We can hear very often of this hand affectation with which a large percentage of the population is affected by. However, what exactly does it consist of?
- WHAT IS THE CARPAL TUNNEL SYNDROME?
The carpal tunnel Syndrome consist on a compression of the median nerve at the level of the wrist. Concretely, between the carpus transverse ligament and the carpus bones, which is known as carpal tunnel.
This situation affects the transmission of information function of the nerve, both in feeling and strength.
In order to understand it better, just imagine a water hose in which the tap has been opened and the water is flowing (our sensitive and motor information). At this moment, someone step on the hose reducing the amount of water that comes out. In other words, that sensitive and motor information mentioned before has been modified.
In light of that situation, the nerve itself begins to irritate. This fact produces a local inflammation that cause a higher level of symptomatology, at the same time, it affects other structures such as muscles, vessels and tendons.
- WHAT SYMPTONS AND SIGNS ARISES?
Usually, it causes pain and tingling (paresthesia) on the ventral side of the hand at the level of the thumb, forefinger, middle and ring finger, although it can also reach the elbow.
- It is also common that things can split from your hands because of the affectation of sensitivity and strength.The pain is accentuated at night, and while performing gestures such as handling daily objects such as glasses, books, bags, etc. Which become very difficult or even impossible activities for the person who suffers that.In addition, this continuous compression can lead to a muscular atrophy of the area.
- WHICH IS THE DIFICULTY IN ORDER TO DIAGNOSIS
One of the main issues is related with the phrase “not everything that shines is gold”. In other words, a great number of pathologies or compressions can end up with those symptoms and not necessarily because of the Tunnel Carpal Syndrome.
Just you can bear in mind, the median nerve proceed from the cervical level (levels C5-D1) and passes through different points or gorges that may compress or irritate it that can lead the symptomatology mentioned.
Among the different places that may appear, we can highlight
- Cervical level (vertebral dysfunction, hernias, osteoarthritis),
- Level of the interscalenic gorge (between anterior and middle scalene muscles).
- Level of acromioclavicular articulation
- Level of the pectoralis minor gorge.
- Level of the wrist flexors
- Pronator level round
- Carpal Tunnel Level
- And an endless number of possible causes.
In addition, as we mentioned in our previous posts, the appearance of the
myofascial trigger points which can cause similar discomfort in this area at neck, arm, forearm, or hand muscles level.
Here you can see one example among all that can be given (myofascial trigger points of the Brachioradialis muscle):
- WHO ARE THE ONES AFFECTED?
It usually arises on those that work in those jobs that involve repetitive gestures such as type on computers, play instruments, do sports, carry heavy weight and so on. Underlining nurses, health care workers, homemakers, computer technician, etc.
It tends to affect to a greater extent those within an age range of 30-60 years old and women.
- IN CASE I’VE BEEN DIAGNOSIED THE CARPAL TUNNEL SYNDROME, WHAT SHOULD I DO?
Recent studies show the efficacy of manual techniques at a level of different compression points in the median nerve pathway regarding the improvement of functionality and pain in patients with short and medium term carpal tunnel. It is compared with carpal surgery techniques.
In the long-term, the efficacy reached regarding the surgery is equalized. As a consequence, a traditional physiotherapist treatment will recover the hand’s condition in a lower frame of time.
- WHAT EXERCISE CAN BE PERFORMED?
Due to the irritation and the lack of mobility of the medium nerve in its pathway, one of the exercises most used in physiotherapy for this type of affectation is the Neurodynamic. There are currently studies that support its use in affectations such as carpal tunnel syndrome.
What does it consist of? In performing a series of mobilizations or tensions maintained at the nerve level (in this case the Median) to favour its correct slip and function. By this way, be able to diminish the symptomatology of the patient.
How to do so? Here you can find a link in order to see how to correctly perform the mobilisation of the median nerve.
As always, go to a physiotherapist in order to obtain advices regarding those exercises in a customized way and adequate to your condition
Fernández de las Peñas C, Ortega Santiago R, De la Llave Rincón AI, Martínez Perez A, Fahandezh Saddi Díaz H, Martínez Martín J, Pareja JA, Cuadrado Pérez ML. Manual physical therapy versus surgery for carpal tunnel syndrome: a randomized parallel-group trial. Journal of Pain 2015; 16 (11): 1087-1094
Fernández de las Peñas C, Cleland JA, Salom Moreno J, Palacios Ceña M, Martínez Perez A, Pareja JA, Ortega Santiago R. Prediction of outcome in women with carpal tunnel syndrome who receive manual physical therapy interventions: A validation study. Journal of Orthopedics and Sports Physical Therapy 2016
S. Jiménez del Barrio, E. Bueno Gracia, C. Hidalgo García, E. Estébanez de Miguel, J.M. Tricás Moreno, S. Rodríguez Marco, L. Ceballos Laita Conservative treatment in patients with mild to moderate carpal tunnel syndrome: A systematic review. Neurologia 2016; Jul 22.
Pablo Rodríguez Sánchez-Laulhé
Physiotherapist and Health Researcher