If your hands go numb or tingle at night, or you find pain or clumsiness with repetitive tasks you may have Carpal Tunnel Syndrome (CTS).  Although these symptoms can have several causes, one of the most common conditions I see at the clinic is caused when a nerve gets irritated at the front of your wrist.  These activities cause it to swell and get pressure on it as it travels through the carpal tunnel. Understanding what causes the symptoms and eliminating the cause is crucial for fixing the problem.

What Causes Carpal Tunnel Syndrome?

The cause of CTS is nerve irritation inside the front of your wrist and the nerve involved is the Median nerve. The nerve can be irritated by repetitive hand movement (too much keyboarding) or swelling in the tunnel (pregnancy) leading to pain, tingling or numbness in the hand and the thumb and first three fingers. The nerve also supplies muscles in your thumb which may feel weaker.

The Carpal Tunnel: Anatomy 101

The red shading shows the band of tissue on top of the Carpal Tunnel with the Median nerve in green passing underneath. Its branches then extend to the Thumb and first three fingers.

  • Carpal…. Wrist
  • Tunnel…. A space inside the front of the wrist
  • Syndrome…. Symptoms (pain) and Signs (muscle weakness, loss of movement, pain on testing)

How do I know if I have Carpal Tunnel Syndrome?

  • Where do you feel the tingling?  Typically CTS presents with symptoms in the thumb and first three fingers.
  • What makes it come on? Repetitive use of the hand is the most common cause.
  • What eases it? Resting, stopping the repetitive activity.
  • Does it wake you up at night? It is very common for CTS to cause numbness at night.

If you answered yes to any of the above questions you may have Carpal Tunnel Syndrome and should see a  health professional to help you correct this condition.

Who gets carpal tunnel syndrome?

CTS happens more to women who work at a desk  and are using a keyboard.  I also see it more often when you have a hobby that involves  repetitive use of the hand i.e. knitting, cooking.  Here are some of the risk factors for carpal tunnel syndrome:

  • Female
  • 40-60 years old
  • Repetitive hand usage
  • Diabetic, Under-active Thyroid condition
  • Pregnant
  • Rheumatoid Arthritis
  • Previous Wrist fracture

Physiotherapy Assessment

When you see your physiotherapist for an assessment they should perform the following tests to help to confirm that the Median nerve is irritated.  This information will help to direct your next steps in treatment. https://www.webmd.com/pain-management/carpal-tunnel/carpal-tunnel-diagnosis#1

  • Phalen’s Test, bending your hand forward and holding it there for one minute
  • Reverse Phalen’s Test, bend your hand back and hold it for one minute
  • Tinel’s Test, tapping on the carpal tunnel directly over the  median nerve
  • Compressing the nerve in the Carpal Tunnel by pressing on the front of your wrist
  • Strength testing of the small muscles at the base of your thumb
  • Sensation testing to see if areas of skin in the palm of your hand or the thumb and first three fingers have reduced sensation
  • Neck movements should also be checked as the neck is a frequent source of tingling in the hand.

Physiotherapy Treatment:

Once your diagnosis has been confirmed it is important to educate yourself about self care strategies.  Your physiotherapist will help you to identify the factors that cause your symptoms and strategies to reduce the strain on the carpal tunnel.  These strategies may include:

  • Identifying, stopping or at least reducing the activity that makes the tingling come on
  • Avoiding repetitive use of the hand and fingers.
  • Recommending frequent interruption of prolonged hand activity
  • Better ergonomic set-ups such as using an Ergonomic mouse or a soft wrist pad in front of the keyboard
  • Having an Ergonomic assessment of your work station
  • Advice on stretching exercises
  • Types of braces and when to wear the brace.
  • Managing of symptoms such as applying ice to the front of your wrist for 15 minutes twice a day
  • Providing specific hand exercises and manual therapy to improve wrist mobility, nerve and tendon gliding

When should I see my Doctor?

Many people do well with physiotherapy and simple changes to reduce the strain on their wrist, however you should see your physician for further testing and/or management if you have:

  • persistent symptoms of tingling, numbness and reduced hand function after trying physiotherapy for 6 weeks.
  • worsening symptoms despite treatment. Your Doctor may order electrical tests to confirm the diagnosis.

Further Diagnostic Tests, Cortisone Treatment and Surgery

If your symptoms persist or are severe your GP may order a nerve conduction or electromyography tests to confirm if the Median nerve is getting irritated and causing your symptoms.

If Carpal Tunnel Syndrome is confirmed your Doctor may request a surgical opinion. Surgery involves a small incision on the front of the wrist which provides more space within the tunnel to reduce the nerve irritation. A cortisone injection may also be considered prior to surgery to relieve symptoms

I see many patients with Carpal Tunnel Syndrome. More often than not the problem has been present for several months and has therefore become chronic.  The longer you leave it the more difficult it is to treat. Early diagnosis and the right treatment is key to preventing long term problems and surgery.  If you have these symptoms come in to see me or contact me by email gsneath@orthophysio.com  or by phone 416 925 4687.