Carpal Tunnel Syndrome
Carpal tunnel syndrome is a grouping of symptoms that comes from compression of the median nerve within the carpal tunnel (the wrist). This compression causes sensation changes or motor deficits in the distribution of the median nerve in the wrist and hand. Risk factors for developing carpal tunnel include prolonged periods of wrist bending, repetitive wrist motions, exposure to prolonged vibration and cold. Carpal tunnel more often is seen in the dominant hand. Other risk factors include diabetes, hypothyroidism, rheumatoid arthritis, and kidney disease. A history of injury to the wrist can also be a contributing factor.
Individuals with carpal tunnel often feel numbness and tingling in the first 3 and a half fingers. This numbness is often more present over night and in the morning. Pain is typically felt over the carpal tunnel itself at the wrist, although it can go up to the elbow. The pain and numbness are often exacerbated with gripping activities and can be made better by shaking the hands out. Individuals often start feeling clumsy in that hand and drop things.
Conservative treatment has been shown to be very effective for carpal tunnel. Manual release of muscles of the wrist and forearm is done to enhance mobility of the tissues and take pressure off of the nerve. Manipulation of restricted joints improves biomechanics and function of the wrist, arm and neck. Rehabilitation exercises consist of working on proper stability through the arm to address underlying dysfunctions as well as improve nerve glide/mobility. Individuals with carpal tunnel should also avoid positions and activities that put their wrist in a bent and loaded position for prolonged periods of time.
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Papanicolaou GD, McCabe SJ, Firrell J. The prevalence and characteristics of nerve compression symptoms in the general population. The Journal of hand surgery. 2001 May 1;26(3):460-6.
National Institute of Neurological Disorders and Stroke, Carpal Tunnel Fact Sheet updated March 1, 2013
Hegmann KT, Merryweather A, Thiese MS, Kendall R, Garg A, Kapellusch J, Foster J, Drury D, Wood EM, Melhorn JM. Median Nerve Symptoms, Signs, and Electrodiagnostic Abnormalities Among Working Adults. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2018 Aug 15;26(16):576-84.
Burke J, Buchberger DJ, Carey-Loghmani MT, Dougherty PE, Greco DS, Dishman JD. A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. Journal of manipulative and physiological therapeutics. 2007 Jan 1;30(1):50-61.
Shi Q, Bobos P, Lalone EA, Warren L, MacDermid JC. Comparison of the short-term and long-term effects of surgery and nonsurgical intervention in treating carpal tunnel syndrome: A systematic review and meta-analysis. Hand. 2018 Jul 1:1558944718787892