24 Jul Carpal Tunnel Syndrome
Explaining Carpal Tunnel Syndrome..
What is it: The carpal tunnel is the space where blood vessels, tendons and nerves run through from your forearm to your hand. Carpal tunnel syndrome is when there is too much pressure on the main nerve that runs through it, called the median nerve.
Cause: It can be caused from repetitive hand movements such as typing, or trauma to the wrist that causes an increase in swelling in the area. It is also common in pregnancy or from other conditions such as arthritis that can cause increased swelling.
Signs & Symptoms: The medium nerve gives feeling to the thumb, next two fingers and half of the ring finger, so symptoms are typically experiencing pain, numbness or pins and needles in this area. Symptoms are often worse at night and your grip may start to become weak.
Confirm diagnosis: Along with your symptoms, there are a few tests a physio can perform that help to diagnose carpal tunnel, such as the Phalen’s test, which is where you hold your wrists against each other in a flexed position for 1 min to see if it reproduces or increases your symptoms. Imaging isn’t usually effective in diagnosing it, but nerve conduction studies can sometimes be helpful.
It is important that the physio assess all possible causes of the symptoms as sometimes the median nerve can be compressed somewhere else, such as the neck, and produce the same symptoms at the wrist.
How to treat it: If it is caused from repetitive action, the first point of call should be to modify the action under the guidance of a physio, as it may be improved by simply changing position or equipment. Wearing a splint that stops the wrist from bending can help to settle the symptoms, especially worn overnight. A physio will then trial some manual therapy techniques such as massage depending on what they have identified as your cause and also guide you through some exercises to try.
If the above conservative approach does not improve symptoms, then surgery may be warranted. Surgery involves cutting the ligament around the carpal tunnel to take pressure off the median nerve, then with healing the ligament will come back together but with more room for the median nerve to pass through.
If you think surgery is needed, you want to be sure that your symptoms are not coming from higher up your arm or neck, as unfortunately there are times where surgery is unsuccessful for this reason. So it is wise to get a second opinion from a specialist hand physio prior to committing to surgery.
Recovery time: Mild to moderate cases of carpal tunnel syndrome tend to improve slowly over 2-3 months. Typically, if after 6 months of physio treatment and wrist splints symptoms are still present or if symptoms become severe, surgery is warranted to prevent long-term damage.
Surgery is typically a day procedure and often symptoms can improve straight away, but it is not uncommon to take weeks or months to notice an improvement (depending on the extent of the nerve damage). It’s important to continue to work with your physio after surgery to guide you through returning to activities using the hand.