"I have carpal tunnel syndrome . "  

This is a common phrase heard in physiotherapy clinics around Australia . But what is Carpal Tunnel Syndrome? Why do you have it? And what can you do about it ? 

The carpal tunnel is the name of a region on the front of your wrist. Passing through it are nine tendons which help to move your fingers and thumb , and an important nerve called the Median Nerve.  Most of the time the tendons and nerve live happily next to each other and get along well. But sometimes they become annoyed , usually because something is squashing in on them .

Typical Symptoms:
- Tingling (pins and needles
- Numbness
- Pain
- Clumsiness
- Weakness

This may be because you are putting your hand in postures or positions that cause the carpal tunnel to become narrower.  For example, if you sleep tucked up with your hands curled forwards, you may wake with tingling (pins and needles) or numbness in your hands.  Or, if you have sustained pressure on the front of your wrists while working on a computer, you may notice these symptoms towards the end of a working day.

Sometimes the pressure is increased in the carpal tunnel because of repetitive or prolonged gripping activities , such as driving or carrying shopping bags . This can be due to some small muscles within the hand being pulled into the carpal tunnel, placing pressure on the nerve. 

There are other possible causes of carpal tunnel syndrome, including inflammation and arthritis around the wrist region.  In some cases, the cause may never be identified.  And in other cases, there might even be a problem further up the nerve (perhaps at the elbow, shoulder, or neck) which is giving you symptoms that mimic carpal tunnel syndrome.  A thorough assessment by your doctor or physiotherapist should help determine what is going on.

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What can I do about it? 
Firstly, find a local expert in wrist and hand problems, like the team at Flex Physiotherapy.  You should be examined thoroughly from your neck to your fingertips. As we mentioned, there are many other possible reasons you might have pins and needles or numbness in your hand. We have a much better chance of helping your symptoms if we can first identify the underlying cause! If your physio or doctor has not already examined the rest of your arm above the wrist, ask them about it. 
In most cases of carpal tunnel syndrome, the nerve is simply annoyed and irritated. There is no actual damage to the nerve, and it will tend to settle down once you modify the factors which are irritating it.  Your actual treatment will depend on your individual situation, but might include the use of a wrist splint, doing some exercises, and modifying some aggravating activities.  In cases that are more severe, or which fail to improve, a cortisone injection or surgery might be considered.

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The American Academy of Orthopedic Surgeons currently advises there is strong evidence for the use of immobilisation devices such as thermoplastic splints in the treatment of carpal tunnel syndrome. 
At Flex Physiotherapy we make custom-fitted thermoplastic splints. These splints are light-weight and completely waterproof, and are highly adjustable.  Your fingers and thumb are completely free, allowing you to get back doing what you love without the inconvenience of pain or tingling. 
One of the most effective methods of reducing your symptoms is to change how you do things. Your physiotherapist should be able to provide you with advice on sleeping positions, alternative methods of gripping and lifting objects, or strategies to use while you are at work.

Exercises for carpal tunnel syndrome  
Two useful exercise strategies should be tried if you have carpal tunnel syndrome - some nerve gliding exercises to help desensitise the irritated Median Nerve, and some general strengthening of the muscles around your shoulder and elbow.  
Getting strong is a great long-term option.  The stronger your arm is, the more you can spread the load evenly throughout your entire arm, rather than overloading your wrists.  
For women who are pregnant or have just had a child, doing weights is usually safe (in fact, it is recommended!), but be sure to consult a health professional before you get started. 
Nerve gliding exercises can be performed several times a day, in sets of 5-10 movements, as long as there are no signs of increasing nerve irritation (more pins and needles or numbness).  Exercises for strengthening should not be performed more than once a day, and an occasional rest day is fine.

Median Nerve Gliding Exercise

  • Bend your elbow and wrist as you turn your neck to the opposite side
  • Straighten your elbow, turn your palm up and bend your wrist backwards as you look at  your hand
  •  Move to the point where you just feel a small increase inyoursymptomsor a mild stretch, then back away immediately

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How long will it take to recover ?

As with any condition, there is a huge range in terms of severity and response to treatment.  We find that most patients notice significant improvement in their symptoms within 6-8 weeks of starting their splinting and exercise program.  Some will report their symptoms have disappeared completely after just a few nights of splint use, while others have no benefit at all from physiotherapy, and may require a cortisone injection or surgery. 

Once again, the most important step for you to take is to find a good physiotherapist, who has the expertise to examine your upper limb from neck to fingertip, and who can guide you through the available treatment options.

American Academy of Orthopaedic Surgeons Carpal Tunnel Syndrome Guidelines (2016)

Intervention Strength of recommendation Recommend/Don't Recommend
Immobilisation Strong**** Recommend
Steroid Injection Strong**** Recommend
Magnet therapy Strong**** Not Recommended
Oral medication Moderate*** Not Recommended
Therapeutic ultrasound  Limited** Unable to make recommendation