Carpal Tunnel Syndrome

Conservative TreatmentUntitled1

Carpal tunnel syndrome (CTS) is a common problem affecting the hand and wrist. Symptoms begin when the median nerve gets compressed, inside the carpal tunnel.

The Median Nerve passes through the carpal tunnel at the wrist and into the hand. It gives sensation to the thumb, index finger, middle finger, and half of the ring finger.

CAUSES

CTS has been linked to the following causes:

  • Wrist injury: may cause swelling and extra pressure within the carpal tunnel. The area inside the tunnel can also be reduced after a wrist fracture or dislocation if the bone pushes into the tunnel.Untitled2
  • Aggravating activities: the way an activity is performed can increase the risk of CTS. Some of these risks include force, posture, wrist alignment, repetition, temperature and vibration.
  • Pregnancy: can cause fluid to be retained, leading to extra pressure in the carpal tunnel.

SYMPTOMS

  • Sensation: pins and needles, tingling and numbness in the areas supplied by the median nerve (see diagram above). This can often be worse at night.
  • Pain: aching in the wrist/hand area.
  • Strength: the muscles of the thumb can weaken and waste, making it difficult to grasp items.

DIAGNOSIS

A Nerve Conduction Study (NCS) is used to diagnose CTS. This study needs to be requested by your doctor. The NCS measures how fast nerve impulses move through the nerve. There are a number of other diagnostic assessments a doctor or therapist can perform to give an indication that CTS is a likely diagnosis.

MANAGEMENT

  • Splinting: A wrist thermoplastic splint or soft brace worn while sleeping can be effective in decreasing the symptoms in the early stages of CTS. The splint is designed to keep the wrist in a neutral/straight position, to take the pressure off the median nerve.
  • Activity Modification: Activities that are causing your symptoms need to be ceased or modified. It is important to avoid repetitive use of your hand, heavy grasping, holding onto vibrating tools and positioning or working with your wrist in extremely bent positions.
  • Cortisone Injection: A cortisone injection may be useful to reduce the inflammation in the hand and therefore take the pressure off the nerve. Speak to your therapist and/or doctor about this and whether a cortisone injection would be suitable for you.

Median Nerve Gliding Exercises

  • These exercises are to help facilitate the normal sliding of the median nerve through layers of fascia/muscle/fat – normal gliding is about 2cm. Injuries and immobilisation can reduce the flexibility and sliding of the nerve and cause pain and discomfort during movements.
  • DO NOT push the exercises into PAIN. They should be done, slowly and rhythmically using deep breathing to help you relax.
    Complete 3 times per day, 6 – 8 repetitions
  1. Watch the watch
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    Start with your hand out in front of you with your elbow extended. Bring your elbow up towards you with your palm facing up.
  2. Stop sign
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    Hold both of your arms out in front of you while extending your wrists backwards. From this position, move your affected hand forwards from your shoulder.
  3. Ball throwing
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    Using a tennis ball, throw the ball against a wall underarm. As this exercise becomes easier to complete, you can upgrade by throwing the ball against the wall overarm.
  4. Finger stretch
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    Start with your elbow bent, palm facing upwards and wrist straight. Slowly straighten your elbow while extending your wrist backwards. Using your other hand push your index finger back towards you.
    To increase tension, slowly move your neck downwards and then backwards.
  5. Prayer
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    In a prayer position, slide your elbows from side to side – slow and controlled.
  6. Zorro
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    Starting with your arm across your body, above your head, make a “Z” shape with your arm.