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Carpal Tunnel Syndrome if you feel pain, tingling, and numbness in your hand and wrist while working on the desk, you must go and get yourself checked for Carpal Tunnel Syndrome. (CTS) it is a progressive painful condition of the wrist caused by the compression of a nerve in the wrist.

What is Carpal Tunnel Syndrome?

First, let’s understand what a carpal tunnel. Carpal Tunnel is a narrow passage in your wrist through which the median nerve and the nine tendons of the muscles that bend your fingers pass. The bottom of the tunnel is made up of the carpal bones (wrist bones), and the top is made up of the band of connective tissue called the carpal ligament.

CTS happens when the tissues around the tendons of the wrist, called synovium swells, and start to put pressure on the median nerve. The swelling of the synovium causes the carpal tunnel to narrow, eventually leading to pressure on the median nerve, which can cause pain, tingling, numbness, and weakness.

The median nerve is responsible for the sensation of the palmar side of the thumb, index, middle, and part of the fourth finger. It is also responsible for the movement of muscles in the thumb.

Few Facts about Carpal Tunnel Syndrome:

1. According to the Bureau of Labor and Statistics and NIOSH (National Institute of Occupational Safety and Health), surgeries performed for Carpal Tunnel are among the commonest types of surgeries. It is estimated that about 230,000 procedures are performed annually.

2. According to NIOSH, only about 23% of CTS patients are able to return to their profession following surgery.

3. Women are more likely to develop the condition as compared to men.

4. There are a variety of post-surgery complications like excessive scar tissue, re-compression of the nerve in the carpal tunnel, etc.

5. In general, CTS is found in about 2.7 to 5.8 percent of the adult population (Atroshi, Gummesson, Ranstam J, 1999)

Symptoms

a. Symptoms start gradually with the feeling of tingling, burning, itching, and numbness in the palmar side of the hand and the fingers (especially in the middle finger, index finger and thumb).

b. Some may even complain of feeling their fingers useless.

c. The symptoms may start mostly in the night as most people sleep with flexed wrists. When the symptoms appear while sleep, the person may feel the urge to shake the hand and wrist to stop feeling unusual.

d. Reduced grip strength is another symptom that may appear once the condition worsens. The person finds it hard to grip small objects and perform the task that needs grasping.

e. In severe cases, even the muscle wasting of the thumb is visible.

f. In severe rare cases, people may find themselves unable to differentiate between cold and hot objects.

Causes of Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is caused by compression of the median nerve and muscle tendons present in the tunnel. The major causes of the condition are:

a. Congenital predisposition- Some people may have a small Carpal Tunnel than others, making them more susceptible to the condition.

b. Gender – Females are generally more prone to carpal tunnel syndrome than males as the condition is concomitant with the estrogen-progesterone balance (Toesca et al., 2007). This is the reason why pregnant and menopausal women complain more about the condition.

Some studies also suggest that the mean cross-sectional area of carpal tunnel is smaller in women than men, making them more susceptible to the condition (S A Sassi, G Giddins).

c. Metabolic disorders – Another group of people who can have CTS (Carpal Tunnel Syndrome) is people with metabolic disorders like diabetes, hypothyroidism, etc. These conditions affect the nerves in the body and make them prone to compression (Onder, 2012).

d.  Occupational factors – Occupational factors also contribute to the compression and damage of the median nerve. Work that demands frequent small movements from the hands like typing or certain repetitive and grasping movements like in sports may also result in CTS.

e. Others – Certain bone diseases like arthritis, rheumatoid arthritis, and osteoarthritis may also cause Carpal Tunnel Syndrome. In addition, there are other contributing factors that result in swelling of the wrist like fracture, sprain, dislocation, inflammation, etc., leading to Carpal Tunnel syndrome.

 

How is the condition diagnosed?

In order to prevent permanent nerve damage, early diagnosis is a must. Here is how the condition is diagnosed:

a. Physical examination – There is a need for a physical examination of hands, shoulders, and arms to determine if the patients’ symptoms are associated with his day-to-day activities or other diseases that may mimic CTS.

Your healthcare provider will check your wrist for swelling, tenderness, discolouration, or warmth. He will check each finger for strength, sensation, and signs of muscle wasting.

There are two specific tests that your healthcare provider will perform to confirm the diagnosis of CTS.

i.     Tinel test is a test where the doctor presses on the course of median nerve in the wrist of the patient. The test is considered positive when it produces a tingling and shock-like sensation.

ii.    In the Phalen test, the patient is asked to hold his forearms upright and point his fingers down. Now he is asked to press the backs of his hands together with each other. If the test causes an increase in the symptoms, CTS is confirmed.

b. Electrodiagnostic test – Electrodiagnostic tests like nerve conduction study and electromyography confirm CTS and diagnose the severity of the disease that may help in making treatment decisions (Pstare, Therimadasamy, Lee, EP, 2009)

During a nerve conduction study, electrodes are placed on the wrist and hand. After that small electric current is passed, the speed of the transmitted impulses is noted to diagnose CTS.

During electromyography, a fine needle is inserted into the muscle, and through the electrical activity on a screen, it is determined how much the median nerve is damaged.

How is Carpal Tunnel Syndrome treated?

Treatment should begin in the early stage under the direction of a specialist. Any underlying cause needs to be treated first. Initial treatment involves resting the affected wrist for a minimum of 2 weeks and avoiding the activities aggravating the condition.

Treatment mainly depends on few factors:

a.    The age of the patient.

b.    The family history of the patient.

c.    How bad is the condition?

d.    Is there any associated condition like diabetes etc.?

Non-surgical treatments

Drugs

There are a variety of drugs that can help in alleviating the symptoms of CTS. Your physician may prescribe you few pain relievers and NSAIDs to provide you quick relief. 

Splints

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A wrist splint can also be advised to the patient with Carpal Tunnel Syndrome for the proper rest. It stabilizes the wrist in a straight position and sometimes in a little bent position if needed. Keeping the wrist in a splint may take off little pressure from the median nerve and thus can reduce the symptoms of CTS.

Therapeutic exercise program

The therapeutic exercise program is another treatment option that your physical therapist will recommend. Exercise like Wrist extension stretch, Wrist flexion stretch, Median Nerve glides (Ballestero-Pérez, 2016), and tendon nerve glides are especially helpful.

a.     Wrist extension exercise – Sit or stand straight, outstretch one arm at your shoulder level with your fingers pointing upside and palm facing opposite to your body. Now hold the tips of your fingers with your other hand and pull them towards your body. Keep doing it until you feel a good stretch on your wrist. Hold the stretch for 20-30 seconds and proceed with the other side.

b.     Wrist flexion exercise – Sit or stand straight. Now outstretch the arm, keeping your fingertips facing downwards and palm facing towards your body. Now with the other hand, pull your hand toward the body until you feel a good stretch in your forearm. Hold the stretch for 15 seconds.

c. Median Nerve glides – Start by making a fist and keeping your thumb out. Now extend your fingers, keeping the thumb close to the fingers. Next, start extending your thumb, keeping all the fingers and wrist in position. Now with extended wrist, fingers, and thumb, turn your palm up. In this position, use your other hand and stretch the thumb a little bit.

Studies prove that therapeutic exercise programs along with night splinting can reduce the need for surgery for Carpal Tunnel Syndrome. However, before beginning the exercise program, there are few things to keep in mind:

a. Length of Program – The exercise program needs to be continued for 3-4 weeks for visible results unless otherwise specified by your physical therapist. After completing the program, you will need to continue a few or all the exercises as a maintenance program.

b.   Do not ignore pain – If you feel significant pain during the exercise, you should immediately report it to your physical therapist.

c. Ask questions – If you are not sure how the exercises are performed, don’t hesitate to ask them. A wrongly done exercise may not provide you with any relief; rather, it may also worsen your symptoms.

 

Surgery

If the symptoms of CTS don’t subside, there are few surgical procedures that you can consider. Usually, surgery is recommended if the symptoms of the condition last for six or more months. Consult your surgeon to know more about your options.

It is essential that an individual undergo physical therapy after the surgery to get back to normal day-to-day activities. A good physical therapist will ensure that your wrist strength is restored after surgery.

How can you prevent Carpal Tunnel Syndrome?

If you find that your work can put you at the risk of developing CTS, then there are few things that you can do:

a. Take frequent rest

b.  Perform stretching exercises

c.  Wear splints suggested by your physical therapist to keep the wrist neutral.

d. Use correct posture

e. Rotate the job

Such small changes at your workplace can bring huge benefits in preventing the symptoms of Carpal Tunnel Syndrome.

To get quick relief from CTS, contact our expert physical therapist from Progressive care, where we care for our patients more than anything!

References:

1. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosén I. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999;282(2):153–158.

2. Toesca, A., Pagnotta, A., Zumbo, A., & Sadun, R. (2007, September 7). Estrogen and progesterone receptors in carpal tunnel syndrome. Cell Biology International. https://www.sciencedirect.com/science/article/abs/pii/S1065699507002120.

3. S A Sassi, G Giddins, S. S. A. G. (n.d.). Gender differences in carpal tunnel relative cross-sectional area: a possible causative factor in idiopathic carpal tunnel syndrome. The Journal of hand surgery, European volume. https://pubmed.ncbi.nlm.nih.gov/26802792/.

4. Onder, B. (2012, April 3). Carpal tunnel syndrome and metabolic syndrome cooccurrence. PubMed. https://pubmed.ncbi.nlm.nih.gov/22476246/

5.Pastare D, Therimadasamy AK, Lee E, Wilder-Smith EP. Sonography versus nerve conduction studies in patients referred with a clinical diagnosis of carpal tunnel syndrome [published correction appears in J Clin Ultrasound. 2010;38(4):226]. J Clin Ultrasound. 2009;37(7):389–393.

6. Ballestero-Pérez, R. (2016, November 11). Effectiveness of Nerve Gliding Exercises on Carpal Tunnel Syndrome: A Systematic Review. PubMed. https://pubmed.ncbi.nlm.nih.gov/2784293

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