Tingling in the night ? Waking up with a “dead hand”? Pins and needles while you are driving?
Do any of these symptoms sound familiar to you?
Many people may have heard of Carpal Tunnel Syndrome. Or perhaps you have had an uncle, mum, or brother who has had surgery for their symptoms. But is there anything that you can do for it aside from surgery?
Fortunately there is! I see many people come into the clinic with symptoms such as these and can often get very good results with conservative treatment.
So what exactly is going on. And what can we do to help it?
WHAT IS CARPAL TUNNEL SYNDROME?
The carpal tunnel is the area of your wrist located just at the base of the palm. The tunnel itself is formed by the small bones of the wrist on one side, and a thick band of connective tissue on the other.
It is a small tight space through which many structures need to pass, including the tendons to all of the fingers. Also in this tight space is the Median nerve. This nerve is responsible for the muscles than move the thumb, and also gives us feeling in the thumb, index, middle and half of the ring finger.
In normal cases, everything fits perfectly in this small space. But if something goes out of balance and takes up too much room, then the nerve becomes squashed as it passes through the tunnel. When the nerve is squashed you can get symptoms such as pins and needles, numbness, pain, and weakness. Depending on the degree of compression, as to how severe or constant your symptoms are.
Causes of carpal tunnel syndrome can include things such as swelling in the tendon sheaths, arthritis in the wrist joints, fluid retention during pregnancy, or following a trauma to the wrist or hand.
Often people find that their symptoms are worse during the night and first thing in the morning. During the day, sustained gripping tasks during the day such as driving, or reading may make your symptoms worse.
WHAT WILL MY PHYSIO LOOK AT?
A Physiotherapy assessment will ask you lots of questions to find out exactly what symptoms you are experiencing. There can be many different causes of pins and needles / numbness which people may confuse with carpal tunnel syndrome.
Your Physio will perform special tests to check if the nerve is being compressed at the wrist. They will also assess the area to determine what the underlying cause of the compression could be ( tendons/joints etc). Identifying the underlying cause can help to direct the correct treatment.
They will also perform a thorough assessment of your whole upper limb and neck.
Although compression often occurs at the wrist, it is also important to check the entirety of the nerve. There are multiple other areas where compression of the nerve can occur, such as the forearm, behind the collar bone and at the neck. For patients who present with carpal tunnel symptoms in both hands, it is especially important to look at movement and function of the neck, and thoracic spine area.
WHAT DOES TREATMENT INVOLVE?
SPLINTING – Carpal tunnel syndrome will often be relieved with night wrist splints, which hold the wrist in a neutral position. This neutral position reduces pressure in the carpal tunnel, reducing compression of the nerve.
ADRESSING UNDERLYING CAUSES OF COMPRESSION AT THE CARPAL TUNNEL – Treatment may also address underlying factors such as inflammation of the tendons or arthritis in the joints. Treatment for this may include rest or anti-inflammatories.
RESTORING NERVE MOBILITY – nerve gliding exercises can be useful in restoring mobility of the nerve. Manual therapy techniques can also be used to improve nerve mobility.
RELEASE OF ANY RESTRICTIONS FURTHER UP THE ARM – If your physio identifies restriction around the neck or shoulder, treatment may need to focus on improving mobility in these areas to restore normal nerve mobility.
Conservative treatment options can have fantastic results for carpal tunnel syndrome. If you have been putting up with symptoms, perhaps its time to see a physio today!