A common condition affecting more women than men of all ages, increasingly with age, particularly affecting menopausal women. CTS causes pain, numbness and a tingling or burning sensation in the hands and fingers; also weakness in the hands and fingers and a dull ache spreading into the forearm.
Anatomy: The carpal tunnel is a narrow passage in the wrist between the small carpal bones; it has a tough band of elastic tissue, the carpal ligament across it that supports the movement of the tendons that attach the muscles to the fingers to bend them. The median nerve passes through the armpit, down the arm and through the carpal tunnel to the fingers.
Symptoms: Most symptoms are caused by irritation of the median nerves that control movement and sensation in the hands; giving pain, numbness and tingling, mostly in the thumb, index, middle fingers and half of the ring finger. Symptoms usually develop gradually and can tend to be worse first thing in the morning and at night. Other symptoms include dull ache in the arm and hand, swelling and change of skin colour in the hand, weakness and wasting of the muscles, particularly at the base of the thumb. Weakness can affect the grip and cause you to drop things. Symptoms can be aggravated by repetitive movements or by keeping the arm still for a long time.
Causes: Compression of the median nerves that control movement and sensation in the hands. Pressure on the nerve can disrupt signals affecting movement and sense of touch. The cause it not always known though it can be related to and the risk increased by repetitive or strenuous use of the hand, such as in playing a musical instrument, manual labour or vibrating tools; injuries to the wrist, pregnancy, family history of CTS, or conditions such as diabetes, underactive thyroid, obesity, rheumatoid arthritis, inflammation and swelling.
Diagnosis: Your doctor may tap your wrist to see if you feel tingling or numbness in your fingers; flexing your wrist or holding it above your head for a minute may produce the same symptoms. A blood test may be suggested to rule out diabetes, rheumatoid arthritis and hypothyroidism. Nerve conduction tests can measure the nerve transmission and determine any nerve damage, X-ray will rule out fractures and ultrasound scan allows examination of the structure of the median nerve.
Treatment: Some cases resolve without treatment, self-care may improve the symptoms in others. With pregnancy CTS, symptoms may take 3-12 months to resolve after birth. Mild cases can be helped by non-surgical treatments such as corticosteroid injections or by wearing a wrist support to protect the nerve. Ibuprofen may help relieve inflammation, though there is no evidence to support this as a treatment. Carpal tunnel release surgery may be recommended, particularly to prevent nerve damage; mild cases may have immediate relief of symptoms, severe cases may still take a while to recover.
Prevention: Avoid repetitive tasks that aggravate the symptoms.
Osteopathic/Manual Management: Take a detailed case history to understand the nature of the problem and surrounding issues. Examine the arm, hand and fingers and all surrounding tissues; muscles, ligaments, nerves, fascia, etc., for movement, strength and functionality and assess nerve pathways. Perform orthopaedic and neurological tests and determine the root cause. Treat to improve strength, functionality and movement and reduce tension, nerve irritation, inflammation, pain and swelling. Advice regarding use of the hand and wrist, rehabilitation exercises and stretching, wrist splint or taping for support. Treatment may include manipulation, deep soft tissue massage, trigger point therapy, muscle energy techniques, fascial techniques, dry needling, etc.
We are happy to advise you on your health matters and offer a free 15 minute joint and spinal check, without obligation.
Lin Bridgeford DO KFRP MICAK MICRA FSCCO MSc
Registered Osteopath & Kinesiologist & Yoga Teacher
Aether Bios Clinic
Saltdean
Tel: 01273 309557
Mob: 07710 227038
www.osteo-info.co.uk
www.biosyoga.co.uk
