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What to know about CARPAL TUNNEL SYNDROME?

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome (CTS) is a type of nerve entrapment where there is a compression of the median nerve as it travels through the wrist’s carpal tunnel. It is a very common condition that is seen by many healthcare professionals.

Early signs and symptoms include pain, numbness, morning stiffness and paraesthesia in the affected hand. The symptoms can later progress, resulting in pain that radiates up the affected arm, hand weakness, decreased fine motor coordination, clumsiness and thenar atrophy. This can induce self-care difficulties such as brushing teeth, combing hair, holding cup and many other activities of daily living using the hand. CTS is also a condition that affects more females than males.

Anatomy of the Carpal Tunnel:

The carpal tunnel situated in our wrist is a non-extendable osteofibrous wall which forms a tunnel to protect the median nerve and nine flexor tendons. The transverse carpal ligament makes up the superior border and the carpal bones make up the inferior border of the carpal tunnel.

What causes CTS?

Some CTS causes are known, however, there are also some idiopathic causes of CTS.

CTS can be possibly caused by:

  • Genetic predisposition (hereditary)
  • Repetitive wrist movement for example; typing, gardening, carpenter
  • Obesity
  • Autoimmune disorders such as rheumatoid arthritis
  • Pregnancy

Management of CTS:

There are two approaches to treat CTS, which include 1) surgical management and 2) conservative management. Doctors want to avoid the surgical approach, so will always try to recommend the conservative management first.

Conservative management includes coming to see your physiotherapist. Everyone is unique and the severity of CTS varies. Therefore, the treatment time period will also vary. Studies have shown that the treatment period can take up to a year or more, so patients/clients need to be patient.

Some general physiotherapy treatment would involve:

  • Education about the condition and prevention for reoccurrence
  • Ergonomic modification
  • Soft tissue massage
  • Carpal bone mobilisations
  • Neuro-mobilisations of the median nerve
  • Electrotherapy such as ultrasound
  • Strength training such grips
  • Referral to other healthcare workers, for example; occupational therapists for splinting of the wrist and return of function of hand activities

According to Kwolek and Zwolinska (2011), they did a study to see if patients with CTS would benefit from a combination of treatments specifically ultrasound, massage and kinesiotherapy (movement therapy) after receiving one year of physiotherapy. Their study showed a significant improvement in the quality of sensation, hand/wrist range of movement and muscle strength from just doing the combination of treatment after one year.

Another study shows that doing neuro-mobilisation with routine physiotherapy can also make a significant difference (Oskouei et al., 2014). Moreover, all these treatment techniques are non-invasive.

In conclusion, physiotherapy can play a huge beneficial role in the management of CTS. Studies have shown that a combination of treatment techniques can result in a better outcome and as well as the period of the rehabilitation takes time. Therefore, patients/clients need to remain patient while their hand/wrist heals.

If you are experiencing any of these symptoms, please book an appointment with us. We are first line practitioners and are able to diagnose whether you have CTS or not. If you have been diagnosed, please book a session with us to commence with treatment and rehabilitation. The earlier we start with treatment, the better the results!

References:

  • Kwolek, A., & Zwolinska, J. (2011). Immediate and Long-term Effects of Selected Physiotherapy Methods in Patients with Carpal Tunnel Syndrome. Ortopedia, Traumatologia, Rehabilitacja, 6(6), Vol. 13, 555-564.
  • Oskouei, A., Talebi, G., Shakouri, S., & Ghabili, K. (2014). Effects of Neuromobilisation Maneuver on Clinical and Electrophysiological Measure of Patients with Carpal Tunnel Syndrome. Journal of Physical Therapy Science, 1017-1022.
  • Sartore, K., Pospiech, J., Ritchie, L., Bossant, S., & Hampton, L. (2020, April 7). Carpal Tunnel Syndrome. Retrieved on 15 April 2020 from Physiopedia: https://physio-pedia.com/Carpal_Tunnel_Syndrome

MICHELLE CHIEN