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Carpal Tunnel Syndrome

Summary:


Carpal Tunnel Syndrome is a condition caused by compression of the median nerve at the carpal tunnel.




Contents

What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome is a condition caused by compression of the median nerve at the carpal tunnel. The carpal tunnel is a narrow space bound by carpal or wrist bones and ligaments. The median nerve and the flexor tendons pass through this tunnel from the forearm to the hand.


What are the common causes?

The specific cause for Carpal Tunnel Syndrome may be unknown. However certain factors may possibly contribute to increased pressure to the median nerve, for example wrist fracture, fluid retention due to pregnancy, and tumour in the tunnel. Another contributing factor may be repetitive gripping and grasping movements during daily activities.

What are the signs and symptoms?

  • Pain, numbness and tingling to the thumb, index, middle and ring fingers. Symptoms are more noticeable at night, but may also be felt during daily activities, for example, carrying groceries, holding a book or newspapers.


  • Loss of grip strength, with a tendency to drop objects.
  • There may be atrophy of the thumb muscles in severe cases.


What types of treatment are available?

Hand Therapy

The long-term goal of therapy is to improve your participation in your work and daily activities without the feeling of numbness.

The therapist will explain to you what Carpal Tunnel Syndrome is, so that you will be able to understand the condition better and learn ways to prevent or reduce the symptoms. You will also pick up tips on how you can modify the way you perform your daily activities in order to avoid the recurrence of the symptoms.

As the initial stage of therapy involves managing the pain and swelling, a splint will be made for you to rest the affected wrist. You are advised to wear the splint for at least 6 weeks. The splint will keep your wrist in a neutral position to relieve pressure on the median nerve at your wrist. Your fingers are free to move even with the splint on. Therefore you will be able to use your hand to do light activities.


You will be taught exercises, such as the tendon and nerve gliding. At the same time, you will also be advised on proper positioning of your wrist when you are engaged in daily tasks.

What can I do to help myself?

How can I prevent it?

  1. Avoid bending your wrist. Keep your wrist in a neutral position during your daily activities performance. For example, ensure that your wrist is not kept in a bent position when typing on the keyboard.


  1. Relax your grip. Avoid using more force than necessary when holding on to an object. For example, do not hold the pen too tightly when writing or grip the steering wheel too hard when driving. Also, loop bags on your forearm or shoulder to make use of your larger muscle groups to carry heavy groceries.


How can I help myself once I have it?

  1. Take frequent short breaks. If you are unable to avoid the repetitive and forceful use of your fingers and wrists during an activity, you should make an effort to intersperse it with other lighter tasks, or take regular breaks to do some stretches.
  2. Keep your hands warm. Bear in mind that lower temperatures may result in pain and stiffness of your hand. If you are in an air-conditioned environment, consider wearing gloves to keep your hands warm. If you often experience early morning stiffness and pain, wearing gloves to sleep may help to decrease the stiffness.
  3. Use ergonomic tools where possible. For instance, use thicker pens with a larger grip as they allow you to write with ease. Choose tools with pistol grip handles as they reduce the need to position your wrist in an unnatural position.


FAQ

  1. How long do I have to wear the splint? Night splinting is recommended for at least 6 weeks.
  2. How many sessions of therapy do I have to attend? It depends on the severity of your carpal tunnel syndrome. A mild case of carpal tunnel syndrome may only require a couple of therapy sessions.
  3. Will conservative (non surgical) treatment help to relieve my symptoms? Research has shown that the rate of successful outcomes with splinting ranges from 20% to 93%.4 There are also studies which show that nerve gliding exercise helps to decrease the severity of the symptoms and improves wrist movements.1
  4. Will the symptoms return? Unless you make an effort to change the way you perform your daily activities and work, the symptoms can recur.

References

  1. Akalin, E., El, O., Peker, O., et. al. (2002). Treatment of carpal tunnel syndrome with nerve and tendon gliding exercises. Am J Phys Med Rehabilitation: 81(2); 108–113.
  2. Jarvik, J. G. (2009). Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomised parallel-group trial. Lancet, 374; 1074-1081.
  3. Mayo Foundation for Medical Education and Research (MFMER). (1998-2009). Carpal Tunnel Syndrome. [Online]. Available: https://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/symptoms-causes/syc-20355603 (10 December, 2009).
  4. McClure, P. (2003). Evidence-based Practice: An Example Related to the Use of Splinting in a Patient with Carpal Tunnel Syndrome. Journal of Hand Therapy:16(3); 256-263.
  5. Muller, M., Tsui D., Schnurr R., Biddulph-Deisroth, L. & Hard, J. (2004). Effectiveness of Hand Therapy Interventions in Primary Management of Carpal Tunnel Syndrome: A Systematic Review. Journal of Hand Therapy, 17(2); 152-164.
  6. Nancollas, M. P., Peimer, C. A., Wheeler, D. R. & Sherwin, F. S. (1995). Longterm results of carpal tunnel release. J Hand Surg [Br]: 20; 470-474.
  7. Piazzini, D. B. et. al. (2007). A systematic review of conservative treatment of carpal tunnel syndrome. Clinical Rehabilitation, 21; 299-314.
  8. Stanley, B. G. & Tribuzi, S. M. (Eds.) (1992). Concepts in Hand Rehabilitation. USA: F. A. Davis Company.
  9. The Hand Rehabilitation Center of Indiana. (2001). Diagnosis and Treatment Manual for Physicians and Therapists. (4th ed.) USA: The Hand Rehabilitation Center of Indiana.
  10. Verdugo, R. J., Salinas, R. A., Castillo, J. L. & Cea, J. G. (2009). Surgical versus non-surgical treatment for carpal tunnel syndrome (Review). The Cochrane Library: 4; 1-22.
  11. Evidence-based Practice: An Example Related to the Use of Splinting in a Patient with Carpal Tunnel Syndrome. Journal of Hand Therapy: 16(3); 256-263.


- Last updated 23 Jan 2018,4:38 pm




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