Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS)  is a common nerve entrapment condition which is characterised by pain, numbness, tingling and sometimes weakness in the hand and arm.

• Pain in the palm side of the wrist and hand that may spread in to the thumb, index finger and middle finger. It may also spread up the forearm.

• Symptoms are commonly aggravated with repetitive movements, gripping actions and when in static positions.

• The pain/altered sensation may be more apparent at night or first thing in the morning.

• Symptoms typically develop spontaneously and tend to progressively become worse.

• In more severe cases, it may lead to weakness and muscle wasting in the affected hand.

• You may experience short-term relief by shaking or flicking the hand.

This condition occurs when one of the main nerves to the hand is compressed as it travels through a passage of the wrist called the carpal tunnel – formed by the bones of the wrist and a ligamentous structure which acts to protect the local nerves and tendons. The nerve is called the median nerve and supplies your thumbs, and 2nd, 3rd and 4th digits of the hand.

CTS can also develop secondary to other factors which can affect the structures of the carpal tunnel such as trauma, inflammation of local structures and systemic conditions, anatomical variances and conditions that impact fluid distribution.

Although the symptoms are experienced in the wrist and hand, this does not always relate to the origin of the symptoms. Disorders of the neck are a common contributor to the common physical complaints of CTS. If the muscles of the neck become over-active and inflamed, they can irritate the nerves in which the median nerve branches off from.

Similarly, brachial plexus injury can also lead to comparable symptoms. The brachial plexus is the network of nerves which stem from the neck and supply the arm, hand and wrist. Following a traumatic injury – causing a vigorous stretching mechanism or compression, can cause damage and inflammation to this cluster of nerves which can lead to referred pain being experienced further along that nerve supply. 

In the general adult population CTS has a prevalence of 2.7-5.8% but in those who have an occupation risk – those partaking in activities/actions which involve repeated bending/gripping tasks, playing instruments, heavy manual jobs, this can rise up to 10-15%. 

Patients who are clinically overweight and those who are diabetic are more likely to develop this condition. The symptoms can also appear whilst being pregnant. Carpal tunnel syndrome has shown to have peak prevalence in those aged 45 – 59 and affects more women than men. 

At Pure Physiotherapy, your therapist will carry out a comprehensive assessment and physical examination to identify potential reasons for why the symptoms may have started. We strive to provide a precise and timely diagnosis so that there is no delay in implementing the most appropriate and effective treatment & management plan.

If CTS is identified early, outcomes are more favorable. Your Physiotherapist will take in to account many factors of your daily life to devise a personalised self-management and treatment plan. This will include advice on avoiding or modifying actions/activities that may aggravate your symptoms and ways in which you can organize your workspace (if applicable) to continue working effectively.

At Pure Physiotherapy, our expert clinicians may also give you advice and signpost to suitable splinting/bracing to help with the symptoms, giving you the ability to address the underlying cause and empower you with the knowledge and skills to manage independently. There is strong evidence that a period of immobilisation can produce positive outcomes in CTS (AAOS, 2016).

Exercises form a pivotal element of your treatment plan for optimal recovery. Our experienced team of Physiotherapists are skilled in personalised exercise prescription. These exercises can include stretching drills for the neck and upper limb, postural/strength work and movements that may help relieve symptoms. To ensure you are making good progress, we will regularly re-assess to make certain that your current plan is helping you reach the goals that will be formed working closely with your clinician.

Please find the patient resources section of our website where we have created a series of recommended exercise programmes to effectively manage carpal tunnel syndrome with wrist and neck movements. We advise consulting with your Physiotherapist prior to trying any of these exercises.

Your Physiotherapist may also use their hands-on treatment skills in the form of joint mobilisations, nerve mobilisations, soft tissue techniques and acupuncture. These techniques can be useful to restore function and alleviate symptoms whilst you continue to strengthen and mobilise the limb.

In patients with chronic symptoms, the American College of Occupational and Environmental Medicine have strongly recommended that a carpal tunnel injection can be beneficial and the American Academy of Orthopaedic Surgeons found that a steroid injection can improve patient-reported outcomes. It is important to note that this procedure provide a ‘analgesic window’ in which pain can be reduced so that exercise rehabilitation and strengthening can be implemented.

https://www.nhs.uk/conditions/carpal-tunnel-syndrome/

These are some examples of wrist splints you can purchase which are used by the NHS: https://actesso.co.uk/used-by-the-nhs/

British Society for Surgery of the Hand information leaflet – click here.

AAOS. (2016). Management of carpal tunnel syndrome: evidence-based clinical practice guideline. American Academy of Orthopaedic Surgeons.

ACOEM. (2011) Carpal tunnel syndrome. 3rd edition. American College of Occupational and Environmental Medicine. Available at: www.acoem.org/

National Institute of Health and Care Excellence. (2016). Management of carpal tunnel syndrome. Retrieved from https://cks.nice.org.uk/carpal-tunnel-syndrome#!scenario. [Accessed 13/7/2020].

Padua, L., Coraci, D., Erra, C., Pazzaglia, C., Paolasso, I., Loreti, C., Caliandro, P. & Hobson-Webb, L.D. (2016). Carpal tunnel syndrome: clinical features, diagnosis, and management. The Lancet Neurology, 15(12), 1273-1284.