Carpal Tunnel Syndrome | Plenty Physiotherapy, Bundoora

Carpal Tunnel Syndrome Document 

Carpal Tunnel Syndrome (CTS) is most common  entrapment neuropathy affecting the median nerve as it passes through the carpal tunnel at the wrist.When this structure becomes irritated and  inflamed, it can cause compression and narrowing  of this space and its structures that are passing  . Compression within this narrow passageway can lead to symptoms including pain,  numbness, tingling, and weakness in the hand, particularly affecting the thumb, index,  middle, and lateral half of the ring finger. Contributing Factors: a) Repetitive wrist and hand movements: Repetitive movements of the wrist and  hand when doing activities such as computer mouse use, typing, assembly  line work (grasping, pinching and other hand movements), sewing/knitting can  all put an individual at higher risk of developing CTS.  b) Sustained Hand and wrist positions: Sustained hand and wrist positions such  as wrist flexion can lead to irritation of these structures which may lead to CTS.  c) Anatomical factors: People can have many anatomical variations in general,  with one being a potential to have a more narrow carpal tunnel region meaning  that they have a more predisposed to developing a conditioning like CTS.  d) Pregnancy: When people are pregnant there are a plethora of changes to the  body, some being fluid retention and hormonal fluctuations which may lead to  increased pressure on the median nerve and altered hand/wrist mechanics  leading to increased aggravation of structures as described above. Women also  have a 3-5x increased risk of developing this condition.  e) Medical: Conditions such as arthritis, diabetes, obesity and other inflammatory  conditions such as rheumatoid arthritis are also highly correlated with CTS.  f) Wrist injuries: Having sustained previous wrist injuries such as wrist fractures in  the past can also damage the carpal tunnel and other structures associated with  CTS development.  Management & Treatment: 1) Activity modifications and ergonomic education: Avoiding and/or minimising  repetitive and sustained wrist flexion/extension movements to reduce strain.  Using a more neutral positioned wrist when completing tasks will minimise  stress on the wrist. Utilising ergonomic friendly keyboard/mouse and desk set  ups. Education on pacing strategies for load management purposes. 2) Splinting: Wearing a wrist splint at night (night symptoms are common due to  wrist flexion in sleep) and during any tasks that may be aggravating is the first  line treatment. This is helpful as it keeps the wrist in neutral and not in positions  like wrist flexion which can reduce irritation and compression on the median  nerve. Some splints may require input from a hand therapist but this will be  discussed with your physiotherapist.  3) Exercise rehab: Exercises that lookto target to increase wrist and hand strength  and mobility. Exercises that also strengthen and focus to increase flexibility in  surrounding muscles are important too. Specialised exercises such as nerve  glides (gentle movements of the wrist/hand) can help mobilise the median nerve  to minimise compression and encourage normalised movements that do not  aggravate CTS related mechanics.  4) Manual therapy: Manual therapy techniques such as soft tissue work and joint  mobilisations to help with releasing forearm tension/compressing factors and  improving wrist mobility to mitigate pain and improve healing. Due to the median  nerve involvement, including treatment to the cervical (neck) and thoracic (mid back) can help if these areas are contributing to nerve entrapment or irritation  more proximally.  5) Medical/Referral imaging: In some scenarios, referral for imaging and or  specialist involvement for potential surgical options may be necessary in severe  cases or failed conservative approaches.