What is Carpal Tunnel Syndrome (CTS)? It is something that most of us have heard of or even suffered with. Commonly found in people using computers and other repetitive actions like playing an instrument; CTS can prevent us carrying out even the most simplest of tasks because of the pain and stiffness this condition can cause in the hand, wrist and forearm.
Symptoms – CTS can affect both wrists but usually the in the more dominant hand. There is local pain at the wrist but also in the hand, forearm and elbow in the later stages of the condition. Movement of the wrist can be limited by pain, swelling due to pressure on the median nerve and hypertonicity (muscle tightness) of the forearm flexors through overuse. Pain can be experienced at night. Pins & needles, tingling and numbness can be experienced in the thumb and first two and half fingers with some sufferers experiencing weakness in the thumb and weakness in their grip.
What is the carpal tunnel? – The carpal tunnel is a fibrosseous canal formed by the carpal bones of the hand covered by a dense fibrous band attaching two carpal bones on the ulnar side of the wrist and two carpal bones on the radial side of the wrist. The structures that feed through the carpal tunnel are the median nerve and a number of muscle tendons and ligaments making it a tightly packed area of the wrist.
Compression of the median nerve generally occurs in two ways:
- The size of the carpal tunnel decreases – for example, rheumatoid arthritis can result in changes to the carpal bones leading to an increase in fluid in the tunnel.
- The contents of the carpal tunnel increases in size – thickening of the tendons, swelling.
It is not usual for both causes to occur at the same time.
Causes – CTS is thought to be caused by the compression of the median nerve in the wrist. It is related to highly repetitive flexion and extension actions of the wrist which can affect those working in repetitive action jobs. Other conditions can cause CTS such as diabetes, pregnancy, hypothyroidism (under active) and menopause but it is also thought to be genetically linked i.e. a parent or close relative can also suffer from the condition. The overuse of the arm flexors and extensors can cause swelling due to the thickening of the tendons in the wrist reducing the size of the carpal tunnel which is thought to be a common cause of the compression of the median nerve.
Prognosis – Medical intervention is necessary for the longer term treatment of carpal tunnel syndrome. Medical treatment may include splinting of the wrist with it being held in a neutral position at night to prevent the wrist being flexed. This prevents further compression of the carpal tunnel. Oral anti-inflammatories and even steroid injections are prescribed but these are not suitable for a long term treatment, only giving temporary relief from pain. Surgery can be done on more severe cases where the ligament/s are cut to take the pressure off the median nerve which has a good success rate. According to patient.co.uk, 1 in 4 cases eventually go away without treatment within a year for mild cases.
Can remedial massage help? – Massage therapy can help reducing local oedema (water retention), reduce hypertension (tightness) in the muscles of the forearm working on trigger points if found which can contribute to the pain of this condition. With the help of the therapist, massage can help bring the client’s awareness to the proper biomechanics of the wrist and arm. Causes of the condition should be taken into consideration as this will determine the treatment. Working on fascial restrictions can help with range of movement of the wrist and it is thought that massage works most effectively on CTS caused by overuse or repetitive activity.
What else can be done to help / prevent CTS? – It’s essential to learn correct posture when preforming activities that aggravate the condition. Computer workers need to keep their wrists in a neutral position so should have their work stations assessed to ensure they are sitting correctly and have a wrist support for their keyboard. Ideally arms should be supported by arm rests on a chair and a computer mouse should also be positioned so the wrist is kept in a neutral position. Whatever the task / job that is aggravating the condition, it would be essential to take regular rest periods throughout the day.
It would also be beneficial to ice the affected wrist/s frequently. Stretching of the forearm flexors often will keep the wrist movement freer. Likewise, stretching the forearm extensors is equally important. Once wrist movement has improved then the next step is strengthening exercises for the forearms once a day. Elastic bands can be useful to strengthen the thenar (heel of thumb) muscles by placing it around the thumb and fingers. This works using resistance by gently opening and closing the thumb and fingers.
If you have suffered with this condition and recovered from it, please do share your experience of what worked or didn’t work for you.
Source: http://Patient.co.uk, Clinical Massage Therapy, 2000, F. Rattray & L. Ludwig