Carpal Tunnel Syndrome (or CTS) is a musculoskeletal injury that affects the wrist, with the issues and pain being referred into the thumb, fingers and occasionally up the forearm. It originates from a nerve, which travels at the base of the thumb near to the wrist. The symptoms of CTS usually consist of numbness, pain, and weakness to the fingers of the affected hand. It is caused by the narrowing/swelling of the small channel or ‘tunnel’ where the median nerve travels. This nerve becomes compressed resulting in the sensation of numbness and pain.
The way in which Carpal Tunnel Syndrome is treated varies depending on how it is caused. The top causes and treatments are:
Obesity, Arthritis and Trauma
These can all cause swelling in the canal through which the median nerve travels. Because of the decreased joint space from tissues swelling, this can often be temporary in some patients, although long-term compression to the nerve can result in permanent damage. For inflammatory issues, which will occasionally fluctuate, and ‘flare-up’ one of the suggested temporary management options is the use of corticosteroids. These are injected into the affected tissues to reduce their swelling, but are not to be used as a long-term management strategy. With any tissue, repeated corticosteroid exposure will weaken and damage the tissue, making them more susceptible to injury.
Manual Jobs with Repetitive Movements
There has been some evidence to suggest that manual workers, or those who perform jobs which require repetitivemovements or use of tools which vibrate or have hammering impacts, may be more prone to acquiring CTS due to the trauma to the hand. It has been shown that management by a physiotherapist and the provision of specialist splints to the wrist can greatly reduce stress on the responsible structures. This is one of the most common management options.
Pregnancy is often associated with ankle swelling due to the retention of water from certain hormonal changes, although this can also affect the hands. This increased water retention can make the soft tissues around the wrist and palm swell. This impinges the nerve responsible for the CTS presentation. Usually, symptoms fluctuate throughout the day from the varying hydration levels, and often fully resolve following the pregnancy.
Fractures or Bone Disorders
Certain fractures or bone disorders (such as arthritis) can cause bony spurs to grow and reduce the space in the carpal tunnel. Usually, cases like this have to be surgically managed due to the limited impact that physiotherapists can have on boney growth compared to soft tissues of the body. Surgical split of the tissues is considered the only management option, which will provide permanent relief.
Tumours, which grow around the nerves in the wrist or in the tissues of the skin, can encroach into the tunnel’s space. This is the rarest case of CTS onset and is seen in less than 1% of individuals who are treated for CTS. Our physios can provide exercises to both manage the condition independently or in conjunction with the other management strategies mentioned above.
For more information on CTS, read our other blog post: 10 Things You Need to Know About Carpal Tunnel Syndrome.
Post by Zoe Birch, Head of Orthopaedic Physiotherapy at Physiocomestoyou