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Carpal Tunnel Syndrome

In order to better understand carpal tunnel syndrome, it helps to understand a little bit about the hand’s anatomy. The image to the right shows the interior surface of the hand and wrist. Under the “transverse carpal ligament” lies the carpal tunnel, a relatively narrow channel that serves as a conduit to tendons as well as to the median nerve. Carpal tunnel syndrome happens when the median nerve becomes compressed by the carpal tunnel following either inflammation, or any other condition that reduces the space around the nerve.

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Symptoms

Because the median nerve provides sensory and motor impulses in the hand and wrist, its compression by the carpal tunnel produces various symptoms:

  • Localized pain in the fingers, comparable to a burning sensation, that can also be felt in the arm and forearm; the pain can often be relieved by massaging the area or by shaking the hand;
  • Numbness and tingling;
  • Difficulty grasping objects, even light ones;
  • In the beginning, symptoms are mostly present during the night or early in the morning and worsen with activity.

Risk Factors

  • Work-related activities: long-term, repetitive movements of the wrist and forearm (flexion or extension movements), strenuous activities involving the hand, use of vibrating equipment and frequent use of a computer mouse;
  • Hobby-related activities: gardening, knitting and sewing, video games, golf, canoeing and wheelchair sports;
  • Hormonal fluctuations during menopause and pregnancy, while taking oral contraceptives or due to hypothyroidism create favorable conditions for the appearance of the syndrome.

Causes

As explained earlier, carpal tunnel syndrome happens when the space available in the carpal tunnel gets reduced and results in compression of the median nerve. Here are the various factors that could be responsible for the reduction in space:

  • Wrist edema
  • Rheumatoid polyarthritis
  • Arthrosis of the wrist joint
  • Neurological condition caused by diabetes
  • Congenital disease
  • Inadequate alignment following a wrist fracture
  • Luxation at the wrist level
  • Tumor
  • Thickening of the transverse carpal ligament
  • Tenosynovitis of the wrist tendons

 

Treatment

Medical (on a per case basis):

  • Corticosteroid injections
  • Anti-inflammatories
  • Splinting of the wrist

Physiotherapy
The goal of physiotherapy is to reduce the pressure exerted on the median nerve and to reduce inflammation:

  • Contrast baths (hot and cold) to reduce the swelling, improve blood flow and decrease inflammation;
  • Analgesic modalities: ultrasound, TENS and ice;
  • Tissue massage;
  • Manual therapy;
  • Exercises: tendon and nerve glides;
  • Gradual strengthening of the wrist muscles;
  • Your physiotherapist will also emphasize the importance of taking regular breaks at work in order to prevent a recurrence.

Occupational therapy – as a complement to physiotherapy
A consultation with one of our occupational therapists could be advisable. This would help correct inadequate movements as well as learn proper posture and exercises in order to prevent a recurrence and obtain properly-fitted orthosis.

Prognosis

The chances of rehabilitation are very good if treatment is received as soon as possible after the first symptoms. Remember that symptoms always first show up during the night!

Do you think you might be suffering from carpal tunnel syndrome? Contact us to get an accurate diagnosis.

 


References
• Daniel Boulet, Richard Leclaire, syndromes de compression nerveuse du membre supérieur, compression du nerf médian, pathologie médicale de l’appareil locomoteur, 2eme édition
• David J. Magee, Test for neurological Dysfunction, orthopedic physical assessment
• Patrick le roux, le syndrome du canal carpien et mobilisations des nerfs, Kinésithérapie, la revue, volume 7, Issues 68-69, septembre 2007

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