Carpal Tunnel Syndrome
Carpal tunnel syndrome is a painful condition which affects your wrist and hand. It may also cause tingling or numbness in your fingers and reduced grip strength. It is caused by compression of the median nerve as it passes through the carpal tunnel.
Symptoms of Carpal Tunnel Syndrome
Common symptoms of Carpal Tunnel Syndrome can include:
- Tingling or numbness in your thumb, index and middle finger.
- Weakness when gripping objects which may result in problems opening jars and dropping things. In severe cases, muscle wastage may be seen in the palm by the thumb.
- Pain in the wrist which can refer into the fingers.
- Pain or numbness which is worse at night and may interrupt sleep.
Causes of Carpal Tunnel Syndrome
Certain conditions can increase your risk of developing carpal tunnel syndrome. These include:
- Joint or bone disease – such as rheumatoid arthritis or osteoarthritis.
- Wrist fractures.
Carpal Tunnel Syndrome is common during pregnancy and with new mums. This may be due to a change in hormone levels that can cause fluid retention and swelling. This can therefore increase pressure on the median nerve.
Those who perform frequent repetitive wrist movements with forceful gripping are at greater risk of developing carpal tunnel syndrome.
Office based workers who spend long hours typing are at increased risk due to the frequent, repetitive small movements with the fingers. This may be worsened with a poor ergonomic set up.
The Carpal Tunnel is a narrow tunnel on the palm side of your wrist. It is made up of the small bones in the wrist (carpal bones) and the transverse carpal ligament. The median nerve and the tendons that bend the finger and thumb pass through this tunnel. The median nerve provides sensation to the thumb, index and middle finger. It also innervates the muscles at the base of the thumb (thenar muscles).
If the flexor tendons or transverse carpal ligaments become swollen or inflamed, this can then put pressure on the median nerve.
How to diagnose
At your consultation, one of our highly skilled physiotherapists will ask a series of questions and perform a physical examination to help develop a diagnosis. The assessment will include checking your hand and wrist range of movement, strength and flexibility of the surrounding musculature and special tests to diagnose your pain. An ultrasound scan may be performed to assess and confirm diagnosis.
Physiotherapy treatment may include:
- Advice on activity modification and ergonomics
- An independent exercise program to improve tendon and nerve gliding.
- Information on wrist splints to relieve pressure on the nerve.
- Advice on topical or oral ibuprofen which may reduce pain.
If symptoms have not improved with physiotherapy, or if the pain is affecting your sleep, stopping you from performing everyday activities such as getting dressed or is limiting you from performing your physiotherapy exercises you may want to consider an ultrasound guided steroid injection. Steroid injections have been found to be effective in treating Carpal Tunnel Syndrome and reducing need for surgical intervention (Goru et al, 2022).
Steroid injections use a small dose of corticosteroid (a strong anti-inflammatory drug) and are injected under ultrasound-guidance. Current evidence found that injections performed under ultrasound guidance are more accurate and more effective at reducing pain and improving function than landmark guided injections (Daniels et al, 2018).
Daniels, E.W., Cole, D., Jacobs, B. and Phillips, S.F., 2018. Existing Evidence on Ultrasound-Guided Injections in Sports Medicine. Los Angeles, CA: SAGE Publications
Goru, p., Butaliu, G.C., Verma, G.G., Hague,S., Mustafa, A. and Paul, A. (2022) Effectiveness of ultrasound-guided local steroid injection in the wrist for the treatment of carpal tunnel syndrome: is it worth it? Egyptian Rheumatology and Rehabilitation. 49(21).