Function under contact us)The carpal tunnel is a compartment within the wrist (located around the area of the wrist crease) that houses 10 vital structures that supply function and sensation to your hand. The 10 structures of the carpal tunnel consist of nine tendons and one of the major nerves in your arm/hand. The flexor digitorum profundus and superficialis contribute four tendons each (both of which allow you to make a fist and grab objects), the flexor pollicis longus (which controls flexion of your thumb) contributes one tendon and the median nerve which breaks off into two seperate nerve branches that supply sensation to your thumb, index, middle and half of your ring finger as well as motor function in the “meaty” part of your thumb (also known as the thenar eminence) makes up the last part of the carpal tunnel.
What are the symptoms of carpal tunnel syndrome (CTS)?
Symptoms include numbness in your thumb, index, middle and part of your ring finger. Sometimes people will also complain of a tingling or “buzzing” sensation in their hand that feels like an electric shock. Often times this will cause people to feel the need to constantly shake their hands out (if you are doing this frequently you may have CTS). This is from compression of the median nerve. Another symptom secondary to compression of the median nerve in the carpal tunnel is a subjective hand weakness and even dropping of objects. If inflammation is present long enough you may even start to notice atrophy or decreased muscle size in the palm of your hand by the meaty part of your thumb.
What are some risk factors for CTS?
CTS is very common in the workplace, in fact, some studies suggest that as many as 50% of work-related injuries can be attributed to CTS. There are many risk factors for CTS, below are a few of the.
Job-related risk factors:
Those that work with heavy machinery that vibrates a lot, those that work on an assembly line that requires a lot of wrist use/flexion, frequent and prolonged computer use.
• Anatomic risk factors: Those that have wrists that are wider and more shallow may be at higher risk for CTS.
• Gender: Sorry ladies, women are more likely to get CTS, especially those that are approaching the end of their pregnancy, are going through menopause or are undergoing hormone replacement therapy (HRT). There appears to be a hormonal link to CTS.
• Previous injuries: Previous wrist fractures, dislocations or presence of bone spurs can increase your chance of getting CTS.
• Present of arthritis: Wrist arthritis can create bone spurs and decreased joint space that can further constrict the carpal tunnel, contributing to an increase in symptoms. Often times those who have sustained a previous wrist injury, fracture or have undergone wrist surgery are more likely to get CTS.
• Diabetes: Diabetes can cause nerve damage, delay healing times and can increase likelihood of, and exacerbate the symptoms of CTS.
• Smoking: Smoking may alter/restrict blood flow to the median nerve (and all blood vessels for that matter) which may exacerbate symptoms of CTS.
• Other inflammatory conditions: Inflammatory conditions such as rheumatoid arthritis can increase your risk for CTS.
Will it get better on its own?
The short answer is…..maybe. Sometimes those with CTS will spontaneously improve with time. However, we recommend that if you start to experience symptoms that are impacting your daily activities or causing you to take time off of work, seek help from a medical professional. If CTS goes on for too long and is untreated it can cause more significant and irreversible nerve damage.
What can you do to help ease the symptoms?
• Activity modification:As mentioned earlier, you may need to do some reflecting. Have you made any changes in your workout routine that could have facilitated this condition? Are you warming up? Are you practicing good lifestyle habits? Do you have a good ergonomic set-up at your desk? Most workplaces do have an ergonomic consultant who can perform an ergonomic assessment and make recommendations, which is usually requested through your management.
• P.R.I.C.E:The PRICE method is good for many common orthopedic overuse injuries. The acronym P.R.I.C.E stands for: protection, rest, ice compression, elevation. Below we will describe how to apply this to carpal tunnel syndrome.Protection: you may avoid activities that hurt your wrist, like the old doctor’s golden tenet: “if it hurts, don’t do it” (sounds like a no-brainer but people can be stubborn!). So if you’re doing any activities that require heavy lifting, any use of vibrating equipment or a lot gripping, attempt to modify or stop doing those activities for a short period of time. Additionally, you may want to pick up an over-the-counter wrist brace for protection.Rest: take 2-4 weeks off of any strenuous activity, let everything calm down. Taking some time off won’t set you back far. Taking months off because of an acute injury turning into a chronic injury will.Ice: You can use a simple ice pack, apply it to the front of your wrist for 15-20 minutes and repeat 4-5 times per day.Compression: For this condition, heavy wrist compression is not actually recommended. Instead utilize a wrist splint (talked about later) to help support your wrist.Elevation: Since carpal tunnel syndrome results from increased swelling and nerve compression within the wrist, try to avoid prolonged periods of time where your wrist is hanging down below the level of your heart. If you are doing a lot of standing or sitting down try to periodically get your hands up and even shake your hand (yes it sounds goofy but often times that “shake maneuver” can help to alleviate symptoms).
• NSAIDsSometimes doctors will recommend taking NSAIDs such as ibuprofen for inflammatory conditions. However, taking NSAIDs in the long-term can have detrimental and possibly devastating side effects on your gut, leading to gastrointestinal bleeding. Generally you do not want to take these medications for more than a few weeks.
• Physical therapyPhysical therapy can be a great option for those that are struggling to control your symptoms on your own and do not want to seek more aggressive treatment (i.e. surgery or corticosteroid injections). A qualified orthopaedic physical therapist will perform an extensive upper quarter evaluation (evaluating your neck, shoulder, elbow and wrist) to see what physical impairments may exist that are contributing to your present symptoms. Sometimes wrist pain mimicking CTS can actually be due to issues with the cervical spine and nerve compression there or elsewhere along the track of the median nerve and can be exacerbated by decreased neck mobility or decreased shoulder strength. The physical therapist will evaluate and screen for any potential more serious or “red flag” findings at the time of the initial examination. From the initial evaluation they will prescribe neck, shoulder, elbow or wrist exercises, or nerve/tendon glides to address your specific impairments. Some of the common PT exercises will be listed at the end of this article.
• BracingA simple but effective treatment for this condition can be buying a simple over the counter (OTC) wrist brace or splint. You can get these splints at any drug store by you. The purpose of the splint is to: 1) make you more aware that you have an injury so you don’t use your hand as much 2) provide support to the strained area and 3) to keep the wrist in a position that fosters the greatest amount of space for the carpal tunnel to alleviate some of the pressure within.
Do I need surgery?
The short answer is probably not. In severe cases of CTS surgery may be indicated. However, a recent randomized controlled trial suggested that a course of physical therapy (including hands-on manual therapy and specific wrist and neck exercises) is just as effective in the long-term with self-reported function, symptom severity and pinch-grip strength and even more effective in the short term than surgery (carpal tunnel release) in regards to self-reported function and pinch-grip strength. Bottom line is that if you have CTS and were sent to an orthopedic surgeon for surgery ask your doctor about more conservative treatments.
What can healthcare providers do to help ease the symptoms?
As mentioned earlier, sometimes injuries don’t get better with just activity modification, PRICE, bracing and self-treatment methods. If you symptoms are persistent (more than 2-3 weeks) always seek conservative care first. With persistent symptoms it is advisable to consult with a physical therapist from Fluid Health & Fitness for conservative care and individualized stretching and exercises. If symptoms still persist, steroid/cortisone injections may be tried by orthopedic physicians and if still persistent sometimes a carpal tunnel release may be performed.