What is the carpal tunnel?

The carpal tunnel is located at the wrist and is bounded by wrist bones and fibrous tissue [1]. The carpal tunnel contains nine muscle tendons and the median nerve (Figure 1) [1]. The median nerve conveys sensory stimulation from different parts of the hands and provides motor stimulation to a group of muscles in the hand (Figure 2) [1].

 

What is carpal tunnel syndrome?

Carpal tunnel syndrome is a group of symptoms resulting from compression, pressure and local ischaemia of the median nerve at the wrist [2]. Cases of carpal tunnel syndrome can occur without a known cause. However, a considerable portion of carpal tunnel syndrome cases are linked to repetitive pathological wrist movements and forceful gripping [2,3]. Additionally, certain injuries or diseases may result in abnormal changes of the contents within the carpal tunnel or the bones and fibrous tissues forming the carpal tunnel [2].

 

 

Risk factors [3,4]

Various factors have been associated with carpal tunnel syndrome (as listed below). Hence, though they may not directly result in median nerve aggravation, these factors may increase the chance of an individual developing carpal tunnel syndrome.

 


  • Female gender

  • Rheumatoid arthritis

  • Wrist fracture

  • Osteoarthritis

  • Overweight/Obesity

  • Diabetes  

  • Smoking

  • Occupations requiring prolonged bent wrist posture

  • Occupations requiring repetitive wrist movements into end of range


 

Patient history

Individuals with carpal tunnel syndrome commonly present with pain, unpleasant numbness, tingling and/or burning symptoms into the fingers and hands (along the median nerve distribution, Figure 2) [5,6]. Additionally, the individual may also report a reduction in grip strength and hand function [6]. These symptoms tend to be worse at night and may relieved by shaking or flicking the wrist [5,6]. The individual may also report increased incidences of clumsiness during daily activities, especially during activities that require wrist movements [6].

 

How can physiotherapy help?

1.     Assessment and appropriate referral

Physiotherapists are equipped with the knowledge and skills to be able to assess the cause of upper limb symptoms. Symptoms in the hand can arise from various diseases, conditions and could be referred from other body parts (e.g. neck, upper and lower back).  Hence, through a subjective history as well as an extensive physical examination, physiotherapists are able to identify if an individual may be presenting with carpal tunnel syndrome or an alternative diagnosis. Additionally, physiotherapists are well networked and will be able to advise appropriate management or provide a referral to a general practitioner for more specialised management. 

 

2.     Advise regarding load management and activity modification

Carpal tunnel syndrome of mild to moderate severity can be effectively managed conservatively, without surgical intervention [5,6]. Physiotherapists can provide individual advice on task and activity modifications, as well as appropriate rest in the workplace or at home. These modifications aim to avoid worsening carpal tunnel syndrome symptoms by avoiding aggravating wrist movements [5]. Research studies have suggested that effective alterations in workplace practice are valuable in managing mild to moderate symptoms of carpal tunnel syndrome [5].

 

3.     Splinting and exercises

Splinting the wrist at neutral positions assist in decreasing repetitive wrist movements that could aggravate symptoms of carpal tunnel syndrome. Research studies have shown that application of wrist splints can effectively reduce pain as well as improve grip strength [7]. These studies have also demonstrated such improvements in both daytime-only and full time (day and night) application of wrist splints; however full-time application has demonstrated the greatest improvements [5,7].

 

Physiotherapists can also prescribe specific nerve gliding exercises aimed to improve the movement of the median nerve within the carpal tunnel and reduce symptoms of carpal tunnel syndrome. Research studies have shown that a combination of splinting and nerve gliding exercise can improve both grip strength and reduce pain [5,7].

 

If you have any questions regarding carpal tunnel syndrome, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

 

References

  1. Presazzi A, Bortolotto C, Zacchino M, Madonia L, Draghi F. Carpal tunnel: Normal anatomy, anatomical variants and ultrasound technique. J Ultrasound. 2011;14:40-46. doi:10.1016/j.jus.2011.01.006.

  2. Werner RA, Andary M. Carpal tunnel syndrome: pathophysiology and clinical neurophysiology. Clin Neurophysiol. 2002;113:1373-1381. https://www.ncbi.nlm.nih.gov/pubmed/12169318. Accessed June 7, 2019.

  3. Palmer KT, Harris EC, Coggon D. Carpal tunnel syndrome and its relation to occupation: a systematic literature review. Occup Med. 2017;57:57-66. doi:10/1093/occmed/kq1125.

  4. Geoghegan JM, Clark DI, Bainbridge LC, Smith C, Hubbard R. Risk factors in carpal tunnel syndrome. J Hand Surg. 2004;4:315-320. doi:10.1016/j.jhsb.2004.02.009

  5. Burke FD, Ellis J, McKenna H, Bradley MJ. Primary care management of carpal tunnel syndrome. Postgrad Med J. 2003;79:433-437. doi:10.1136/pmj.79.934.433.

  6. Ibrahim I, Khan WS, Goddard N, Smitham P. Carpal Tunnel Syndrome: A Review of the Recent Literature. Open Orthop J. 2012;6:69-76. doi:10.2174/1874325001206010069.

  7. Piazzini DB, Aprile I, Ferrara PE, Bertolini C, Tonali P, Maggi L, Rabini A, Piantelli S, Padau L. A systematic review of conservative treatment of carpal tunnel syndrome. Clin Rehabil. 2007;21:299-314. doi:10.1177/0269215507077294.

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