Management & Prevention of Carpal Tunnel Syndrome         

Carpal tunnel syndrome is one of the most commonly diagnosed repetitive strain injuries. It occurs when the median nerve, which is the main nerve that travels down the inside of your forearm to your hand, becomes compressed or irritated as it passes through the carpal tunnel at the wrist. The carpal tunnel is an opening formed by ligaments and bones on the inside of the wrist which allow tendons and nerves to pass through it.

The problem is that this passageway is narrow and can be easily obstructed by local swelling and inflammation, usually from overuse or direct trauma. For example, repetitive work or leisure activities that involve a lot of gripping or use of the flexors (inner forearm muscles) can cause inflammation of the tendons. Similarly, long hours of computer work with improper ergonomics can cause excessive pressure on the inside of the wrist.

The common symptoms of carpal tunnel syndrome are numbness, tingling, or burning sensations in the palm of the hand and fingers, often accompanied by skin sensitivity and grip weakness. As the symptoms worsen people often experience sharp, shooting pain from the inner wrist up the forearm and decreased ability to use the affected hand.

Our treatment strategy is geared towards reducing the pressure on the carpal tunnel area and allowing the median nerve to function properly again. We are able to use a number of different treatment strategies such as:

• Joint mobilization – stiff joints around the carpal tunnel can cause narrowing of the passageway and compression of the median nerve and flexor tendons. Using manual techniques we will loosen stiff joints and work to restore normal mobility and range of motion in the wrist and hand bones, taking pressure off the nervous tissue.

• Soft tissue release – it is important to release tight muscles in the forearm and hand that may be compressing the median nerve and contributing to nerve pain and tightness. We can use a number of techniques to achieve this such as massage, cupping, acupuncture, and IMS.

• Ergonomic correction – we will work with you to determine how to optimize your ergonomic set-up for work or home to minimize strain on your body. A brace may also be recommended to manage symptoms at work or at night. A brace will keep your wrist in a neutral position and prevent the wrist from flexing and compressing the carpal tunnel.

There are also a number of prevention strategies that you can use to reduce your risk of developing carpal tunnel syndrome:

• Optimize your ergonomic set-up – position your keyboard and mouse so that your wrists are neutral and not hyperextended or flexed. Also be aware of your posture and try to keep your neck, shoulders, and back in a straight and relaxed position. Ergonomic equipment may also be useful especially for people who spend long hours at the computer. For more detail see the full blog on correct ergonomics.

• Take regular breaks from repetitive activities – prevent tension and strain from building up in your tissues by planning regular breaks for stretching and changing position.

  Seek help from a physiotherapist at the first signs of pain; don’t wait for it to get worse.

Carpal tunnel release surgery is also an option for chronic cases that do not completely resolve with physiotherapy; however it should be seen as a last resort. A course of physiotherapy treatment is always recommended before having an invasive procedure.

**It should be noted that NOT ALL WRIST AND HAND TINGLING IS DIAGNOSED AS CARPAL TUNNEL SYNDROME. Your nervous system is a continuous network of tissue, therefore nerve compression or irritation in other areas of the body such as the neck, back, shoulder, or elbow can contribute to or cause your hand symptoms. Especially if your condition is bilateral (symptoms on both sides), it is likely that body parts other than your wrist and hand require treatment.

As physiotherapists we are trained to comprehensively assess and diagnose your body as a whole and treat all the factors contributing to your pain. We can help ensure you get thorough treatment to eliminate your symptoms as quickly as possible and prevent it from becoming a chronic condition. Don’t try to treat it yourself off the internet! Leave it in the hands of the trained experts.