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Carpal Tunnel Syndrome

Carpal tunnel syndrome is a common condition that causes pain, numbness, and tingling in the hand and arm. It occurs when the median nerve, which runs from the forearm into the hand through a narrow passageway called the carpal tunnel, becomes compressed or squeezed. The carpal tunnel is a narrow, rigid passageway located on the palm side of the wrist, and it houses the median nerve as well as several tendons that facilitate finger movement. Several factors can contribute to the development of carpal tunnel syndrome including repetitive hand and wrist movements, trauma or injury, wrist anatomy, hormonal changes such as those that occur during pregnancy or menopause, or medical conditions including diabetes, hypothyroidism, and rheumatoid arthritis.

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Symptoms

1.Numbness, tingling, or burning sensations in the thumb, index finger, middle finger, and half of the ring finger.
2.Weakness of clumsiness with the hands which makes it difficult to perform fine motor skills such as gripping objects or buttoning clothing.
3.Pain or discomfort that radiates from the wrist up the arm or down into the fingers.
4.Symptoms often worsen during activities which static gripping of objects such as a phone or steering wheel but may also be worse at night or early in the morning.

Treatments

Carpal tunnel syndrome can be treated using a wide variety of methods, and your physiotherapist will be able to identify which treatments will benefit you most based on your symptoms.
Physiotherapy is commonly the primary approach for managing symptoms linked to carpal tunnel syndrome. Physiotherapy interventions aim to decompress the median nerve with the wrist canal, and will often use exercises, mobilisations, and nerve glides to facilitate this [1]. These interventions are designed to stretch the median nerve, improve tendon gliding, and increasing range of motion at the wrist where appropriate, and are shown to have significant benefits on carpal tunnel syndrome symptoms [2].
Another important aspect of rehabilitation for carpal tunnel syndrome is activity modification. Physiotherapists will assist in the identification of movements or daily activities that may be increasing compression of the median nerve and provide education on how to best manage this. Ergonomic changes have been shown to significantly reduce carpal tunnel symptoms [3].
Splinting has also been shown to improve symptoms in mild to moderate cases [4]. By keeping the wrist in a neutral position, splints decrease the extremes of wrist flexion and extension which are shown to increase pressure within the carpel tunnel. Splits are typically prescribed for predominately night-time use; however they can also be used during the day depending on an individual’s lifestyle, work, and activity demands [5].

References

1.Soyuer F. Effectiveness of current physiotherapy in carpal tunnel syndrome. Int J Fam Commun Med. 2021;5(3):87-9.
2.Bobowik PŻ. Effectiveness of physiotherapy in carpal tunnel syndrome (CTS). Advances in Rehabilitation. 2019;33(2):47-58.
3.Trillos-Chacón MC, Castillo-M JA, Tolosa-Guzman I, Medina AF, Ballesteros SM. Strategies for the prevention of carpal tunnel syndrome in the workplace: A systematic review. Applied ergonomics. 2021 May 1;93:103353.
4.Wipperman J, Goerl K. Carpal tunnel syndrome: diagnosis and management. American family physician. 2016 Dec 15;94(12):993-9.
5.Ostergaard PJ, Meyer MA, Earp BE. Non-operative treatment of carpal tunnel syndrome. Current reviews in musculoskeletal medicine. 2020 Apr;13:141-7.
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