Carpal tunnel syndrome
Carpal tunnel syndrome is a painful disorder of the wrist and hand. It occurs when pressure is applied to the median nerve. The median nerve passes through your forearm into your hand. As it goes to the hand it passes through a tunnel know as the carpal tunnel. The carpal tunnel has as its floor the wrist carpal bones and as its roof a layer of connective tissue. Inside the tunnel are also the tendons of the hand and finger muscles. The tendons are covered by a lubricating membrane that under certain circumstances can become enlarged and swollen. This results in decreased space in the carpal tunnel that leads to pressure on the median nerve.
The lubricating membrane of the tendons can become swollen under the following circumstances:
• repetitive and forceful grasping with the hands
• repetitive bending of the wrist
• broken or dislocated bones in the wrist which produce swelling
• arthritis, especially the rheumatoid type
• thyroid gland imbalance
• sugar diabetes
• hormonal changes associated with menopause
• Pain, numbness, or tingling in your hand and wrist, especially in the thumb and index and middle fingers
• Pain may radiate up into the forearm
• Pain that increases with increased use of the hand
• Pain that increases at night
• Weak grip and tendency to drop objects held in the hand
• Sensitivity to cold
• Muscle deterioration especially in the thumb (in later stages)
Diagnosis and treatment
Through assessment of your symptoms and physical examination of your hand your physiotherapist or doctor will be able to diagnose this condition. In some cases your doctor may also prescribe nerve tests.
Initial management of this condition involves reducing pain and inflammation. This would involve rest from aggravating activities, the use of electrotherapeutic modalities and soft tissue techniques by your physiotherapist and the wearing of a night brace/splint to prevent bending of the wrist/hand. Your physiotherapist will also educate you about this condition and preventative measures to try and avoid re-occurrence. In some cases the condition does not settle and surgery is required to release the connective tissue to allow more room for the median nerve.