What Is Carpal Tunnel?
Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist.
Causes of Carpal Tunnel
A combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself, is the most likely cause. The carpal tunnel is simply smaller in some people than in others, and therefore some are more predisposed. Other contributing factors include trauma or injury to the wrist that cause swelling, such as a sprain or fracture.
Signs and Symptoms of Carpal Tunnel
Symptoms usually start gradually, with frequent burning, tingling, or itching numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers. A person with carpal tunnel syndrome may wake up feeling the need to “shake out” the hand or wrist. Decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks
Diagnosis of Carpal Tunnel
Specific tests to try to produce the symptoms of carpal tunnel syndrome are used. In the Tinel test, the median nerve is tapped or pressed in the patient’s wrist. The test is positive when tingling in the fingers or a resultant shock-like sensation occurs. The Phalen, or wrist-flexion, test involves holding the forearms upright by pointing the fingers down and pressing the backs of the hands together. The presence of carpal tunnel syndrome is suggested if one or more symptoms, such as tingling or increasing numbness, are felt in the fingers within 1 minute. In order to confirm this diagnosis, a nerve conduction study can be performed.
Conservative treatment involves initial rest until the swelling settles down. A cortisone injection can help relieve the inflammation, combined with physical therapy to strengthen weak areas in the neck or upper limb that may be contributing to the compression of the nerve.
Surgical treatment involves surgical release of the carpal tunnel to offload the median nerve, and is generally recommended if symptoms persist for more than 6 months.
Written by Michael Dermansky
Senior Physiotherapist and Founder of MD Health Pilates