In this blog post we will take a closer look at what carpal tunnel syndrome is, why it occurs and what to do if you think you have carpal tunnel syndrome.
What is the carpal tunnel?
The carpal tunnel is a channel in the wrist formed by a band of connective tissue called the flexor retinaculum and the bones of the wrist. Both muscle tendons and two of the main nerves of the hand pass through this channel. These nerves send nerve impulses to several muscles in the forearm and hand, control movements and give us sensation in the hand and fingers.
What is carpal tunnel syndrome?
Carpal tunnel syndrome occurs when the largest nerve (the median nerve) that passes through the carpal tunnel in the wrist is compressed or squeezed. This can lead to pain, numbness/tingling and weakness in the palm and thumb. The index finger and middle finger are usually affected as well. When sensation and motor function in this area change, even the simplest tasks for the hand can become difficult to perform.
Why does carpal tunnel syndrome occur?
The causes of carpal tunnel syndrome can vary, but some of the most common are:
- Overloading of the wrist and/or fingers through repetitive work
- During pregnancy – this is due to increased fluid in the body
- Previous injury or fracture of the wrist
- Diabetes
- Arthritis
Carpal tunnel syndrome is the most common cause of nerve pain in the forearm/hand. It is most common to get this problem between the ages of 40 and 60, and women are 10 times more likely to get it than men.
What should you do if you have symptoms of carpal tunnel syndrome?
If you suspect you have carpal tunnel syndrome or experience pain that resembles it, you should see a healthcare professional for an accurate diagnosis and recommendations on the right course of treatment. In some cases a referral for ultrasound or MRI will be necessary to confirm the diagnosis. Treatment of carpal tunnel syndrome depends on the severity of the symptoms and the causes of the condition.
Here are some of the common treatment options:
Conservative treatment:
To begin with, it is wise to offload activities that trigger the symptoms. This can be done by immobilising the wrist, using a wrist support/splint at night to reduce the pressure on the nerve. No studies have shown that wearing a splint around the clock works better than at night only.
At the same time, research has shown that long-term reduced mobility of the nerves in the carpal tunnel can result in increased accumulation of fluid (oedema) and formation of scar tissue, which can lead to reduced mobility. Our therapists can guide you with specific exercises to mobilise the nerves and increase strength.
Injections:
Corticosteroid injections can help relieve the pain. A study from 2018 did, however, show that there was not much difference in long-term effect between those treated with a cortisone injection and those with a wrist support.
Surgery:
If the conservative treatment methods mentioned above do not provide sufficient relief, surgery can be considered.
The surgeon will release the pressure on the nerve by cutting the connective tissue that surrounds the carpal tunnel. This is done under local anaesthetic and about 9 out of 10 people who have surgery are better a year later. There is a very low risk of complications with this type of operation. Some may experience residual weakness in the hand and numbness. It is therefore also important to build up muscle and mobility and to make some changes to everyday tasks.
Summary
Carpal tunnel syndrome can occur in up to 4% of the world's population. At Behandlerverket we can help with making the diagnosis and advise on rehabilitation. If an ultrasound is needed, we also have practitioners who can carry out an ultrasound examination. In addition, our chiropractors and manual therapists can refer you to specialist health services if surgery should be considered.
References
- Bobowik, P. Ż. (2019). Effectiveness of physiotherapy in carpal tunnel syndrome (CTS). Postępy Rehabilitacji, 2019(2), 47-58. doi:10.5114/areh.2019.85023
- Duckworth, Andrew D., MBChB, MSc, Jenkins, P. J., MBBS, & McEachan, J. E., MBBS. (2014). Diagnosing carpal tunnel syndrome. Journal of Hand Surgery, 39(7), 1403-1407. doi:10.1016/j.jhsa.2014.03.03
- Chesterton, L. S., Blagojevic-Bucknall, M., Burton, C., Dziedzic, K. S., Davenport, G., Jowett, S. M.,... Roddy, E. (2018). The clinical and cost-effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome (INSTINCTS trial): An open-label, parallel group, randomised controlled trial. The Lancet (British Edition), 392(10156), 1423-1433. doi:10.1016/s0140-6736(18)31572-1
- https://www.physio-network.com/blog/carpal-tunnel-treatment/
- https:/ /www.helsenorge.no/sykdom/muskel-og-skjelett/karpaltunnelsyndrom/
- https://nhi.no/sykdommer/hjernenervesystem/nerveskader/karpaltun nelsyndrom/