Carpal tunnel syndrome (CTS) is a condition that affects the hand and wrist. It occurs when the median nerve is compressed or squeezed as it travels through the wrist’s carpal tunnel, known as entrapment neuropathy. Interestingly, it is the most common nerve entrapment neuropathy, accounting for 90% of all neuropathies.

The carpal tunnel is formed by a thick osteofibrous wall that forms a tunnel protecting the median nerve and tendons of the wrist. When there is increased pressure in the carpal tunnel, this results in compression of the median nerve which is carpal tunnel syndrome. There are 2 mechanisms that result in this increased pressure: 1. A decrease in the size of the carpal tunnel space, or 2. A disease that results in the changing of the carpal tunnel structure.

There are common causes or risk factors of carpal tunnel syndrome:

• History of Repetitive Hand Movements: When there is a rapid increase in the use of the hand and wrist, this could make the tendons inflamed and increase the blood supply, which will increase the pressure within the carpal tunnel and compress the median nerve. These repetitive movements could be typing, writing, or machine work.
• Anatomical or Biomechanical Abnormalities: How the carpal tunnel is structurally sitting, the way the tendons move in reference to the median nerve and the irritability of the median nerve can all be because of your genetic predisposition, which is essentially how you are born. These variations can influence the pressures that are placed within the carpal tunnel and surrounding structures.
• Co-morbidities and Pregnancy: Other conditions such as obesity, diabetes, rheumatoid arthritis, thyroid gland imbalance, tumour, wrist fractures/traumas and pregnancy can all influence the pressures within the carpal tunnel that can result in carpal tunnel syndrome. These conditions influence carpal tunnel syndrome by either the nerve sensitivity, fluid retention or the irritability of the carpal tunnel.

• Numbness and Tingling: Often in the thumb, index, middle, and ring fingers.
• Pain: Can extend from the wrist up the arm to the shoulder or down into the palm or fingers.
• Weakness: Difficulty grasping objects, a tendency to drop things.
• Swelling: A feeling of swelling in the fingers, even if no actual swelling is present.

Carpal tunnel syndrome is typically diagnosed through a combination of clinical evaluation, patient history, and diagnostic tests.

• Patient History
  • During the initial assessment, a thorough subjective assessment will be completed which can help streamline the objective assessment. This will also identify the potential factors and causes of carpal tunnel syndrome. If a patient reports a drastic change in arm/wrist use (either work or hobby related), reports symptoms of tingling in the thumb or fingers and some weakness in the hand, then we will tend of narrow down the path of carpal tunnel syndrome.
• Physical Examination
  • Observe your forearm and hand muscles for sign of weakness
  • Feel for sensory deficits around the hand and thumb region
  • Assess the range of motion of the wrist and hand, looking for any motor deficits
  • Assess the strength of the fingers and various grip squeezes
  • Complete special tests to help either rule in or out the diagnosis of carpal tunnel syndrome. Some special tests include: carpal compression test, phalens and reverse phalans test, scratch collapse test, etc.
• Electrodiagnostic Tests:
  • Nerve Conduction Studies (NCS): Measures how quickly electrical impulses move through the median nerve. Slow conduction can indicate carpal tunnel syndrome.
  • Electromyography (EMG): Evaluates the electrical activity of muscles. It can help rule out other conditions that mimic carpal tunnel syndrome, like cervical radiculopathy.
• Imaging
  • Ultrasound: Can visualize the median nerve and assess swelling or changes in its appearance.
  • X-ray: Though not commonly used to diagnose carpal tunnel syndrome directly, it can rule out other conditions like arthritis or fractures.

MRI: Provides detailed images of the wrist’s soft tissues but is usually reserved for complex cases.

Most patients improve over time with conservative management. However, if the pain does not improve, the following medical management can be done:

• Pharmacology/medications: types of medications than can help include anti-inflammatories and/or analgesics.
• Injections: Corticosteroid Injections can be used to reduce inflammation and swelling. More invasive measure like nerve blockers can be used if the case is complex.
• Surgery: Carpal Tunnel Release Surgery is the process where a surgeon cuts the ligament pressing on the median nerve. This can be done through open surgery or endoscopic surgery.

Physiotherapy plays a crucial role in the conservative management of carpal tunnel syndrome. Based on the subjective and objective assessment, your physiotherapist will be able to determine the best treatment plan. Here’s how it can help:

• Pain Management
  • Manual Therapy: Massage or releases can help reduce pain, improve blood circulation to the affected area and release any tension of muscles to provide effective short-term relief.
  • Heat/Cold: Using heat or cold can provide short term relief and assist in reducing inflammation.
• Splinting/Taping/Bracing
  • In most cases, a brace or splint is needed to offload the wrist but allow patients to continue with there daily activities. These are used to reduce the load that the wrist joint may be put in, reducing the pressure build up within the carpal tunnel. Night splints may also be used.
• Stretching and Strengthening Exercises
  • Stretching: Stretching and releasing of muscles and structures can help improve the flexibility and muscle length of the muscles around the hand, wrist, and forearm. This will also include nerve gliding exercises to improve the movements of the median nerve.
  • Strengthening: An appropriate strengthening program is important to complete as this will improve the strength and endurance of the upper limb muscles.
• Education
  • Understanding the cause of carpal tunnel syndrome, how to treat it and what to expect from your rehabilitation will improve the overall outcome and give you a sense of autonomy. Your physiotherapist will help explain the condition and prognosis. And there is no such thing as a silly question!
• Activity Modifications
  • During the rehabilitation, you made need to adjust your daily activities and exercising to avoid flaring the injury. Activity modifications can include frequency and duration of breaks, adaptations of techniques, and a gradual return to activity. Additionally, postural guidance, ergonomic setup, and lifting techniques will be reviewed to ensure proper form is used.

Carpal tunnel syndrome can get to a point where it impacts every part of your daily activities. If you suspect you have carpal tunnel syndrome, it’s important to seek professional advice early. With the right diagnosis and physiotherapy treatment, you can manage the pain, prevent further injury, and get you back to your normal activities. Remember, early intervention is key to preventing serious or chronic problems.

If you or someone you know is struggling with carpal tunnel syndrome, contact us today to schedule a comprehensive assessment and personalised treatment plan.

Our experienced physiotherapists are here to help you recover quickly and prevent future injuries.

Call us now on (02) 4721 1222 or book an appointment online.