Carpel Tunnel Syndrome (CTS)
Carpal tunnel syndrome (CTS) is a relatively common complaint in individuals that perform constant and repetitive motions of the hand and wrist. This applies to individuals sitting prolonged periods in front of their computers; my “industrial athletes“. Also, any athlete playing a sport requiring them to repeatedly grasp something while the wrist joint is twisting and turning, are at a high risk of developing the complaint.
Sports that have a high incidence of CTS sufferers include most racquet sports, handball, swimming, body building, rowing, golf, archery, and rock climbing. However, any sport that involves prolonged use of the wrist and hand can unfortunately cause the condition.
What is CTS?
Carpal tunnel syndrome is a compression neuropathy in which the median nerve becomes entrapped in the region of the wrist. This entrapment means the thumb and the first three fingers, as well as the majority of the palm may become numb. The median nerve also supplies limited movement to the thumb through the “Thenar” muscles (the muscle pad at the base of the thumb) and so the condition normally causes partial paralysis of the thumb.
Anatomy of CTS
As already mentioned, carpal tunnel syndrome is caused by the entrapment and compression of the median nerve. This nerve runs from the forearm to the hand where it branches to supply innervations to the thumb and the first two fingers.
As it traverses the wrist area the nerve passes through the carpal tunnel, which is composed of the carpel bones and the transverse carpal ligament. The carpal bones make up the base and sides of the tunnel so that a semicircular shape or valley is formed. Stretched across this, much like a bridge that crosses the valley is the tough transverse ligament. The median nerve, along with nine tendons that give the thumb and fingers movement, pass through the tunnel and into the hand. The carpal tunnel is a rigid structure and the inner space is fixed and very confined.
Causes of CTS
Carpal tunnel syndrome is ultimately an inflammatory disease and so any job, sport, or pastime repetitive in its actions can cause either the muscles or the tendons crossing the wrist to become irritated and inflamed.
In addition to the median nerve, a set of nine tendons run through the carpal tunnel. When the protective linings, or synovial sheaths, of these tendons become swollen and inflamed this puts excessive pressure on the tendons and median nerve. This occurs because of the limited amount of space within the tunnel. Other causes of increased pressure occur when the tough transverse carpal ligament becomes swollen or when a bone fracture or break causes edema or the build up of fluids.
When the median nerve becomes compressed because of excess pressure in the carpal tunnel, the nerve signals normally transmitted through the nerve become slowed, which ultimately results in abnormal sensations in the affected hand i.e. numbness, pins and needles or a tingling, burning feeling.
Symptoms of CTS
The majority of the symptoms felt by sufferers of carpal tunnel syndrome are ultimately due to the entrapment of the median nerve. Common symptoms include:
• Weakness in the affected hand which affects grip. Many sufferers find that picking up a bag or opening a door becomes difficult because they can no longer grip with enough force.
• A feeling of numbness in the thumb, fingers (not the little finger) and the thumb-side of the palm. Alternatively some individuals may have a tingling sensation instead.
• Impaired coordination of the thumb and forefingers so that fine movements become difficult.
• Pain in the wrist and hand that can stretch up as far as the elbow. The pain that is associated with carpal tunnel syndrome is not actually caused by the nerve compression; rather it is caused by inflammation or by a bone fracture which in turn causes the nerve compression. Most cases of CTS cause absolutely no damage to the nerve itself and so when the pressure is relieved the symptoms abate.
• Tinel’s sign – this is a diagnostic test which involves tapping the carpal tunnel area lightly to see if a sharp pain is felt. If pain is felt then a diagnosis of CTS is generally given.
It is important for athletes to warm up the wrist area before they engage in any serious training so that the risk of developing carpal tunnel syndrome is reduced.
Isometric strength exercises (these are exercises where the muscles are contracted but they do not lengthen) not only warm the wrists and nearby areas up, but they also strengthen the muscles and improve blood flow. Below are a few exercises that will help to strengthen the wrist and reduce irritation.
1. Make a fist with the right hand, palm face up. Using the left hand gently push down on the fisted hand while keeping the right wrist straight.
2. Turn the fisted hand over and again push down gently on the knuckles. Remember to keep the wrist straight.
3. Turn the fisted hand so that the thumb is pointing up and repeat the exercise.
4. Next hold the first two fingers up (like the “peace” sign but with the fingers closed). Draw 5 clockwise circles and then 5 anti-clockwise circles in the air.
These simple exercises should be practiced each day, especially if one of the sports mentioned above are regularly performed. One should avoid extreme flexion as this action doubles the pressure applied to the median nerve. Extreme extension virtually triples it. Only perform warm up and strength exercises as far as feels comfortable; pushing things too far can result in the very condition you’re trying to prevent.
Because it is often inflammation of the tendon sheaths that cause carpal tunnel syndrome, flexibility exercises that reduce pressure on the tendons should also be practiced. A number of the sports mentioned in the introduction cause the muscles of the forearms to tighten, in turn causing pressure on the tendons. Thus, stretching exercises to reduce tension in the forearms will help to prevent carpal tunnel syndrome.
Interlock your fingers in front of your chest and then straighten your arms and turn the palms of your hands outwards.
Place one arm straight out in front, parallel to the ground. Rotate your wrist down and outward. Use your other hand to further rotate your hand upwards.
Another form of prevention is by using a wrist brace which helps to stabilize the wrist and stop possible overextension and flexion.
CTS is a soft tissue injury of the muscles and tendons around the wrist joint and therefore should be treated like any other soft tissue injury. Immediately following an injury, or at the onset of pain, the R.I.C.E.R. regime should be employed. This involves Rest, Ice, Compression, Elevation, and Referral to an appropriate professional for an accurate diagnosis.
It is critical that the R.I.C.E.R. regime be implemented for at least the first 48 to 72 hours. Doing this will give you the best possible chance of a complete and full recovery.
As part of the R.I.C.E.R. regime a night splint that provides support to the wrist and keeps it in a straight line (i.e. the position that applies least pressure to the median nerve) may be useful. Consult with the clinic Chiropractors prior to purchasing any supplemental material to ensure it is necessary. If the symptoms persist, it may be worth while splinting the wrist during the day so there is a lower chance of further aggravating the injury.
The next phase of treatment (after the first 48 to 72 hours) involves a number of mulitimodal chiropractic and sports therapy techniques. The application of ultrasound, TENS, heat, massage, and elbow and wrist adjustments is one of the most effective treatments for speeding up the healing process of the muscles and tendons.
Once most of the pain has been reduced, it is time to move onto the rehabilitation phase of your treatment. The main aim of this phase is to regain the strength, power, endurance and flexibility of the muscles and tendons that have been injured.
Supplements are also commonly prescribed in cases where the pain in the wrist and hand is quite severe. Nature’s Relief is a natural anti-inflammatory supplement often prescribed to combat the effects of carpal tunnel syndrome. It works by reducing the pain and also acting on the underlying cause of the condition, the inflammation.
Enjoy your day,
Dr. Crysta Serné
Chiropractor and owner of Vitality Clinic