Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is irritation of the median nerve as it passes through the carpal tunnel at your wrist. The median nerve provides signals to the muscles in the forearm and hand causing them to move, as well as providing the hand with sensation to the thumb, index finger, middle finger and half of the ring finger. As the median nerve passes into the hand it passes through the carpal tunnel. The carpal tunnel houses a number of tendons, connective tissue and the median nerve.

If the carpal tunnel narrows or becomes irritated, it can cause irritation to the structures that pass through it, especially the median nerve. If the median nerve becomes irritated or compressed then the patient will experience neural symptoms into the area of the hand that it provides sensation and movement. This may include pins and needles, numbness, deep aching pain or loss in movement. The median nerve needs to be able to glide within its sheath in the carpal tunnel as the wrist moves, however with long term compression to the nerve, scarring can develop. When the nerve becomes scarred it will adhere to other tissue close to it, inhibiting its ability to glide and move within the carpal tunnel. This will cause irritation and the symptoms above may become apparent.

What Causes Carpal Tunnel Syndrome?

There are a number of different contributing factors to CTS and it is believed that it is a combination of factors which predispose the nerve to become irritated. These contributing factors include:

  • Obesity
  • Osteoarthritis and Rheumatoid Arthritis
  • Diabetes
  • Under-active thyroid
  • People who take oral contraception
  • People who have a manual job – forceful and repetitive use of the hands and wrists.
  • Women who are pregnant
  • People who have a poor posture – This leads to abnormal biomechanics and with repetitive movements the median nerve can be predisposed to excessive, repetitive compression in the carpal tunnel.

How can Physiotherapy help with Carpal Tunnel Syndrome?

Physiotherapy can be extremely beneficial in treating carpal tunnel syndrome, whether it is with or without surgery. After a thorough assessment by one of our highly qualified Physiotherapists it will become clear which treatment methods will be beneficial to you in improving your symptoms. Physiotherapy can target a number of the different contributing factors including tight connective tissue, tight muscles, poor posture and nerve irritation, through a variety of treatment techniques to improve the symptoms. These can be used for patients who are suffering with CTS both before and after surgery. As mentioned above it may be appropriate to undergo surgery for the CTS or be administered with a corticosteroid injection. The surgery is performed under local anaesthetic using a keyhole (arthroscopic) procedure. This reduces post-operative complications and ensures a quicker recovery. The surgery is designed to reduce pressure on the median nerve within the carpal tunnel through releasing part of the transverse carpal ligament. It is extremely important to see a physiotherapist after surgery to ensure optimal tissue repair and reduce post-operative complications.

Treatment techniques that can be used by physiotherapists when treating CTS include:

  • Soft tissue/deep tissue massage can be used around the wrist, forearm and even the shoulder and neck to reduce muscle tension which may be contributing to the symptoms. Massage over the operation site/scar (post-surgery) is extremely beneficial to prevent scar tissue from developing and causing the tissues to adhere to one another.
  • Stretching to the wrist, forearm and neck can be used to help lengthen the tissue, reducing the risk of the muscles developing trigger points and becoming painful. This can also be beneficial post operatively as it will allow the tissues to repair in an orderly manner, preventing excessive scar tissue accumulation and reducing pressure within the carpal tunnel.
  • Neural glides can be used to ensure that the median nerve maintains good mobility within its sheath, preventing the nerve tissue from adhering to the tissue close to it. This will ensure optimal function of the median nerve and reduce symptoms of CTS. This is extremely important post operatively as it will allow the nerve to maintain its mobility within its sheath and ensure optimal recovery after irritation/compression.
  • Postural correction is important to ensure correct biomechanics, reducing the pressure that is put through the carpal tunnel during repetitive movements. This will involve the patient completing a number of exercises to improve their posture for when they are at work or completing their daily tasks.

 

  • Acupuncture can be used at our clinics to help provide pain relief when suffering with CTS. There are a number of different acupuncture points that have been shown to be extremely beneficial in treating pain in relation to CTS, which will in turn allow the patient to function more effectively on a day to day basis.

acupuncture
  • Wrist splints have been proven to be extremely beneficial when worn at a night time to give the carpal tunnel some rest and avoid further irritation. With support from the splint over night, the wrist will be slightly extended, allowing the carpal tunnel to be in a stress free position. These splints can be provided from our clinics and the physiotherapists can ensure that it is the correct fit, as well as showing you how to put the splint on and off.

If surgery is required, it is usually performed under local anaesthetic using a keyhole (arthroscopic) procedure. This reduces post-operative complications and ensures a quicker recovery. The surgery is designed to reduce pressure on the median nerve within the carpal tunnel through releasing part of the transverse carpal ligament. It is extremely important to see a physiotherapist after surgery to ensure optimal tissue repair and reduce post-operative complications.

If you would like to discuss your problem before booking an appointment please give our physiotherapy team a call, we will do our best to help.