Physiolair/ Carpal Tunnel Syndrome CTS

Table Of Contents

Introduction:
What is the Carpal tunnel syndrome CTS?
Anatomy of the Carpal tunnel
Main Causes of the Carpal tunnel syndrome
Signs and symptoms of Carpal tunnel syndrome:
Examination and Diagnosis
Management and treatment
Best books about Carpal tunle syndrome
References

Introduction:

CTS affects millions of people each year due to repetitive stress on the wrist, and can cause numbness, stiffness, and pain in the fingers and hands. Here in this article is a brief about the CTS and a simple stretching exercise to relieve your pain and symptoms.

What is the Carpal tunnel syndrome CTS?

It’s caused by pressure being placed on the median nerve, which provides motor function to the forearm, wrist, and hand.

Median nerve:

A branch of the brachial plexus “C5-T1”.
Supply most of the superficial and deep flexors muscles in the forearm, thenar and lumbrical.
Give sensory supply to certain areas of the skin of the hand.

area of numbness in carpal tunel syndrome in hand — area of numbness in carpal tunel syndrome

Anatomy of the Carpal tunnel

Carpal tunnel is made of a group of “ tendons, ligaments, and carpal bones”. It’s a passageway from the wrist to hand.
Median nerve passes through this tunnel and provides sensation to the thumb, index, middle fingers, and the thumb side of the ring finger.

Anatomy of carpal tunel syndrome — Anatomy of carpal tunel

Main Causes of the Carpal tunnel syndrome

Although most cases are idiopathic, CTS can be associated with any condition that causes pressure on the median nerve at the wrist.

Inflammation of tendons or tissue.
Repetitive stress like typing, using the computer, …etc.

Repetitive stress during typing lead to carpal tunnel syndrome — Repetitive stress during typing

It’s all concluded in “MEDIAN TRAP”:

M: Myxedema.
E: Edema” heart failure, OCP”
D: Diabetes Mellitus. DM
I: Idiopathic.
A: Acromegaly.
N: Neoplasia.
T: Trauma.
R: Rheumatoid arthritis.
A: Amyloidosis.
P: Pregnancy.

Signs and symptoms of Carpal tunnel syndrome:

Numb sensation in the hand.
Weak sensation in the hand.
Pain and aches in the fingers, hand, or arm.
Paresthesia ” Pins or needle sharp pain”.
A burning or itching sensation in the palm.
Difficult gripping.

** Symptoms get worse at night or a day after use.

Examination and Diagnosis

Phalen and Tinel’s sign.
Confirm with an EMG test.

Phalen test technique:

Raise Px arms at shoulders level.
Patient flexes his elbows, allowing wrists to fall into maximum flexion.
Ask the patient to push the dorsal surface of the hands together. “hold this position for 30-60 seconds”

** This position should increase the pressure in the CTS and nerve.

Positive test: when numbness and pain is increased.

Tinel’s sign: the way to detect the irritated nerve. Technique: Therapist taping or squeezing the nerve

tinle's sign for carpal tunle syndrome — tinle’s sign for carpal tunle syndrome

Risk factors

Obesity.
Pregnancy.
Underlying conditions: rheumatoid arthritis, autoimmune disease.
Repetitive activity using the wrist joint.

Management and treatment

Physical therapy management may help to relieve numbness and pain, and restore normal hand and wrist function as possible before surgical intervention, this management include:

Rest.
Ice/ hot.
Work adaptation.
Wrist splint.
Stretching exercise: to improve mobility of the wrist and hand, and improve joint function.
Strengthening exercise: to improve the strength of the hand and finger muscles.
Median nerve gliding.
Taping therapy.
Steroid injection.
Surgery: may be needed when symptoms are severe.

If you want more exercises, you can watch these videos .

Here are 8 of the tips to deal with CTS

Break: Take enough breaks or rest during activity, even 30 seconds of changing activity or position may help.
Avoid extreme ROM for prolonged periods, try to keep your wrist in neutral position.
Stretching exercise.
Hot packs: to relax the tighten muscle and reduce stiffness.
Relax: don’t press so much on your hand while writing pr using the computer.
Wear splint: specially at night to reduce numbness, tingling and pain.
Try to use gel, cream to reduce the pain and relax your hand muscles.
Consulting your Physiotherapist.