Any time someone has pain, numbness and tingling in the hand(s), we have to think about the possibility of carpal tunnel syndrome. The carpal tunnel is significant because the median nerve, which supplies muscles to your hand and fingers, runs under this tunnel. It is formed by the boundaries of the flexor retinaculum (carpal ligament), which serves as the roof, and the carpal bones of the hand, which serves as the floor. Along with the median nerve, there are nine other tendons in this tunnel, whose respective muscles flex the wrist and fingers.
This condition is most commonly found in sports/activities/occupations that involve forceful and/or repetitive hand movements (eg. keyboarders, assembly-line workers, carpenters, butchers, work where hand-held devices are subject to vibration, cycling, racquet sports, knitting). It can also occur in women who are pregnant.
Common Signs and Symptoms:
Burning, tingling, pins and needles, and/or numbness in the thumb and first 2 fingers that may radiate up the arm
Weakness in the hand when gripping
Pain that is worse at night
Pain with sustained wrist flexion or repetitive wrist movements
Why does it happen?
Compression of the median nerve in the carpal tunnel can occur due to several reasons. Firstly, it can be caused by repetitive strain/overuse of the wrist muscles causing thickness and scarring of the tendon sheaths or inflammation and swelling of the tendons themselves. Secondly, it can be caused by direct trauma to the wrist, resulting in swelling. Lastly, it can be caused by systemic factors, such as pregnancy, rheumatoid arthritis, or diabetes. In all three cases, the symptoms arise due to compression on the median nerve. If this syndrome is caught early and treated appropriately, a full recovery is likely. However, should symptoms last longer than 12 months and/or the syndrome isn’t being treated effectively, surgery to release the carpal ligament may be indicated.
If you are trying to avoid surgery, physiotherapy can help to reduce your pain and inflammation, increase your wrist/finger movement and strength, and help educate on what positions you should avoid. If you have had surgery, we can help with your post-operative pain and swelling, decrease your physical scar and the scar tissue that will form, help desensitize the nerve, and assist you in regaining your functional strength.
Therapeutic modalities that we use in the clinic during treatment to help with pain and inflammation/swelling may include ultrasound, laser, electrical current, ice, and taping. In some case, wearing a night splint may also be suggested. We will also provide you with a specific exercise program including stretching and strengthening for you to do at home. It’s important for us to work together to maximize your function and get you back to doing the things you love.
Leanna Taggio, Physiotherapist