ROSIE is an osteopath with Swansea Body Kinetics at the Natural Health Service in Page Street, Swansea. This month Rosie offers advice on the subject of Carpal Tunnel Syndrome
Carpal tunnel syndrome or median nerve entrapment is the most commonly experienced neuropathy (trapped nerve) with up to 11% of us experiencing it at any one time1,2 . Carpal tunnel syndrome can lead to time spent off work and therefore can result in lost wages and a great deal of frustration. The symptoms of carpal tunnel are often worse at night and so can be particularly disruptive.
What is the carpal tunnel?
The carpal tunnel is a canal leading from the wrist in to the hand, it contains nine tendons and a nerve – the median nerve. Inflammation and swelling in the carpal tunnel can lead to compression of the median nerve, and this leads to pain and changes in sensation (pins and needles, tingling, numbness, burning) in the middle finger, index finger and half of the ring finger (these are the fingers supplied by the median nerve)3. However, it is worth remembering that symptoms like those just mentioned can have a variety of causes including compression of a nerve or nerves somewhere higher up the arm or even in the neck!
What causes carpal tunnel?
No one is 100% sure what causes carpal tunnel syndrome specifically, but it has been linked with previous trauma to the wrist including previous fractures and arthritis. Mechanical factors such as repetitive hand movements, vibration and strong gripping are also known to be provocative as they may cause irritation and scarring that leads to inflammation in the carpal tunnel4. In addition certain health conditions such as diabetes, having an underactive thyroid and obesity have all been linked and carpal tunnel syndrome appears to be particularly common in post menopausal women5.
What are the treatment options for carpal tunnel?
Current treatment options include manual therapy (such as osteopathy), corticosteroid injections into the carpal tunnel, ultrasound, using a splint to keep the wrist in neutral, and – in unrelenting cases – surgery. A recent study into the effectiveness of physical therapy and surgery found that both methods had the same results in the end, but that the symptoms eased sooner with manual therapy6 .
In my practice I find that many of the people who come in talking about pain in the hands and arms have more than one thing going on- there may be some compression of the nerve or nerves higher up in the body – perhaps through the muscles of the arm or in the shoulder or neck as this can give symptoms very similar to carpal tunnel syndrome. For example, there is a muscle called pronator teres in the forearm; this muscle has two heads and if it is too tight it can squeeze the median nerve! I find that people who work with computers and phones often have postural adaptations that have predisposed them to neck and arm problems and that the use of a mouse can encourage strong gripping and irritation to the hand and wrist.
Thankfully postural education and good movement can lead to improvements and doing something as simple as investing in a keyboard wrist rest may help. Structures that are putting pressure on the median nerve can be released using techniques to loosen muscles that are too tight and to increase blood supply and therefore promote healing to the nerve itself. Neural flossing exercises are targeted towards promoting neural health and I find these often have good results. Finally, I work in conjunction with a yoga therapist in order to promote moving in a way conducive to the health of your joints and the nerves.
For further information or to book an appointment call Rosie on 07540 453280 or visit www.swanseabodykinetics.co.uk
- Thiese MS, Gerr F, Hegmann KT, Harris-Adamson C, Dale AM, Evanoff B, Eisen EA, Kapellusch J, Garg A, Burt S, Bao S, Silverstein B, Merlino L, Rempel D. (2014) Effects of varying case definition on carpal tunnel syndrome prevalence estimates in a pooled cohort. Arch Phys Med Rehabil 95: 2320-2326
- Ibrahim, I., Khan, W.S., Goddard, N., Smitham, P. (2012) Carpal tunnel syndrome: a review of the recent literature. Open. Orthop. J. 6, 69e76.
- Pratelli E, Pintucci M, Cultrera P, Baldini E, Stecco A, Petrocelli A, Pasquetti P. (2014) Conservative treatment of carpal tunnel syndrome: Comparison between laser therapy and fascial manipulation. Journal of Bodywork and Movement Therapies 19(1) 113-118
- Raja S, Carlos A. (2015) Carpal tunnel syndrome – current controversies. Orthopaedics and trauma 29 (4) 273-277
- Fan Z, Harris-Adamson C, Gerr F (2015) Associations between workplace factors and carpal tunnel syndrome: a multi-site cross sectional study. Am J Ind Med 58 509-518
- Fernandez-de-las Penas C, Ortega-Santiago R, de la Llave-Rincon A, Martınez-Perez A, Fahandezh-Saddi Dıaz H, Martınez-Martın J, Pareja J, Cuadrado-Perez M. (2015) Manual Physical Therapy Versus Surgery for Carpal Tunnel Syndrome: A Randomized Parallel-Group Trial. The Journal of Pain 16 (11) 1087-1094