Carpal Tunnel Syndrome

Introduction

Carpal tunnel syndrome (CTS) is a condition caused by compression of the median nerve as it travels through a passageway at the wrist called carpal tunnel. Since the median nerve is responsible for sensation and movement in the thumb and first three fingers, the main symptoms are pain, numbness and tingling in the lateral hand region. There may be weaker grip strength and muscle wasting at the base of the thumb.

Causes

Signs and Symptoms

• Muscles atrophy
• Numbness, tingling, or burning sensations
• Forearm discomfort
• Pain in the hand
• Loss of grip strength
• Loss of manual dexterity.
• Discomfort, which is usually worse at night and in the morning.

Physical Examination

A number of physical examinations can be done to help diagnose carpal tunnel syndrome:

1. Check for weakness in the muscles around the base of your thumb.
2. Look for atrophy in the muscles around the base of your thumb. In severe cases, these muscles may become visibly smaller.
3. Tinel sign: Press down or tap along the median nerve to see if it causes any symptoms.
   
4. Phalen’s test: Bend and hold your wrists in a flexed position to test for complains.
   
   
   
5. Sensitivity test: Fingertips and hand sensation test with a special instrument with the eyes closed
   

Other Tests

 
Electrophysiological tests

These tests will help your doctor measure how well your median nerve is working and help determine whether there is too much pressure on the nerve.

• Nerve conduction test
• Electromyogram (EMG)

Ultrasound

Ultrasound imagining to evaluate the median nerve for signs of compression.

Magnetic resonance imaging (MRI)

Determine other causes for your symptoms or to look for abnormal tissues that could be impacting the median nerve.

Treatment

Generally accepted treatments include: physiotherapy, steroids either orally or injected locally, splinting, and surgical release.

Medical Treatment

• Non-steroidal anti-inflammatory drugs:

-- As initial therapy, followed by more aggressive options.

• Corticosteroids:

-- To decrease median nerve swelling

Surgical Treatment

• Release of the transverse carpal ligament. It is recommended when conservative interventions no longer control intermittent symptoms.

Ergonomic Modifications

• Carpal tunnel syndrome often occurs when your hand and wrist are in the flexed or extended position for too long. Changing or modifying these postures can prevent the disease. In some cases, this may involve making changes to your work task or work station.

Physiotherapy

Physiotherapist will provide suitable treatment for patient depending on the assessment findings.

1. Wax therapy
2. Ultrasound Therapy
3. Pain relief electrotherapy (TENS, IFT)
4. Acupuncture
5. Shockwave Therapy
6. Therapeutic exercises
7. Different types of rigid splints
   
   
8. Home exercises:

• Stretching exercise of forearm flexors (15 seconds each for 8 times)
  
• Massage of the forearm flexors (5 minutes each)
  
• Strengthening exercise
  

**Please contact your physiotherapist for tailor made exercise program**

The above information was produced by Physiotherapy Department, Canossa Hospital (Caritas).

Please call 28255392 for physiotherapy appointment

Reference:

Physiopedia: https://www.physio-pedia.com/Carpal_Tunnel_Syndrome