Hand & Wrist - Carpal Tunnel Syndrome

Hand & Wrist - Carpal Tunnel Syndrome

From Numb to Nimble: Power of PT in Carpal Tunnel 

Carpal Tunnel Syndrome (CTS) is a common condition that affects the hand and wrist due to the compression of a nerve (Median Nerve) as it travels through the “carpal tunnel” - a narrow passageway in the wrist. 

This nerve plays a critical role in providing sensation and movement to the thumb and first three fingers and when compressed, can lead to a range of symptoms which if left untreated, can result in significant discomfort and functional impairment.

Who is at Risk and Why?

CTS can affect people of all ages but is more common in women and people in the 40-60 age range. Anybody who performs repetitive hand movements in their job, such as typing, sewing, assembly line work, or playing musical instruments is prone to CTS. These repetitive motions can cause inflammation and swelling in the wrist, which in turn puts pressure on the median nerve. 

There are also a few other factors, such as a wrist bone that has healed differently after a fracture,  wrist injuries and a smaller carpal tunnel which can make a person more susceptible to the condition. Hormonal changes during pregnancy can also contribute to CTS, as well as conditions like diabetes and Rheumatoid Arthritis. 

Signs and Symptoms

The main symptoms of CTS include: 

1. Numbness and Tingling in the thumb, index, middle, and ring fingers often like pins and needles and it can be quite uncomfortable. 

2. Pain and discomfort in the wrist and hand, especially during activities that involve gripping or flexing the wrist. 

3. Some people may experience weakness in the hand, making it difficult to perform fine motor tasks, such as buttoning a shirt or holding a pen. 

4. The pain waking you up at night or the pain being particularly bad after extended use. 

Complications if Untreated

If left untreated, CTS can lead to permanent nerve damage leading to chronic pain, loss of hand function, and muscle loss. In severe cases, individuals may struggle with basic tasks, significantly impacting their quality of life. Early intervention is crucial to prevent these long-term complications and to restore normal hand function.

Assessment Techniques

When assessing for CTS, our Relive Physiotherapist will conduct a thorough evaluation, starting with a detailed medical history and symptom review to understand the nature and duration of the symptoms. 

A physical examination of the hand, wrist, and arm is also essential to identify any signs of swelling, tenderness, or weakness. Special tests are used to provoke symptoms and confirm the diagnosis.

Nerve conduction studies may be performed to assess the function of the median nerve, while ultrasonography can provide a visual of the carpal tunnel anatomy, but this is not something that we offer at Relive Physiotherapy.

Physiotherapy Treatment Options

At Chester’s Best Physiotherapy Clinic for treating Carpal Tunnel Syndrome, we focus on reducing pressure on the median nerve, relieving symptoms, and preventing recurrence.

• Manual Therapy: this involves techniques such as mobilisation of the wrist and carpal bones and soft tissue massage. These techniques help to reduce pressure on the median nerve, improve blood flow, and alleviate pain and improve wrist mobility. By addressing the underlying mechanical issues, Manual Therapy can provide significant relief for people with CTS.

• Modalities such as Ultrasound Therapy and TENS (Transcutaneous Electrical Nerve Stimulation) are used to reduce pain and inflammation and promote tissue healing. Ultrasound Therapy uses sound waves to penetrate deep into the tissues to help with pain and swelling control, and is often used in conjunction with other Physiotherapy treatments to enhance their effectiveness.

• Exercise Therapy: Includes stretching and strengthening exercises for the forearm and wrist muscles, as well as nerve gliding exercises. Stretching exercises help to enhance flexibility, while strengthening exercises support the muscles that stabilise the wrist. Nerve gliding exercises promote nerve mobility, reducing the irritation and inflammation experienced within the carpal tunnel.

• Splinting involves the use of wrist splints, particularly during the night. The splint maintains the wrist in a neutral position, reducing nerve compression and alleviating night time symptoms. By wearing a splint, you can experience significant improvement in your overall sleep quality.

Preventing Recurrences of CTS

• Ergonomic Education: Crucial for preventing symptom recurrence. It is necessary to have a proper hand and wrist positioning with required workstation adjustments to help reduce strain on the wrist. 

• Patient Education and Self-Management: Physiotherapists can help you and guide on activity modification, Regular stretch breaks and home exercise programs. 

Other Treatment Options

In cases where Physiotherapy alone is insufficient, additional treatments may be considered.

• Corticosteroid Injections  involve the injecting of Anti-inflammatory medication which helps reduce swelling and ease the pain. It often gives relief within hours or days and can last for weeks or even months. But, as the injection masks the pain, it works amazing when used in conjunction with Manual Therapy as it helps work on the root cause of the pain.

At our clinic we practice Ultrasound-Guided Injection which uses sound waves to visualise the wrist interior and thereby help guide the needle accurately, which is very important as the area to inject is very small!

• Surgical intervention, known as carpal tunnel release, may be necessary to release the compressed median nerve and provide long-term relief. Surgery is typically considered when conservative treatments have failed, and symptoms are severe.

Carpal Tunnel Syndrome is a common and often debilitating condition, but with timely intervention and effective Physiotherapy, you can regain hand function and quality of life. By addressing the root causes and providing tailored treatments, Relive Physiotherapy can play a vital role in managing CTS and preventing its recurrence.

Happy recovery!