Carpal Tunnel Syndrome – Symptoms, Causes and Physiotherapy Management

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome (CTS) is a musculoskeletal disorder in which the median nerve is compressed due to excessive narrowing of the carpal tunnel. The carpal tunnel is a narrow passageway at the wrist region and is made up of ligaments and bones. It provides a channel for the median nerve to pass through the forearm towards the hand where it innervates the intrinsic muscles thus controlling the course movements of the hand. The median nerve is also known as “the eye of the hand” as it innervates the major muscles of the hand thus providing motor control and it also gives sensory innervations to the skin surface of the hand. As the carpal tunnel is already a narrow structure, any kind of pressure on the nerves or the tendons can compress the median nerve and this can cause pain in the hand and wrist making it difficult for the person to write, type or carry heavy objects. In its early phase, carpal tunnel syndrome can get better through rest, exercise and other non-surgical treatment options but in case of delaying the treatment, it can also require surgery.

What are the causes?

Carpal tunnel syndrome can be caused due to increased pressure on the median nerve either due to narrowing for the carpal tunnel space or any external factors such as muscle strain, wrist injury or overuse injury. Also, it is mostly seen in people whose occupation requires repeated and forceful wrist movements such as mechanics, painters or typists. In some cases, the cause of this condition is difficult to figure out. Some factors that might contribute to increasing the risk of CTS are:

Pregnancy: CTS is quite common in pregnant women and this occurs due to build-up of tissues in the wrist causing compression of the median nerve

Repetitive wrist movements and using vibratory tools: repetitive movements cause micro-trauma in the tendons resulting in inflammation. Vibration can also cause inflammation in the nerve and surrounding tissues. This inflammation can cause the median nerves to be compressed resulting in CTS.

Tumour or cyst in the carpal tunnel: Any cyst developed due to either injury or any other reason can put pressure on the structures in the carpal tunnel.

Hypothyroidism: studies have shown that an under-active thyroid gland can also cause fluid build-up in the tissues which can put pressure on nerves in arms and legs.

More common in females: it is seen that CTS occur in more women than men probably because they have a narrow carpal tunnel.

Other risk factors include diabetes, obesity, rheumatoid arthritis and osteoarthritis.

What are the symptoms?

Persons with CTS may experience:

Tingling (pins and needles like sensation) that moves up to the arm
Numbness in the palm and thumb mostly at night
Weakness felt in hand especially thumb and difficulty in gripping
Pain in hand during carrying things

Symptoms tend to appear gradually with tingling and numbness occurring frequently in the thumb, index and middle fingers. Symptoms appear in one or both hands and they usually appear in the dominant hand first. Tingling and numbness are also experienced in the morning and it might extend to the shoulder region. Weakness in the hands makes it difficult to perform daily activities such as driving, writing or reading a book. The symptoms might come and go but they get worse if the condition is not treated early.

When Do We Need Surgery for CTS?

Carpal tunnel surgery is mostly required when the symptoms stop responding to other treatments. And also in cases where patients have delayed treatment and the condition has deteriorated to an extent that surgery becomes important. There are two ways to perform carpal tunnel surgery:

Open carpal tunnel release: It involves making a cut on the flexor retinaculum (a fibrous band in the wrist) to release the pressure off the median nerve.

Endoscopic carpal tunnel release: In this technique, a tiny camera is inserted by making a small cut on the patient’s wrist or palm to monitor the procedure and another cut is made to insert an instrument to make a cut on the flexor retinaculum. This is a minimally invasive technique so the patients recover more quickly and can get back to daily activities sooner.

What are the Non-surgical Treatment Options?

Some non-surgical treatment options for CTS are:

Wearing wrist splint can stabilize your wrist in a straight and slightly bent-back position can it reduces the pressure from the median nerve.
Avoiding continuous repetitive tasks and take frequent breaks in between work to avoid the exaggeration of symptoms.
Prescription medications such as corticosteroids are helpful in relieving pain. They are also available as injections which are more effective than tablets for quick pain relief.
Physical therapy can be beneficial for pain relief and some techniques help to reduce pressure from the median nerve.

Role of Physiotherapy in CTS

In the early stage of CTS, it is best to manage it conservatively through physiotherapy and lifestyle modifications. Physiotherapy can help you to relieve symptoms and get back to normal routine activities. In your first physiotherapy consultation, the physiotherapist will ask you about your medical history and current symptoms and will prepare a treatment plan for you according to your need.

Some physiotherapy procedures include:

Manual therapy for mobilization of soft tissues, carpal bones and the median nerve
Neck and wrist stretching exercises to improve mobility of the median nerve (nerve mobilization techniques)
Pain relief modalities such as EMS (electrical muscle stimulation) can help to reduce inflammation around the median nerve.

A physiotherapist can diagnose the stage and severity of your condition and can help you manage your symptoms accordingly. If you think you have the symptoms of CTS, be sure to consult a physiotherapist as early as possible.