• The Carpal Tunnel Syndrome

    12th March 2015 | donaldt
  • If you frequently wake up at night with a tingling or numbing sensation in your hand or if you have a constant heaviness and discomfort in your hands while working at your desk it is most likely you may be suffering from carpal tunnel syndrome or CTS as it is very often referred to. CTS is a painful progressive condition caused by compression of a nerve in the wrist.

    The carpal tunnel consists of a passage inside the wrist through which nerves, arteries, and veins pass. It is formed by wrist bones roofed over by a broad ligament known as the transverse ligament. CTS occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes compressed due to some form of swelling within this passage. Rheumatoid arthritis, mechanical problems in the wrist joint, repeated use of vibrating hand tools, or the development of a cyst in the canal may contribute towards the development of CTS. The median nerve controls sensation to the thumb, index, middle and one side of the ring finger. It also sends impulses to muscles in the palm that control hand movements. Compression of this nerve gives rise to a sensation of numbness, tingling, heaviness and pain in the palm and fingers. These symptoms may come and go over many months and may go unnoticed. With time the symptoms get worse leading to increased pain with eventual muscle weakness and loss of function if left unseen to.

    This condition is common in occupations where the wrist is subjected to significant stress such as hairdressers and restaurant workers. The need to strengthen the shoulder, forearm, wrist, and hand muscles through adequate exercises must be emphasised. Pregnant women, clerical workers and construction workers are also prone to this condition. In the case of pregnancy it is the result of increased swelling within the body. The symptoms usually resolve after delivery.

    As always prevention is better than cure. It may be possible to avoid the development of CTS by ensuring adequate ergonomic design and through the avoidance of situations which over strain tendons, ligaments and bones around the wrist. Avoiding repetitive strains in the wrist through correct work station design as well as through maintaining a strong wrist and upper limb capable of performing daily tasks will prevent injuries in this area that could otherwise lead to narrowing of the passage within the carpal tunnel.

    Physiotherapy examination and treatment is a very important aspect in the management of CTS. Initially when symptoms start to set in the cause of the problem should be identified. This could be repetitive use of the upper limb and wrist or a fall on the wrist and hand which may have generated swelling in the carpal tunnel as a result of injury to the ligaments or tendons in the area. Sometimes the exact cause of pain and numbness in the hand may not be obvious and nerve examinations become necessary to find out whether the problem could be originating from a location higher up the arm. There are specific tests which can be carried out to identify such possibilities. Electromyography (EMG) testing is occasionally recommended. This procedure tests nerve function giving a clear indication of the extent of nerve damage apart from identifying more clearly which nerve is involved. Diagnostic ultrasound is also sometimes used to measure the space swelling within the carpal tunnel. Progress can be recorded using this tool along with symptom improvement.

    Physiotherapy in the form of stretches and swelling reducing measures’ such as ice, ultrasound and magneto-therapy are all means of reducing the potential pressure on the nerve. If a tendon or ligament is injured it is very important to ensure that adequate healing has occurred followed by the appropriate strength training program. A carpal tunnel splint is often recommended for use at night. The splint keeps the wrist in slight extension allowing the carpal tunnel to remain as open as possible throughout the night with an attempt to minimise the pressure on the nerve. Certain nerve vitamins are often recommended to aid in the repair of a strained or damaged median nerve.

    In severe cases when the condition fails to respond to conservative treatment, becomes a serious cause of sleep disturbance and leads to loss of hand function, surgery is often performed. Surgery releases the pressure on the nerve through severing the transverse ligament as well as through clearing out any scar tissue present inside the tunnel. Rehabilitation following surgery is very important as this helps recovery and avoids future recurrence.

    Pain in the hand may be the result of many other conditions. CTS is considered to be one of the most common causes of hand pain. It also happens to be the most common entrapment neuropathy in which one of the body's peripheral nerves is compressed and traumatized. Needless to say it is essential that a proper examination is carried out by competent health professionals to identify the source of the problem and treat it accordingly.