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If you are troubled by numbness, pins and needles or pain in the wrist or hand, often worse at night or first thing in the morning, you could be suffering from Carpal Tunnel Syndrome. This is a common condition and often responds well to physiotherapy treatment.

What is Carpal Tunnel Syndrome?

The carpal tunnel is a small passage way between the bones and connective tissue in your wrist, through which tendons, nerves and blood vessels pass to your hand. The base of the tunnel is formed by several small bones in your wrist, known as your carpal bones. The roof is formed by connective tissue particularly your transverse carpal ligament.

Carpal Tunnel Syndrome occurs when the median nerve is compressed as it passes through the tunnel. The nerve is responsible for supplying sensation and motor control to parts of the hand and therefore these are often affected.

What are the symptoms?

Common symptoms of Carpal Tunnel Syndrome include:

• Numbness or pins and needles in the hand, often worse at night or first thing in the morning

• Pain in the wrist or hand, particularly at night

• Shooting pain from the wrist

• Referred pain into the forearm or arm

• Weakness and loss of motor function in the hand

• The little finger and half of the fourth finger are unaffected

• Symptoms aggravated by prolonged or repetitive flexion of the wrist

What causes Carpal Tunnel Syndrome?

• Arthritis – especially rheumatoid arthritis, can cause inflammation and swelling which restrict the carpal tunnel

• Pregnancy – hormones causing general fluid retention, which can compress the median nerve.

• Wrist fracture – bone fragments can irritate the connective tissue or reduce the amount of space in the carpal tunnel

• Congenital factors – smaller carpal tunnel size

• Flexor tendons – damage or irritation to the tendons that pass through the tunnel can result in swelling and inflammation of the tendons, which can compress the median nerve. This usually occurs due to overuse of the forearm flexors, however it may also occur as a result of trauma

What are the treatment options?

Surgery is an option for Carpal Tunnel Syndrome however physiotherapy treatment is also known to be effective and is often recommended prior to surgical intervention. Treatment methods include:

• Deep tissue massage and acupuncture to release tight flexor muscles

• Carpal bone mobilisations to open the carpal tunnel

• Flexor retinaculum and tendon stretches

• Ultrasound to reduce inflammation and improve extensibility

• Nerve and tendon gliding exercises to ensure full unrestricted nerve movement

• Assessment and elimination of the cervicothoracic spine or shoulder as referral sources

• Night bracing or splinting to avoid carpal tunnel compression when sleeping

• Kinesio Taping to reduce flexor tendon tension and carpal tunnel compression

• Eccentric wrist flexor strengthening program

• Strengthening for posture, grip, fine motor skills and hand dexterity

• Ergonomic assessment to reduce contributing factors

• Activity modification of any aggravating duties

Poor mobility, alignment or stability in the spine or shoulder blade can result in poor core mechanics and increased loading of the peripheral arm muscles. This can often be evident in patients who have recurring Carpal Tunnel Syndrome. It is important to strengthen not only the forearm flexors but also the core scapular, trunk and cervical musculature.

Live Well’s physiotherapists are experienced in treating Carpal Tunnel Syndrome and have had great success in helping many people avoid surgery. Contact us today to find out how we can help you.