Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is the most common peripheral nerve entrapment condition, making up around 90% of all entrapment neuropathies, affecting up to 5% of people at some point in their lives. Carpal Tunnel Syndrome is caused by compression of the median nerve at the level of the wrist where it passes through the Carpal Tunnel.

The carpal tunnel is a narrow passageway in the wrist, usually around an inch wide. The floor and sides of the tunnel are formed by the row of small bones in the hand / wrist called the carpals, whilst the roof of the tunnel is formed by a strong band of connective tissue called the transverse carpal ligament. There are nine flexor tendons that run through the carpal tunnel as well as the median nerve.

The median nerve is formed by a group of nerve roots in the neck that then come together as a single nerve in the arm. It then travels down the front of the arm and forearm and through the carpal tunnel. It supplies the sensation to the thumb, the index and middle fingers and half of the ring finger and also supplies the power to the muscles around the base of the thumb.

Any increase of pressure within the Carpal Tunnel can lead to compression of the median nerve and Carpal Tunnel syndrome.

Risk Factors

There are several risk factors that have been identified for developing carpal tunnel syndrome, the most common of these are environmental factors, hence why CTS was previously grouped under the umbrella of a repetitive strain injury. Some of these include:

  • Prolonged postures in extremes of wrist flexion or extension (Eg typing)

  • Repetitive use of the flexor muscles (Any repetitive action involving gripping or wrist movement)

  • Exposure to vibrating tools or equipment

  • Participation in ports such as gymnastics, golf, cycling or racquet sports (involving gripping and repetitive wrist movements)

The other common risk factors are more medical and normally involve conditions that increase the fluid volume in or around the carpal tunnel. These include:

  • Diabetes

  • Rheumatoid Arthritis

  • Pregnancy

  • Kidney failure

  • Obesity

  • Hypothyroidism

 

While it is also seen after wrist fractures or with the development of Osteoarthritis in the wrist or hand as these can lead to a structural change to the tunnel.

Signs & Symptoms

  • Gradual onset of symptoms, normally first noticed at night

  • Pain, itching, burning, pins and needles and numbness in the thumb, index finger and middle finger

  • Feeling of the need to “shake out” the hand in order to obtain relief

  • Loss of strength in the hand which often leads to difficulty gripping or carry & in some cases dropping of objects

  • Wastage of the muscles around the thumb

Diagnosis

A diagnosis of Carpal Tunnel Syndrome is usually clinical, based on your history and the presenting symptoms. There are many other conditions that can give similar symptoms to CTS and as part of a thorough assessment your physiotherapist will look at your neck, shoulder, elbow and wrist to rule out the possibility of any tenosynovitis, bursitis or tendinopathy as well as any other neural or vascular issues.

There are 2 clinical tests that your physiotherapist can perform to confirm the diagnosis, these are called the Tinlel’s and Phalens tests. These tests involve tapping over the nerve as it passes through the carpal tunnel (Tinel’s) and placing the wrist into extreme flexion or extension and holding it there (Phalen’s) and these will usually reproduce the symptoms into the fingers. In severe cases, your Doctor may also arrange a Nerve Conduction Study which involves assessing the electrical function of the nerve and muscles it supplies to determine where a nerve compression exists and the severity of the issue.

Treatment

As with most conditions, it is important to commence treatment as soon as possible as this leads to better outcomes. In the early stages, most cases respond well to conservative management which will include:

  • Rest from aggravating activities

  • Use of anti-inflammatories and painkillers as recommended by your GP

  • Use of a wrist splint or brace

  • Manual mobilisations of the bones of the hand and wrist

  • Soft tissue release techniques

  • Prescription of home exercises including nerve glides, tendon glides, stretches & strengthening

  • Therapeutic ultrasound

  • Advice on how to modify activities to prevent recurrence

 

In more severe or chronic cases further treatment may come in the form of corticosteroid injections or even

Carpal Tunnel Release surgery which is only usually considered once other treatments have been tried unsuccessfully.

 

If you have any questions or you like to speak to one of our physiotherapists about this, or any other issue, please get in touch.

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