Carpal tunnel syndrome

What is Carpal Tunnel Syndrome (CTS)?

Carpal tunnel syndrome is a painful disorder of the wrist and hand. CTS is classified as a cumulative trauma disorder. The carpal tunnel is a narrow tunnel formed by the bones and other tissues of your wrist. It is the area under a ligament (a tough, elastic band of tissue that connects bones and organs in place) in front of the wrist. This tunnel protects your median nerve. The median nerve, which passes through the carpal tunnel gives you feeling in your thumb, and index, middle and ring fingers. Repetitive movements of the hand and wrist can cause inflammation of structures (such as tendons and their coverings) that surround the median nerve. The inflammation may compress this nerve, producing numbness, tingling, and pain in the first three fingers and the thumb side of the hand-a condition known as carpal tunnel syndrome.

Symptoms of carpal tunnel syndrome

• Numbness or tingling in your hand and fingers, especially the thumb and index and middle fingers.
• Pain in your wrist, palm or forearm.
• More numbness or pain at night than during the day. The pain may be so bad it wakes you up. You may shake or rub your hand to get relief.
• More pain when you use your hand or wrist more.
• Trouble gripping objects.
• Difficulty gripping or making a fist, to dropping things.

Risk factors

Many activities outside of work may contribute to carpal tunnel syndrome: knitting, sewing, or needlepoint; cooking and housework; TV computer games and home computer work; playing sports or cards; and hobbies or projects like carpentry or using power tools for extended periods of time.

• Work-related cumulative trauma of the wrist.
• Diseases or conditions that predispose to the development of carpal tunnel syndrome include pregnancy, diabetes, rheumatoid arthritis and obesity.
• Jobs require pinching or gripping with the wrist
• People at risk include people who use computers, carpenters, grocery checkers, assembly-line workers, meat packers, violinists and mechanics.
• Hobbies such as gardening, needlework, golfing and canoeing can sometimes bring on the symptoms.

Diagnosis

Physiotherapist will ask you about your, past medical history, symptoms, social history such as hobbies and occupation. They will then examine you by performing some special tests as following:

• Tap the inside of your wrist. You may feel pain or a sensation like an electric shock.
• Bend your wrist down for 1 minute to see if this causes symptoms.
• Perform a nerve conduction test or an electromyography (EMG) test to see whether the nerves and muscles in your arm and hand

Prognosis

Carpal tunnel syndrome usually isn't serious. With treatment, the pain will usually go away and you'll have no lasting damage to your hand or wrist.

Approximately 1 percent of individuals with carpal tunnel syndrome develop permanent injury. The majority recover completely and can avoid re-injury by changing the way they do repetitive movements, the frequency with which they do the movements, and the amount of time they rest between periods when they perform the movements.

Treatment

Physical therapists can target and correct poor work habits and improper work designs, such as tools, furniture, equipment, and work space. They also can assess the risk potential of an individual and determine if that person is physically unsuited for a particular job. They work closely with employers to educate employees about CTS- what causes it and how to avoid it through proper use of the musculoskeletal system. Among their many responsibilities, physical therapists teach health awareness and job safety. A typical education program includes exercises employees can do at work and at home, adjustments to the overall work environment and individual work stations, plus early detection of symptoms to avoid painful and costly surgery.

A physical therapist will begin by observing how employees work and evaluating the ergonomics of the work environment. Ergonomics is the study and control of the effects of postures, stresses, motions, and other physical forces on the human body engaged in work. For instance, computer programmers may be sitting in a chair that forces them to slouch. Their computer screen may be too high, causing stress in the neck and shoulders, and the keyboard may be in a position that forces continued pressure on the wrist muscles. Factory workers standing on their feet all day may have to use tools that are designed for individuals with a larger grip. Their work station may be too high or too low, forcing them into an awkward body position. This action puts added strain on the neck, shoulders, and arms.

A physical therapist can show employees how to adjust their work area, handle tools, or perform tasks in a way that puts less stress on the body. They may teach employees a number of exercises to increase flexibility of their arm/hand region while they are at work. Frequent brief stretching and relaxation exercises can help reduce injuries and improve productivity in the workplace. Physical therapists also suggest short rest breaks after two hours of using the hands.

Prevention

Recent studies have shown that carpal tunnel syndrome, like all other cumulative trauma disorders, is on the rise while other workplace injuries have leveled off. Many companies are turning to physical therapists for help in designing and implementing health promotion and injury prevention programs to protect their employees from CTS.

You may need to wear a wrist splint at night, while playing sports, or when working at home. The wrist splint assists in maintaining the wrist in a neutral or straight position and allows the wrist to rest.

• Avoid bending your wrists down for long periods.
• Pop up your arm with pillows when you lie down.
• Avoid using your hand too much.
• Find a new way to use your hand by using a different tool.
• Try to use the other hand more often.
• Lose weight if you're overweight.
• Get treatment for any disease you have that may cause carpal tunnel syndrome.
• If you do the same tasks with your hands over and over, try not to bend, extend or twist your hands for long periods.
• Don't work with your arms too close or too far from your body.
• Don't rest your wrists on hard surfaces for long periods.
• Switch hands during work tasks.
• Make sure your tools aren't too big for your hands.
• Take regular breaks from repeated hand movements to give your hands and wrists time to rest.
• Don't sit or stand in the same position all day.
• If you use a keyboard a lot, adjust the height of your chair so that your forearms are level with your keyboard and you don't have to flex your wrists to type

Your physical therapist will help you design an exercise program that allows you to enjoy daily activities at home. To begin with, your physical therapist will instruct you on exercises to stretch the forearm muscles to reduce tension on tendons that pass through the wrist. After swelling in the wrist decreases, your physical therapist will give you some isometric strengthening exercises that are correct for your particular injury.