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Articles
Carpal Tunnel Syndrome
Carpal tunnel syndrome
is a neurological condition in the wrist that causes symptoms of pain,
tingling, numbness, weakness, burning, and “pins and needles “
sensation into the fingers. The symptoms are most commonly noted in
the thumb, index, middle, and ½ of the ring finger. Symptoms
occur due to compression or squeezing of the median nerve as it passes
though the wrist through the carpal tunnel. Symptoms can be worse at
night.
The median nerve passes through the carpal tunnel along with multiple
tendons to the fingers. The carpal tunnel is a ligament that provides
support for these structures on the palmer surface of the wrist.
There are numerous causes for carpal tunnel syndrome. Sometimes trauma,
injury, or fractures, can cause changes to the bony structures of the
wrist altering the anatomy of the carpal tunnel and creating compressive
forces. For example, a wrist fracture, or arthritis of the thumb joint
can lead to bony changes within the carpal tunnel. Many times repetitive
activities or motions can increase inflammation within the carpal tunnel
and cause thickening of the tissues leading to increased pressures and
squeezing of the nerve. Certain diseases and conditions can lead to
carpal tunnel syndrome such as thyroid conditions, diabetes, pregnancy,
systemic diseases, tumors, etc., creating changes within the soft tissues
and altering pressures within the carpal tunnel.
Carpal tunnel syndrome can be treated either non -operatively or surgically
depending upon the severity of the condition and degree of disability.
Non-operative therapy may consist of placing the wrist in a carpal tunnel
splint that relieves pressure off the median nerve and positioning the
wrist in a less stressful and more neutral position. Splinting is usually
required during repetitive activities, at night, and over a 4-6 week
period to allow tissues to rest. Patients may be educated in ergonomic
modifications to their work environments or computers stations that
allow better placements of the wrists and hands in less vulnerable positions.
Sometimes simple positioning of the keyboard and mouse at appropriate
levels and angles can make a significant difference.
Therapists can also work with the patient on specific hand and arm exercises
that promote excursion of the tendons and median nerve through the carpal
tunnel and decrease congestion and swelling of these structures. Sometimes
modalities are incorporated along with the exercise program i.e.; ice,
electrical stimulation, ultrasound, iontophoreis to decrease inflammation,
decrease pain, and improve soft tissue mobility.
If symptoms continue to persist and do not respond to therapeutic efforts
the patient sometimes must consult with a Surgeon who may elect to decompress
the carpal tunnel ligament.