Carpal tunnel Syndrome
Carpal tunnel syndrome or CTS develops when a patient’s median nerve becomes squeezed or pressed around the wrist. The median nerve runs from forearm to palm of a person’s hand. The carpal tunnel is a narrow and rigid passageway comprised of bones and ligament. It is present at the base section of the hand. The tendons and median nerve bending the fingers are stored within the carpal tunnel. The median nerve presents with sensation to palm side of thumb as well as to the middle and index fingers. They also stimulate parts of ring fingers even not the actual little finger itself. The median nerve also controls certain small muscles located around the base of thumb.
In some cases, thickening caused by the lining of the irritated tendons and other forms of swelling eventually narrows the tunnel, thus compressing the median nerve. This may lead to numbness and weakness. Sometimes it may also cause pain in the wrist, hand, arm and forearm. Carpal tunnel syndrome is by far the most widely occurring entrapment neuropathies wherein intense pressure is exerted into one of the peripheral nerves of the body.
Symptoms of carpal tunnel syndrome may include:
- Numbness, tingling, burning, and pain—primarily in the thumb and index, middle, and ring fingers
- Occasional shock-like sensations that radiate to the thumb and index, middle, and ring fingers
- Pain or tingling that may travel up the forearm toward the shoulder
- Weakness and clumsiness in the hand—this may make it difficult to perform fine movements such as buttoning your clothes
- Dropping things—due to weakness, numbness, or a loss of proprioception (awareness of where your hand is in space)
In most cases, the symptoms of carpal tunnel syndrome begin gradually—without a specific injury. Many patients find that their symptoms come and go at first. However, as the condition worsens, symptoms may occur more frequently or may persist for longer periods of time.
Night-time symptoms are very common. Because many people sleep with their wrists bent, symptoms may awaken you from sleep. During the day, symptoms often occur when holding something for a prolonged period of time with the wrist bent forward or backward, such as when using a phone, driving, or reading a book.
Many patients find that moving or shaking their hands helps relieve their symptoms.
- Splinting. Initial treatment for this condition involves wearing a splint at night.
- Avoiding all daytime activities that can provoke the symptoms. If you experience slight discomfort in your hand you may want to take breaks on a frequent basis so that it can help you to rest your hand. In case you find the wrist to be red, swollen and warm, you should apply cool packs for easing such symptoms.
- Over-the-counter drugs. Various types of over-the-counter drugs can be used for easing the pain, discomfort and swelling caused by carpal tunnel syndrome. Non-steroidal anti-inflammatory drugs like aspirin and ibuprofen as well as other notable nonprescription pain relievers can be used for achieving short term relief from discomfort. However, it is important to remember that these drugs cannot treat the condition of CTS itself.
- Prescription medicines. Corticosteroids like prednisone and the lidocaine drug can be easily injected into the wrist to manage the condition. Prednisone can be taken orally to achieve the same effect. These drugs are often useful in relieving the pressure on median nerve for patients experiencing mild and intermittent symptoms. Nevertheless, it is to be remembered that people having diabetes or are prone to diabetes should use corticosteroids with care as prolonged use of these drugs can eventually make it increasingly difficult to regulate the insulin levels.
- Alternative therapies. Alternative therapies such as yoga exercises have been proven to greatly reduce pain as well as improve overall grip strength in patients of CTS. There are also people who report substantial relief through chiropractic care and acupuncture. However, effectiveness of such therapies remains unproved.
If the initial evaluation indicates early-stage CTS, the medical experts are going to recommend conservative care as the first step. The symptoms can be reduced with physical therapy treatment and you can also get back to your normal activities. While discussing your case with physical therapist, make sure that you describe all your symptoms with great detail. You should also mention the risk factors that make your CTS symptoms worse.
By studying the specific factors responsible for your case, your doctor will recommend a custom therapy program for you. This may involve:
- Education regarding:
- changing wrist positions, like avoiding bent wrist positions for a prolonged time
- proper posture for your neck as well as upper back region, such as avoiding forward head position or slouching
- the program is also going to instruct you on how to use sharp utensils and tools in a safe manner; this is important if sensory changes are detected
- “stretch breaks” that you need to take during your daily routine or when you work
- Exercises that help in increasing strength of muscles in the hands, forearm and fingers as well as in some instances, the postural back and trunk muscles
- Stretching exercises for improving flexibility of hand, wrist and the fingers
- Using heat/cold treatments for relieving pain
- Using a night splint for reducing discomfort
- The therapist may recommend a worksite visit for assessing your work area. This is important to make sure that ergonomic rules are followed in your work area. For instance, if you have to sit at the desk as you work on the computer, you must make sure that the keyboard is placed in proper alignment so that you can avoid working in bent wrist position.
- Increasing sizes of the utensil and tool handles; this can be done by simply adding some extra material to ensure a comfortable grip
- Anti-vibration wraps or anti-vibration gloves must be used with tool handles in case vibration is a major disturbing factor in your workplace
The physical therapist is also going to consider your current leisure and home activities. The therapist may recommend you to wear gloves so that you can keep your wrist or hands warm. You should also limit your participation in sports that might aggravate the condition, like racquet sports for as long as the symptoms resolve.
The primary objective of physical therapy is to reduce the symptoms without actually going for a surgery. The therapist will also try to make you as active, healthy and functional as it is possible so that you may resume your home, work and leisure activities and get back to normal life.
Physical Therapy Following Surgery
In case evaluation shows that your CTS case is more severe, your physical therapist is likely to refer you to surgeon or physician for surgical consultation. This also applies if the symptoms persist for long. Surgery will be carried out if necessary to effectively release band of the tissue causing undue pressure on median nerve. The physical therapy treatment must be continued after the surgery so that you may have your strength restored on the wrist. The therapy can also help you to modify your habits which may have caused the symptoms to begin with. The physical therapy treatment might include the following:
- Exercises which can help in improving strength of your hand and wrist muscles which in turn can improve function
- Stretching for improving overall mobility of wrist and fingers as well as for improving function
- Scar management will be carried out so as to maintain skin suppleness and flexibility
- Education will be provided regarding the appropriate posture as well as wrist position for avoiding carpal tunnel compression when you are performing home and leisure activities
- A simulation or worksite visit can be carried out to optimize the positions and postures