Conditions Treated

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is a common hand and wrist condition which can be quite painful and disruptive to your sleep and everyday life. It can be really worrying for some people but there are some very effective treatment options that should have you sleeping well again soon.

Definition

Carpal tunnel syndrome is when your median nerve is squashed at the level of your wrist where it passes through a tunnel of bone and ligament called the carpal tunnel. The floor and walls of the tunnel are made up of the carpal bones of your wrist. The roof of the tunnel is a ligament called the transverse retinacular ligament. These bones and ligaments are tough and strongly bound together with little movement or stretch between them. The median nerve passes through this tunnel along with the tendons that bend your fingers and your thumb.

Causes

There are many reasons that the nerve might become squashed. It is common for pregnant women to experience it during pregnancy because increases in peripheral fluid mean there is less space in the tunnel for the nerve. It can also occur when there is swelling in the wrist as someone recovers from surgery or an injury. Sometimes the swelling can occur after a big day in the garden or on the golf course, or after a period of increased activity or work factors. In other cases, someone might be predisposed to carpal tunnel syndrome because of a small, tight tunnel or big, thick tendons.

Other risk factors include diabetes, some types of arthritis and being overweight.

Whatever the cause, the compression of the nerve means that it is no longer able to send its signals normally.

Signs & Symptoms

Symptoms of carpal tunnel syndrome include numbness or tingling, pins and needles, burning pain or electric shocks in the median nerve distribution. This refers to the area of the hand that the median nerve is responsible for – the palm side of the thumb, forefinger and middle finger as well as the half of the ring finger that faces the middle finger. The other half of the ring finger and the little finger are looked after by the ulnar nerve and are not usually affected in carpal tunnel syndrome.

These symptoms are often worse at night and may wake you during your sleep. Patients often report having to hang their arm off the bed or shake it around in order to get back to sleep. It can also strike during the day, especially if you have been in the same position for a prolonged period of time. Some people report dropping or fumbling objects, or having difficulty with fine motor tasks such as doing up buttons or tying shoelaces.

If the compression is severe the muscles of the hand may become weak or atrophy (become softer or smaller) as the nerves can’t send signals to them.

Carpal tunnel syndrome can be diagnosed by performing manual tests in a clinic and completing questionnaires with your doctor or therapist. Your doctor may request nerve conduction studies to find out more about how the nerve is sending signals.

Treatment

Therapy is the first line of treatment. Lots of people have complete relief from seeing a hand therapist learn how to avoid aggravating activities or positions, such as bending the wrist forward. We can also recommend wearing wrist splints or braces at night to hold the wrist in a neutral position and therefore, keep the carpal tunnel open. This decreases pressure on the nerve. We may also teach nerve gliding exercises to improve nerve health.

If this is unsuccessful after a number of weeks, a surgical review may be indicated.

Different medical procedures can include corticosteroid injections or carpal tunnel decompression surgery. This is a surgical procedure in which the ligament that makes up the roof of the carpal tunnel is cut open to allow more space for the median nerve and tendons.

How Can I Prevent Carpal Tunnel Syndrome?

  • Keeping fit and healthy by following the Australian government recommendations for physical activity and exercise has been shown to reduce the likelihood of developing carpal tunnel syndrome, as well as many other health benefits. This includes the following:
    • 2.5-5 hours of moderate activity per week    OR
    • 1.25-2.5 hours of vigorous activity per week    AND
    • Muscle-strengthening activity at least 2 days per week (this could include activities like gardening or carrying shopping)
  • Quitting smoking or avoiding smoking is really good for the health of your nerves
  • Modify activities that require maintaining prolonged postures, take regular movement breaks during your day.
  • If you have a health condition that is a risk factor for carpal tunnel syndrome, try to ensure the condition is well managed with your general practitioner

Melbourne Hand Therapy Can Help You

Like many conditions, carpal tunnel syndrome is more responsive to treatment if diagnosed and treated early. The hand therapists at Melbourne Hand Therapy are experts in diagnosing and treating carpal tunnel syndrome.

They will be able to assess you and provide advice regarding the best treatment options. Our therapists have strong professional relationships with excellent surgeons who can be consulted if medical intervention is required.  The sooner carpal tunnel syndrome is diagnosed, the more effective treatments can be, so book an appointment to see a Melbourne Hand Therapist today!

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