Light at the end of the carpal tunnel
Do you suffer from pain, numbness or tingling in your wrist and hand? If you answered yes to any of these symptoms you may be suffering from carpal tunnel syndrome. CTS is the compression of the median nerve as it passes through the wrist and was first described in 1894. Since then, with medical advancements, CTS is easier to diagnose and that may account for the rising number of people suffering from this painful condition. It may also be due to change in lifestyles and technological advancements.
CTS is thought to be aggravated by repetitive movements and more and more people are now regularly using computers and game consoles, but, as it has been around for many years, we know there must be other causes.
CTS is a narrowing of space on the inside of the wrist where the median nerve and other structures pass through to the hand. The median nerve provides sensation to the thumb, index finger, middle finger and part of the ring finger; also innervates the muscles of the thumb. The onset of CTS is usually gradual, starting with symptoms at night, and on waking the hand needs to be shaken-out and feels “useless”, progressing to symptoms during the day as well.
But wait, before you self-diagnose your symptoms as CTS, it’s important to know there are other conditions that are similar, like repetitive strain injury. RSI can also affect the wrist and fingers but there are some minor differences. RSI is used to describe pain and tenderness in the nerves, muscles and tendons caused by repetitive tasks, not compression, and can occur at the shoulder, elbow or wrist. However, unlike CTS, it does not cause weakness in the thumb.
It is best to seek help early and your doctor or physiotherapist will undertake a thorough assessment to determine if you have CTS and rule out other possible causes. A thorough history of the onset of your symptoms and aggravating movements and activities will be taken followed by a physical examination. Do not be surprised if the focus moves from your wrist to your elbow, shoulder and neck. Some of the obvious signs that will be looked for are muscle wasting around the thumb, reduced sensation, reflexes and your response to special tests. If the results are inconclusive, or a clearer picture is required, it may be necessary for you to undergo nerve conduction tests.
The exact cause of CTS is still not known but it is more common in women than men, maybe because women have a narrower space than men. One of the underlying causes is inflammation and it has been found that people with certain conditions and lifestyle habits run a higher risk of developing this painful condition, such as: • Diabetes • Hormonal changes that can occur during pregnancy or the menopause • Underactive thyroid • Overactive pituitary gland • Arthritis • Wrist sprains or fractures • High blood pressure • Smoking • Being overweight
Having a job with repetitive movements or using equipment that vibrates also puts you at a higher risk of developing CTS. But it isn’t only work that can be a problem; leisure activities like sailing can aggravate symptoms—holding the steering wheel or holding on tight to the tiller may seem like simple tasks but not if you have CTS.
The earlier the condition is diagnosed, the better the chances of a full recovery without needing surgery. In the initial stages rest and ice can help reduce inflammation and pressure on the nerve. If you use your hands at work, whether typing, writing or using equipment or machinery, you should take lots of rest breaks. Wearing a splint can also help stabilise your wrist and stop excessive bending. If these early interventions are not successful your doctor may suggest a steroid injection into the wrist or, in severe cases, surgery.
Of course, the best action is always prevention; prevention is always better than cure. The first step would be to make lifestyle changes and reduce the risk factors alongside a stretching and exercise programme. Speak to your physiotherapist who will help you design the perfect programme for whatever stage you are at.
Kim Jackson is a UK-trained physiotherapist with over 20 years' experience. She specialises in musculoskeletal pain and dysfunction including back pain and sciatica, stroke and other neuro conditions plus sports physiotherapy, having worked with local, regional and international athletes and teams treating injuries and analysing biomechanics to improve function and performance. She is registered with the Allied Health Council and is a member of PASL. She currently works at Bayside Therapy Services in Rodney Bay, O: 458 4409 or C: 284 5443; www.baysidetherapyservices.com