disorders:

• Ensure your monitor is at eye level and is directly in front of you
• Adjust the height of your chair accordingly
• Sit straight with your legs uncrossed and your feet placed directly onto the floor
• Have your keyboard straight in front of you when typing
• Leave a gap of approximately 6 inches between the edge of the desk and the keyboard, to allow a space to be able to rest your wrists in between typing
• Hands and wrists should be in the correct position over the keyboard, with the forearms parallel to the floor
• Some people like to use a wrist mat for additional support
• The mouse should be positioned close to the keyboard on a mouse mat preferably
• Stand up and walk around at regular intervals
• Look away from the monitor every few minutes
• Exercise regularly
• Eat healthily, drink plenty of fluids and get enough sleep
• Read more about correct sitting posture

Lifestyle Alterations

If carpal tunnel symptoms are a result of repetitive strain in the workplace or elsewhere, this will need to be addressed and changes made to prevent the development of further symptoms.

How We Can Help

We are a leading London based physiotherapy practice, offering specialised physiotherapy services to treat a wide range of disorders including carpal tunnel syndrome. To find out more on our physiotherapy and other services, get in touch today.