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 compressed or flattened at the level of your wrist where it passes through a tunnel of bone and ligament called the carpal tunnel and into your hand. 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 minimal 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 why carpal tunnel syndrome may develop. It is common for pregnant women to develop symptoms during pregnancy due to the increase in peripheral fluid resulting in 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. Symptoms can also be caused by prolonged repetitive activity such as spending many hours typing on a computer or manual work in the garden. 

Other risk factors include diabetes, arthritis and various medications. 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, index finger and middle finger as well as the half of the ring finger that is on the side of the middle finger. The other half of the ring finger and the little finger are innervated by the ulnar nerve and are not affected in carpal tunnel syndrome.

Symptoms of carpal tunnel 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 be symptomatic during the day, especially if you have been in the same position for a prolonged period of time. Some people report dropping 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 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 hand therapist. Your doctor may request nerve conduction studies to find out more about how the nerve is sending signals.

Treatment

Engaging in hand therapy is a great first option to try when experiencing carpal tunnel syndrome symptoms. It is important for you to be educated on carpal tunnel and 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. Our team of experienced therapists are able to fabricate custom thermoplastic splints for optimum comfort and wrist positioning to decrease pressure on the nerve. We may also teach nerve gliding exercises to promote nerve health.

If conservative management is unsuccessful after a number of weeks, a surgical review may be indicated. We can assist you in this process by recommending surgeons, facilitating a referral from your GP, and helping you to arrange an appointment. 

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.

Prevention Of Carpal Tunnel Syndrome

  • 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
  • Attempt to avoid sleeping in postures that compromise your median nerve at the wrist level. Wearing a wrist brace can assist with this as it keeps your wrist in a neutral position.

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 surgical intervention is required.

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