Carpal Tunnel Syndrome

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is a common condition, affecting approximately 3% to 6% of adults in the general population it is also known as median nerve entrapment. Carpal tunnel syndrome occurs when the median nerve is compressed by a ligament that runs directly across the wrist, with nerves running under it. This leads to the entrapment of the median nerve. While the median nerve extends down the entire arm, the affected area is specifically at the wrist, just before it reaches the palm. (Sevy et al, 2023)

Why Does it Occur

The reason why carpal tunnel or median nerve entrapment occurs can be due to a range of potential factors that decrease the space between the ligament (flexor retinaculum)  and the structures underneath (muscles, tendons, and nerves) then the ligament begins to press on other structures like the median nerve which leads to pain felt at the fingers, wrist, and forearm. These risk factors include: inflammation of structures that pass under the flexor retinaculum (carpal tunnel ligament) which can be caused by:   repetitive hand movements, history of wrist injuries, obesity, arthritis (Rheumatoid arthritis), Hormonal changes like menopause, pregnancy or diabetes and age.  (Sevy et al, 2023)

Signs and Symptoms

Some signs and symptoms include numbness and tingling in the thumb index and middle finger on the palmar aspect of the hand, weakness and pain gripping objects, pain worse at night in the wrist and hand that can prevent sleep and swelling in the fingers.

Treatment options

Some of the different treatment options for carpal tunnel/Median nerve entrapment include:

Ice therapy can be used to reduce the inflammation that is pressing on the median nerve. The ice helps constrict the (flexor retinaculum ligament) to give the median nerve more space and less compression therefore decreasing pain. (Laymon et al, 2015)

Surgery: In the surgery, they will cut the flexor retinaculum which forms the roof of the carpal tunnel which prevents the nerve from being compressed or entrapped. (National Library of Medicine, 2024)

Wrist splints: Wrist splinting and immobilising the hand and wrist can provide support and allow the body to time to recover. Night splinting is a useful strategy to decrease pain.  This can help decrease the irritation/ inflammation of the structures that pass through the carpal tunnel.

(Karjalainen et al, 2023)

Exercise therapy: Forms of exercises that can be implemented in the rehab of carpal tunnel to decrease pain and improve function. Exercise can also be used as a tool to measure progress. Some of the exercises are stretching in the forearm flexors and nerve glides.

Ergonomic changes:  Ergonomic changes in everyday tasks or at work can improve symptoms and limit reaggravation which will help the condition improve and recover at a faster rate. Some ergonomic changes include: using tools to pick things up limiting gripping motions, using an open-handed grip to pick things up, using both hands rather than one hand, Lifting lighter loads, altering bottle feeding positions, and many more. By implementing these strategies this can improve quality of life and speed up the recovery process. (Conor et al, 2012)

Steroid injections: Corticosteroid injections are used to provide temporary relief however they have not shown promising long-term effects. The steroid injection is a more effective way to be administered than oral steroid tablets. (National Library of Medicine, 2024)

When to go for surgery

As osteopaths, we recommend initially adopting a conservative treatment approach. However, if the condition persists and the pain becomes severe or significantly impacts daily activities, surgical intervention may be necessary for optimal patient outcomes.

How can osteopathy help?

As an osteopath we can help with a conservative approach to the management of the condition through the use of a range of techniques and approaches these include:  soft tissue massage, ergonomic changes within your daily activities to help take the pressure and reduce inflammation on that area, Dry needling, joint mobilization, nerve glides, and joint manipulation. These techniques aim to decrease your pain, increase function, and get you back to normal function as fast as possible. 

References:

Institute for Quality and Efficiency in Health Care (IQWiG). (2024). Carpal tunnel syndrome: Learn more – How effective are steroids? In InformedHealth.org. https://www.ncbi.nlm.nih.gov/books/NBK279598/

Karjalainen, T. V., Lusa, V., Page, M. J., O’Connor, D., Massy-Westropp, N., & Peters, S. E. (2023). Splinting for carpal tunnel syndrome. Cochrane Database of Systematic Reviews, 2023(2), Article CD010003. https://doi.org/10.1002/14651858.CD010003.pub2

Laymon, M., Petrofsky, J., McKivigan, J., Lee, H., & Yim, J. (2015). Effect of heat, cold, and pressure on the transverse carpal ligament and median nerve: A pilot study. Medical Science Monitor, 21, 446–451. https://doi.org/10.12659/MSM.892462

O’Connor, D., Page, M. J., Marshall, S. C., & Massy-Westropp, N. (2012). Ergonomic positioning or equipment for treating carpal tunnel syndrome. Cochrane Database of Systematic Reviews, 2012(1), Article CD009600. https://doi.org/10.1002/14651858.CD009600

Sevy, J. O., Sina, R. E., & Varacallo, M. A. (2023). Carpal tunnel syndrome. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK448179/