Imagine if it hurt every time you used your hands, drinking coffee, getting dressed, or driving. Working on a computer would be impossible. That’s what it’s like to have Carpal Tunnel syndrome (CTS) – and this condition is increasingly common in our society.
The term ‘carpal’ refers to the wrist; the carpal tunnel, as you might expect, is a ‘tunnel’ created by the wrist (carpal ) bones and a broad firm ligament called the carpal ligament. The tendons for the muscles that bend the fingers and a nerve called the median nerve run through this tunnel into the hand. The median nerve supplies sensation to the thumb, index, middle and half the ring fingers, as well as supplying some of the muscles of the thumb-particularly the ones that allow you to pick objects up.
Each of the muscle tendons has a sheath called the tenosynovium, which keeps the tendons running freely. However, if the tendons become irritated or inflamed, the tenosynovium swells, and in time will thicken. This means that the space in the ‘tunnel’ gets smaller; if the problem persists, the swollen sheaths almost fill the tunnel, and the median nerve gets compressed against the carpal ligament.
When the nerve is compressed, it cannot function properly, and the individual begins experiencing symptoms such as numbness, tingling and pain in the parts of the hand the nerve services. People generally first experience the symptoms of CTS at night. As the condition progresses, the thumb muscles may weaken, and it can become difficult to hold or lift even the lightest object. Sometimes the pain will even radiate up the arm toward the shoulder or neck.
CTS can be caused by many things – arthritis, wrist fractures, and even from fluid retention during pregnancy. However, the most common cause groups CTS with other Repetitive Strain Injuries. This means that it is likely caused by any activity that involves overuse or sustained rapid hand movements – like keyboarding.
When CTS is first diagnosed, a resting splint, which holds the wrist in a neutral position, may help relieve symptoms, especially those that occur at night. Changing the way a work station is set up, modifying the length of time spent on a computer, or on any other activity that aggravates the wrist, can also be helpful.
Physiotherapy can be very effective in the early stages of CTS. A physiotherapist will be able to treat the symptoms with modalities such as ultrasound or interferential therapy, as well as prescribing gentle graded exercises that will assist the recovery process.
Physiotherapists also understand the causes of CTS – which in the long run, are even more important than treatment. There is substantial research suggesting that poor body mechanics play a significant role in developing CTS. Physiotherapists are trained in body mechanics, and can help their clients adjust or modify their work situation to reduce the factors which aggravate or precipitate symptoms. Early intervention is the key to management of Carpal Tunnel Syndrome, and physiotherapists are professionals that can make a difference. Call your local physiotherapist for help, no referral is necessary.
Submitted by Metrotown Orthopaedic and Sports Physiotherapy Clinic in conjunction with the Canadian Physiotherapy Association.