What is Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist. The carpal tunnel—a narrow, rigid passageway of ligament and bones at the base of the hand—houses the median nerve and the tendons that bend the fingers.

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Most patients experience numbness in the middle of the day rather than at night or in the morning.

Most patients experience numbness at nighttime or in the morning, as the tendons swell overnight. After they wake up and move their fingers, the fluid moves out of the tendons and the numbness usually goes away.

In more severe cases, pain can radiate up to the shoulder.

As carpal tunnel syndrome symptoms worsen, patients experience numbness and pain in the daytime whenever the wrist is bent or extended. Pain is felt in the palm of the hand and the forearm, with occasional radiation up to the shoulder.

Hyperthyroidism is a risk factor for carpal tunnel syndrome.

People whose jobs involve heavy gripping or vibrating tools often develop carpal tunnel syndrome. Other risk factors include hypothyroidism and inflammation of the tendons from rheumatoid arthritis. Many pregnant women develop carpal tunnel syndrome as a consequence of the swelling that they have through pregnancy.

The typical treatment for carpal tunnel syndrome includes splinting during the night.

The typical treatment for carpal tunnel syndrome includes splinting during the night. These are hard splints that help to immobilize the wrist and decrease the pressure that is being applied to the wrist.

If the condition progresses and becomes more severe, you may need surgery.

Other carpal tunnel syndrome treatment methods include anti-inflammatories, cortisone injections into your carpal canal and physiotherapy. If the condition progresses and becomes more severe, you may need surgery.
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Gordon Bohlmann, BSc.PT, IMS, Physiotherapist, discusses what is a triangular fibrocartilage complex injury of the wrist (TFCC)

Dr. Herb VonSchroeder, MD, FRCSC, Orthopaedic Surgeon, talks about carpal tunnel syndrome and the various treatment options available to patients

Dr. Bert Perey, MD, FRCPC, Orthopedic Surgeon, discusses carpal tunnel syndrome symptoms and treatment including physiotherapy, bracing and surgical options.

What is Carpal Tunnel Syndrome and How is it Treated?

Carpal tunnel syndrome really is a condition of a nerve. It’s a neuropathy, which means that the nerve is not functioning as well as it should. It pertains to the median nerve, which is one of the nerves that run down the arm from the neck to the hand.

So the carpal tunnel is located in the wrist right about this region between the thumb side and the small finger side of the hand and it’s made up of the carpal bones in the wrist – there’s seven of them – and a tunnel is created by some soft tissue, which runs across the top through the tunnel.

We have some of the flexor tendons of the forearm that will move the fingers and the median nerve. And when that median nerve gets pushed on we get the signs and the symptoms of carpal tunnel syndrome.

Typically, if you have carpal tunnel syndrome you’d be feeling the pain on the thumb side of the hand and the first three-and-a-half fingers, and this is also where you would get the tingling and the numbness and the thumb muscles are where they would get really weak and eventually you would get wasting of the thumb muscles where they got smaller and atrophied.

So if you think that you have symptoms of carpal tunnel syndrome it’s important for you to be assessed right away by your doctor or your physiotherapist. Your physiotherapist will do some special tests such as a balance test or the tunnel tap sign to determine whether or not you have Carpal Tunnel Syndrome.

Once that’s been determined the physiotherapist will address the treatment specifically at the nerve to find ways of decompressing the nerve, and we have various ways of doing that.

They’re all conservative and non-surgical. And they’ll be various different plans based on the various patient types that we see. We may address your neck and shoulder as well, but the important thing is to be assessed. Local Physiotherapists

And so if you think you have any of these signs and symptoms or you’re worried or you have questions about it see your local physiotherapist today.

Presenter: Gordon Bohlmann, Physiotherapist, Vancouver, BC

Local Practitioners: Physiotherapist

Understanding carpal tunnel syndrome

Carpal Tunnel Syndrome is a common condition that causes pain, numbness and tingling in the hand. The condition occurs when one of the major nerves to the hand, the median nerve, is squeezed or compressed as it travels through the wrist.

The median nerve travels through a narrow tunnel within the wrist, called the Carpal Tunnel. The Carpal Tunnel is approximately 2 centimetres wide and 4 centimetres long. The Carpal Tunnel is formed by the wrist bones on one side and by the transverse retinacular ligament on the other side.

Within the Carpal Tunnel are 9 flexor tendons to the digits. There are 2 flexor tendons to for every digit, except for the thumb where there is only one. Flexor tendons are structures that cause the fingers to bend.

Carpal Tunnel Syndrome occurs when the median nerve, travelling through the Carpal tunnel gets compressed. This compression is usually the result of swelling to the flexor tendons.

Most cases of Carpal Tunnel Syndrome are caused by a combination of factors.

The most common and important factor is likely hereditary. The Carpal Tunnel may be smaller in some people and there may be anatomic differences that change the amount of space for the nerve. These traits can run in families. Heavy, repetitive use of the hand can lead to swelling of the flexor tendons. This repetitive activity usually needs to be prolonged.

Light repetitive use of the fingers is not likely a cause of Carpal Tunnel Syndrome. Heavy gripping of objects, especially when vibration is incurred, can lead to swelling in the flexor tendons.

Doing activities that involve extreme flexion or extension for prolonged periods of time, can also increase pressure on the nerve. Systemic hormonal changes, such as those that occur during pregnancy, can also cause swelling and lead to Carpal Tunnel Syndrome.

Health conditions such as diabetes, rheumatoid arthritis, or thyroid gland imbalance, are also conditions that are associated with Carpal Tunnel Syndrome. These health conditions, however, are rare causes of Carpal Tunnel Syndrome.

The most common symptoms are of Carpal Tunnel Syndrome are numbness and tingling, primarily in the thumb, index, long, and ring fingers. The small finger is rarely affected as the nerve carrying feeling to the small finger is not the median nerve. Feeling to the small finger is carried by the ulnar nerve, also known as the “funny bone”. If patients have numbness primarily in the small finger, then one must reconsider the diagnosis of Carpal Tunnel Syndrome.

Patients may also exhibit burning and pain in the median nerve distribution of the hand. That pain, or tingling, may travel up the forearm towards the shoulder. Weakness and clumsiness in the hand may make it difficult to perform fine movements, such as buttoning clothes. Dropping objects, as a result of this loss of sensation is a common symptom.

In most cases, symptoms of Carpal Tunnel Syndrome begin gradually.

There is rarely any specific injury to account for the onset of symptoms, although an acute injury can precipitate the problem. Night time symptoms are very common. The reason for this is that the flexor tendons swell spontaneously at night time, when the digits are not moved.

Resolution of the symptoms usually involves shaking of the hand, or moving of the digits. This causes the localized swelling to decrease and the numbness to resolve. Symptoms often occur when holding something for a prolonged period of time with the wrist bent forwards or backwards, such as when using a phone, driving, or reading a book. This can also occur during sleep when most people are unaware of the bent position of their wrist.

Presenter: Dr. Bertrand Perey, Orthopaedic Surgeon, New Westminster, BC

Local Practitioners: Orthopaedic Surgeon

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