Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

It is an irritation or compression of the median nerve at the front of the wrist, in its tunnel.

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Specifically, what is the carpal tunnel?

It is a tunnel in the wrist through which several tendons and the median nerve pass. The tunnel is formed by the bones of the wrist and ligaments. If the space in the carpal tunnel is too small for the median nerve to move properly, irritation of this nerve can develop, and this is called carpal tunnel syndrome.

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What is a nerve?

The nerve is the structure in the body responsible for transmitting information to our nervous system. Information travels in the nerve in the form of electricity. For example, nerves allow us to feel our skin when we touch a part of our body. They also allow us to send electricity to our muscles to contract them and move our joints.

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What is the median nerve?

The median nerve is one of the three main large nerves in the arm. It starts in the neck, runs down the front of the arm and forearm, passes in front of the wrist through the carpal tunnel, and splits into several small nerves that go into the fingers. The median nerve is responsible for sensation in a large part of the first three fingers and the hand. It also provides the nerve signals to the muscles that allow you to close your hand and grip.

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What are the causes of carpal tunnel syndrome?

The syndrome is caused by a combination of compression and stretching of the median nerve, which leads to blood circulation problems within the nerve.

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The exact cause of the syndrome varies from person to person. Here are several factors that may be associated with carpal tunnel syndrome:

• Repetitive hand and wrist movements
• History of overload to the hand and wrist
• Direct trauma to the wrist (falling on the hand)

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Several occupations have been linked to a higher incidence of carpal tunnel syndrome, such as:

• Construction work
• Food preparation industry
• Manufacturing work
• Forestry work

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What are the symptoms of carpal tunnel syndrome?

The main symptoms are:

• Pain, burning, numbness, or tingling in the fingers
  
  • Often in the first four fingers
  • The pain is generally worse at night
• Feeling of loss of hand strength
• Change in sensation in the hand or fingers

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Symptoms can also be felt in the wrist or even radiate up the arm. When symptoms radiate up the arm, it is also referred to as brachial neuralgia. See the brachial neuralgia section.

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How is carpal tunnel syndrome diagnosed?

Diagnosis is made based on a review of your symptoms and a clinical examination.

Sometimes, an EMG (electromyographic examination) may be necessary to evaluate nerve function. However, the vast majority of carpal tunnel syndromes are treated without this test.

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When should I consult a physiotherapist for carpal tunnel syndrome?

You should consult a physiotherapist if you have symptoms as described above or if your doctor has already ruled out any other cause that may be responsible for your pain.

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You do not need to see a doctor before consulting a physiotherapist. If your condition requires you to see a doctor, your physiotherapist will be able to tell you.

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What are the physiotherapy treatments for carpal tunnel syndrome?

Your physiotherapist will perform an evaluation to determine why your median nerve is irritated. To do this, they will assess the following elements:

• Your joint mobility
• The gliding of your nerves
• Your postural habits
• The quality of your movements
• Your strength and stability

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Based on the assessment results, your physiotherapist will:

• Mobilize the median nerve with specific nerve techniques to reduce pain and improve movement
• Mobilize the joints that prevent the nerve from moving properly (wrist, elbow, shoulder, neck).
• Provide you with specific nerve exercises to do at home to address the cause of the problem and relieve pain.
• Teach you how to properly manage your daily activities and hobbies to optimize healing
• Provide advice on your posture and movements
• Advise you on the ergonomics of your workstation.

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What can I do at home for carpal tunnel syndrome?

Temporarily stop doing movements that cause too much pain, and then gradually start doing them again.

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Here are some other tips that may help:

• Sometimes, wearing a wrist splint temporarily, especially at night, can help reduce pain.
• If you have pain at night or morning stiffness, make sure your neck is well supported while sleeping with a pillow that fills the hollow of your neck.
• Avoid sleeping with your arm behind your head or under the pillow. Keep your arm along your body or supported with a pillow.

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If you don't see any improvement after 10 days, you should consult a physiotherapist.

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Did you know that...

• Physiotherapy is as effective as surgery in treating carpal tunnel syndrome?
• Women are more likely to develop this syndrome than men?
• Is carpal tunnel syndrome responsible for 90% of median nerve problems?
• Does 3.8% of the population suffer from carpal tunnel syndrome?
• Do the physiotherapists in our clinics have advanced training in nerve treatment?

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Sources

• Duncan SF, Bhate O, Mustaly H. Pathophysiology of carpal tunnel syndrome. InCarpal Tunnel Syndrome and Related Median Neuropathies 2017 (pp. 13-29). Springer, Cham.
• Kerwin G, Williams CS, Seiler 3rd JG. The pathophysiology of carpal tunnel syndrome. Hand clinics. 1996 May 1;12(2):243-51.
• Werthel JD, Zhao C, An KN, Amadio PC. Carpal tunnel syndrome pathophysiology: role of subsynovial connective tissue. Journal of wrist surgery. 2014 Nov;3(4):220.

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