One of the most common diagnoses related to the upper extremity is Carpal Tunnel Syndrome (CTS)… but what is it?! I thought everyone had carpal tunnel??
Yes, everyone has a carpal tunnel!
The carpal tunnel is an anatomical structure that is made up of 8 small wrist bones (collectively called the carpals) and a ligament that spans the top of these bones, the flexor retinaculum, also called the transverse carpal ligament. This creates a space for 10 structures to pass from the forearm and into the wrist – 2 muscles that go to each finger (8 total), 1 thumb muscle, and 1 nerve.
Carpal tunnel syndrome is a compression of the median nerve at the carpal tunnel resulting in altered sensation or numbness, grip weakness and often night pain. The median nerve starts at the neck and goes through the forearm and wrist to the tips of the fingers – that’s a long way to travel! Sometimes issues arise along this journey, such as compression. Other times, people are born with a smaller tunnel or thicker flexor retinaculum, which predisposes them to compression of this nerve. Even still, other factors like lifestyle and overuse facilitate inflammation which results in compression of the nerve.
How is CTS diagnosed?
Clinically speaking, CTS is distinguished by numbness and/or tingling in the tips of the thumb, index, middle, and part of the ringer finger. However, CTS is definitively diagnosed via electromyography (EMG), which tests the conduction speed of the Median nerve to determine the degree of compression, and location of compression.
- Commonly associated with overuse or repetitive motions.
- Women have a higher diagnosis rate.
- Nighttime symptoms are the most distinguishing characteristic.
- Severe cases or prolonged cases can cause muscle atrophy in the thumb.
- The longer one waits for treatment, the symptoms are more long lasting (and potentially permanent!)
Light at the End of the Carpal Tunnel!
There are a variety of treatment methods to address carpal tunnel syndrome, from hand therapy to surgery. The goal of treatment is to increase soft tissue mobility, unhindered glide of the Median Nerve, decreasing altered sensations and pain; all for improved neurological conduction and a decrease in symptoms. A variety of therapeutic modalities are used to treat CTS, including ultrasound and phototherapy. Exercises may include sensory re-education/desensitization, range of motion and strengthening exercises, as well as coordination and postural training.
Tips for Preventing Symptoms:
- Frequent rest breaks
- Decrease force or intensity during tasks out of respect for tissues at risk for over use
- Ergonomic work space -- talk to your AHT provider for personalized feedback!
- Night wrist immobilization bracing
- Median nerve glides to decrease or prevent nerve compression