Carpal Tunnel Syndrome.
The carpal tunnel is a narrow passageway in your wrist. It lies at the base of your palm, between the small hand bones called Carpal Bones and a broad ligament, TRANSVERSE CARPAL LIGAMENT, and also the nine tendons; The tendon of flexor pollicis longus, 4 tendons of the flexor digitorum profundus and 4 tendons of flexor digitorum superficials,pass through this tunnel.
These tendons connect to muscles in your forearm and allows your fingers to bend. The median nerve also pass through the carpal tunnel. This nerve connects with the tissues in your palm, thumb and first 3 fingers. It allows you to feel sensation in this part of your hand and helps move your thumb and fingers.
Carpal tunnel syndrome happens when the median nerve gets compressed or pinched inside the carpal tunnel. Often this happens when the tendon becomes swollen and press the nerve. This pressure causes the pain, tingling and numbness associated with carpal tunnel syndrome.
Carpal tunnel syndrome is much more common in women than men in a ratio of 3:1.This is because the carpal tunnel tends to be smaller in women. A smaller tunnel area make it more likely that the nerve and tendon that pass through it are affected.
Some other factors that make people more likely to get Carpal tunnel syndrome are.
1. Pregnancy
During pregnancy, your blood volume doubles. That extra fluid increases pressure and swelling in the blood vessels throughout your body. In tight spaces such as the carpal tunnel area of the wrist – through which nine tendons and one nerve pass – the swelling can compress the median nerve, which runs to the hand.
2. Obesity
Being overweight accounts for all the risk factors for carpal tunnel syndrome. Losing weight eliminates many of these risk factors and can reduce the inflammation on your median nerve.
3. Diabetes
Multiple mechanisms, including both biochemical and structural factors, contribute to the susceptibility of peripheral nerves to compression in diabetes, where CTS is more common among individuals with diabetes. CTS is more common in type 1 diabetes than in type 2 diabetes.
4. Thyroid disease
Specifically, hypothyroidism may cause: Muscle aches, tenderness and stiffness. Joint pain and stiffness, particularly in the hands and knees in adults. Swelling of the small joints in the hands and feet.
5. Occupation
Work-related CTS is a cumulative trauma disorder caused by job tasks that subject the hand and wrist to certain biomechanical stresses, including
– Repetitive movements of the hand.
– Forceful grasping or pinching of tools or other objects
-Awkward positions of the hand and wrist
– Direct pressure over the carpal tunnel
– Use of vibrating hand-held tools.
Because repetitive hand movements are required in many service and industrial occupations, new high-risk groups for CTS and other cumulative trauma disorders continue to be identified.
People with this condition may have a number of signs and symptoms.
1. Pain and discomfort
This may feel tingly, achy, burning or stabbing. The pain sensations may radiate up your arm.The discomfort may be worse at night. If you curl your wrist during sleep, the pain may wake you up.
2. Numbness
A compressed median nerve can produce numbness on the thumb side of your hand
3. Weak grip and trouble with fine finger control.
A compressed median nerve affects control over small mescles in your hand.This can make it hard to grasp objects or do tasks that require hand coordination.
4. Sensation of swollen fingers
It may feel as if your fingers are swollen, even though they are not.
5. Flick sign
You may feel the urge to shake or flick your wrist as a way to try relieve the pain. This is a common sign
6. Symptoms that worsen after certain activities
Activities that require you to grip an object may worsen your symptoms. For instance, you might feel symptoms after holding a phone, steering wheel, newspaper or book.
7. Permanent loss of sensation and muscle wasting.
In severe long-term cases,the median nerve may be damaged.This can cause permanent loss of feeling and muscle wasting at the base of the thumb.
DIAGNOSIS
Diagnosis is confirmed by physical examination or electrodiagnostic studies .Other conditions that produce similar symptoms should be excluded by appropriate clinical evaluation.
TREATMENT
Physiotherapist helps to ease pain and prevent future injuries and be generally managed in the following ways.
1. Pain relief
Heat modalities, cold therapy, therapeutic ultrasound showed better outcome in relieving pain.
2. Splints
Wearing a resting splint can help prevent the symptoms occurring at night.
Working splints can be useful if the symptoms are aggravated by particular activities.
3. Massage and Tapping techniques
Transverse friction massage had the best effects in the short and long term
4. Stretching, Mobility and Strengthening exercises are also implemented for quick recovery.
Carpal Tunnel Syndrome can usually be easily treated
Written by
Mercy Iminza Kavita
Physiotherapist.
Chiropractic & Physiotherapy Health Centre
