Living with pain can affect your every day movements, and stop you from living your Barefoot Lifestyle. It’s important to understand your condition, to be able to treat and prevent further injury in the future. This blog post will look at Carpal Tunnel Syndrome.
We have teamed up with Sophie Halsall-McLennan from Fresh Start Physiotherapy to discuss the symptoms and treatment of CTS. Carpal Tunnel Syndrome (CTS) is a common condition that occurs when there is too much pressure on the median nerve in one or both wrists. It may include symptoms of; tingling, numbness and pain in the wrists, hands and fingers.
The term ‘carpal tunnel’ refers to a small corridor running to the wrist inside the forearm. It is comprised of the carpal bones at the top of the tunnel and the transverse carpal ligament on the underside of the tunnel. Tendons, blood vessels and the median nerve all occupy this small space and each structure contributes to the function of the hands and wrist (Figure 1).
The primary symptoms of CTS may include sensations of tingling, pain or numbness, and weakness, resulting in difficulty gripping objects and moving fingers. Pain, pins and needles and weakness is often concentrated in the thumb, index and middle finger and half of the ring finger as well as in the wrist itself. Symptoms are generally worse at night, and symptoms tend to be stronger on your dominant hand side.
Generally, anything that reduces the space in the carpal tunnel, or increases the volume in the tunnel or irritates the median nerve can result in carpal tunnel syndrome. Most commonly, inflammation from an underlying condition can lead to increased swelling in the wrist and sometimes reduced blood flow. Some of the causes include:
- Wrist fracture – sometimes either the long bones in the forearm or the small carpal bones in the wrist can change in alignment in the presence of a fracture. The bone itself can squash the structures in the carpal tunnel including the median nerve, thus resulting in CTS. This onset of symptoms is primarily acute in nature.
- Rheumatoid arthritis in the wrist – this particular type of arthritis can alter the bony structure of the wrist and in the presence of inflammation, the carpal tunnel can often reduce in size. The onset symptoms of CTS generally slow.
- Pregnancy – onset typically occurs in the second and third trimester, the increase of blood volume (up to 50%) and fluid retained in the body can compress the structures in the tunnel. The symptoms generally resolve a few weeks after the birth of the baby.
- Flexor Tenosynovitis or flexor tendinitis – these two conditions relate to inflammation of the tendon within the tendon sheath, or inflammation of the tendon and the sheath itself. These structures are often flared by repetitive wrist movements or sustained wrist bend and even increased exertional activities by the wrist.
- Repetitive bending or sustained bending of the wrist – again there are many activities and professions that require repetition or sustained bend of the wrist. For example; admin clerks, factory workers, cleaners, rigger and scaffolders etc. The onset of symptoms generally occurs over time.
Some treatment modalities may include a wrist splint. Positioning the wrist in a splint will enable the wrist to rest, thereby reducing the swelling in the tunnel. A splint will maintain the wrist in the best position to minimise the pressure within the tunnel. Your Hand Physiotherapist may also use manual treatments to reduce inflammation and swelling, improve movements in the hand and wrist and to maintain the strength of the hand and wrist.
Other modalities that you may try with the guidance of your treating Physiotherapist include: icing the hand and wrist, elevating the hand and wrist and gently exercising to try to restore some flexibility and strength may also be incorporated in the management for Carpal Tunnel Syndrome. If these methods are not effective, other options will be suggested. To book an appointment with one of our Barefoot Physiotherapists, click here.
More About The Author: Sophie Halsall-McLennan is Physiotherapist from Australia who specialises in running clinical pilates in the Geelong region and is the owner of Fresh Start Physiotherapy. She has a Bachelor of Physiotherapy from Charles Sturt Physiotherapy, and over 12 years of clinical experience as a Physiotherapist and is registered with AHPRA. She is also a Lecturer at Deakin University.
We understand that when you are in pain, it can be extremely hard to function and enjoy life on a daily basis. At Barefoot Physiotherapy, our treatment plan is focused on helping you to do what you want with your body!
We use a thorough whole body assessment to work out the underlying cause of the condition. We can then treat it, teach you to treat it and together take care of your body long term – getting you back to doing what you love sooner.
At Barefoot we use a systematic testing process to assess your whole body, this assessment includes testing your:
- muscles (including tendons)
- joints (ligaments, discs, bones, cartilage) and
In the vast majority of sports and musculoskeletal conditions, this process leads to a rapid and full recovery. During this initial phase, you can trust that you are either going to get rapidly fixed, or a ‘Plan B’ is required.
In a small percentage of conditions, this process quickly identifies that a referral for a different management of the condition is most appropriate, i.e. ‘Plan B’ where we help you find the right path (whether that be imaging, acupuncture, medical etc.) – this is because we don’t continue treating without results.
For the majority of cases (not a Plan B case) treatment then focusses on the underlying cause to reduce its impact on the rest of your body.
We chart your progress including how long and how many sessions will be required to achieve pain free, full function. Below is an example recovery graph.
Importantly – this involves teaching you how to look after your condition to minimise recurrence. Click here for muscle retraining.
Once you are back doing what you want with your body, looking after your condition is the mainstay of treatment. We call this the ‘maintenance phase’ where your Barefoot Physiotherapist checks in on you at increasing intervals (up to 3 months).
There are three main reasons for these sessions:
1. To test and confirm your good self-management
2. Progressing your skills for achieving better performance
3. To treat any re-accumulation of strain that occurred in between sessions as a result of life’s challenges
We know that for each of our clients, their day to day life can be a mix of different activities. To make sure that you are able to keep doing what you love, we offer home, work and gym setups.
This allows you to:
- Optimise motor control and postures
- Improve progression from injured to non-injured state
- Minimise avoidable strain placed on the body (and therefore decrease the frequency of maintenance sessions in the clinic).
Whether you love hiking, walking, rock climbing or just want to be pain free, we want to help you get back to doing what you love. Want to find out more? Click the link here.