Carpal Tunnel Syndrome
What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is a condition in which the median nerve, a major nerve in the upper extremity that travels down the arm and enters the hand through a very small gap called carpal tunnel located in the central part of the wrist, gets compressed in the carpal tunnel. This causes irritation of the nerve leading to tingling or pain. Typically, this disease affects the thumb, index, and middle fingers.
Athletes participating in golf, bowling and tennis are generally affected with carpal tunnel syndrome though the most common cause remains keyboarding activity.
Causes and Risk Factors of Carpal Tunnel Syndrome
The main cause of carpal tunnel syndrome is pressure on the median nerve, which may occur due to swelling or any other injury resulting in narrowing of the size of the carpal tunnel. Causes may include:
- Diseases like rheumatoid arthritis, diabetes, and hypothyroidism.
- Repeated wrist movement such as typing, bowling, and racquetball.
- Inflammation or swelling.
- Bone spurs.
- Wrist injuries and sprains.
- Smoking as it reduces the flow of blood to the median nerve.
Watch Video of Carpal Tunnel Syndrome: Anatomy, Causes, Tests, Treatment- Carpal Tunnel Release Procedure
Signs and Symptoms of Carpal Tunnel Syndrome
Carpal tunnel syndrome causes numbness, weakness, pain, or tingling in the hand or fingers. Some individuals experience pain in the arm between their elbow and hand.
- Symptoms generally may occur in the thumb, index finger, middle finger, and half of the ring finger.
- Pain in the other fingers except little finger may be a sign of carpal tunnel syndrome.
- Hands and fingers get weak.
- Slight pain in forearm and wrist.
- Pain will be severe at night.
- Feeling of relief just by shaking out the hand.
Treatment for Carpal Tunnel Syndrome
Carpal tunnel syndrome is first treated by conservative method. The general treatment includes complete rest for the wrist by wearing a splint. Cold therapy helps a lot to relieve the swelling and inflammation.
Antiinflammatory medicines are used to clear fluid retention or to reduce inflammation. Diuretics, ibuprofen and naproxen are highly recommended ones. Apart from this corticosteroid injections are injected into the carpal tunnel area, which helps to eradicate symptoms for some period of time. However, in case the above treatments don't work well and the symptoms remain the same after six months then the next step may be surgery.
Surgery is performed in severe cases. Carpal tunnel release is a very simple operation in which carpal ligament is cut in order to enlarge the carpal tunnel and relieve the pressure on the median nerve. This is done either by open technique or endoscopic technique.
Physiotherapy for carpal tunnel syndrome is important in speeding up the healing process and to get the optimal results. Physiotherapy also decreases the likelihood of recurrences in the future. Physiotherapy may include:
- Soft tissue massage.
- Joint mobilization.
- Heat and ice treatments.
- Bracing or splinting.
- Exercises to improve strength and flexibility.
- Activity modification and training.
- Appropriate plan for return to activity.
Exercises for Carpal Tunnel Syndrome:
Stretching and strengthening exercises are really helpful for the prevention from re-occurrence of symptoms. Pain free exercises are recommended. Aim for a full, pain-free range of motion before moving on to strengthening exercises. It is better to use resistance bands for perfect performance of wrist strengthening exercises.
Wrist Flexor Stretch: Take the wrist and fingers backwards keeping the elbow straight using the other hand until a mild to moderate pain-free stretch is felt. Hold for 15 seconds and release. Repeat 4 to 5 times ensuring there is no exacerbation of symptoms.
Wrist and Finger Extensor Stretch: Curl the wrist and fingers up using the other hand keeping the elbow straight until a mild to moderate pain-free stretch is felt. Hold for 15 seconds and release. Repeat 4 to 5 times ensuring there is no exacerbation of symptoms.
Exercises for Carpal Tunnel Syndrome
Alternative Treatments for Carpal Tunnel Syndrome:
Alternative treatments, like yoga and acupuncture could also be practiced for treating symptoms of carpal tunnel syndrome.
Tests to Diagnose Carpal Tunnel Syndrome:
The first step towards investigation is a thorough physical examination and discussion about the symptoms. There are few specific tests performed under physical examination such as:
- Phalen Test
- Tinel Test
- Wrist Flexion Test
The next step toward investigation is diagnostic tests which may include:
- Electromyography (EMG).
- Nerve Conduction Velocity Test (NCV).
- Magnetic Resonance Imaging (MRI).
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