Definition
The carpal tunnel is a tunnel of connective tissue that lives just at the base of the wrist on the palm side. The Median nerve, Wrist flexor tendons and blood vessels travel through this tunnel.
If the carpal tunnel tightens up of collapses around the nerve and tendons then this can put pressure on the median nerve and blood vessels causing pain, tingling, numbess or a sensation of coldness.
It is often worse at night or after aggravation through using computer or doing an activity that involves lots of gripping, driving a car, motorbike, lifting weights.
Symptoms
- Pain, tingling, numbness especially in the thumb, index, middle and half of ring finger on the palm side of the hand. This pattern may vary due to severity. Some people may only feel this in the finger tips.
Causes
Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself.
Most likely the disorder is due to a congenital predisposition - the carpal tunnel is simply smaller in some people than in others. Other contributing factors include trauma or injury to the wrist that cause swelling, such as sprain or fracture; overactivity of the pituitary gland; hypothyroidism; rheumatoid arthritis; mechanical problems in the wrist joint; work stress; repeated use of vibrating hand tools; fluid retention during pregnancy or menopause; or the development of a cyst or tumor in the canal. In some cases no cause can be identified.
There is little clinical data to prove whether repetitive and forceful movements of the hand and wrist during work or leisure activities can cause carpal tunnel syndrome. Other disorders such as bursitis and tendonitis have been associated with repeated motions performed in the course of normal work or other activities.
Too much computer time can also overuse the flexor muscles in the forearms which can inflame the area in the carpal tunnel leading to swelling and impingement on the median nerve.
Treatment
Remedial massage to the wrist flexors such as Flexor Digitorum Superficialis, Profundus and Flexor Pollicis Longus.
Stretching techniques and Activie Release Techniques to the carpal tunnel, transverse carpal ligament can help to take pressure off the median nerve.
Stretching of the wrist flexors multiple times per day.
Limiting aggravating factors like computer time, sleeping with a bent wrist.
If conservative treatment has no success or if the problem has been there for over 6 months then it is likely surgery to cut the carpal tunnel and increase space will be required.
Diagnosis
The easiest orthopaedic tests are Tinels sign and Phalens test.
Tinels sign involves tapping just over the carpal tunnel and seeing if symptoms are reproduced.
Phalens Test involves pressing the tops of hands together (flexing the wrist). If symptoms are reproduced then this is a positive sign.
Prognosis
Early detection and treatment is key to a conservative outcome. Often some ART, Remedial massage and stretching can alleviate symptoms within a few treatments.
If you can't modify or stop the aggravating factors then it is likely CTS will return.
If the carpal tunnel is genetically small then surgery may be the only option. This surgery can have mixed results and there are different variations of surgery from open hand invasive surgery to more keyhole based surgery which has reduced recovery time.
More Info
For more information or if you think you may have this then book in for a session to have it looked at. The earlier you start treatment the better your outcomes.