Carpal Tunnel Syndrome (CTS) has an occurrence in the general population of up to 7% and is becoming ever more prevalent. With over 35,000 surgeries performed for CTS in the UK each year it is costing its sufferers discomfort but also time and money. Not only that but it is putting the health service under pressure so much so that there are initiatives to introduce Nurse led surgery for CTS underway in the UK. I think this expansion of skill across the health service is fantastic and more of it please, but I cannot help but think that in some cases there may be a more conservative approach to help in less extreme cases or indeed in preventing CTS from getting to a stage where surgery is the only option that remains.
The Carpal Tunnel is the passageway between the small carpal bones in your hand and the transverse carpal ligament across your wrist. Through this tunnel runs the Median Nerve along with the tendons of the forearm flexor muscles. Carpal Tunnel Syndrome comes about where this nerve (which by the way is bigger than you think – pencil sized!) gets pinched/squeezed in this space. This impingement can manifest itself by creating symptoms like numbness, tingling, burning and/or weakness in the thumb and fingers (but not in the little finger). It can be worse at night and when doing certain actions or being in certain positions. At times it can even cause pain up the muscles of the forearm and into the elbow or shoulder following the line of the Median nerve itself.
Who gets CTS and why?
Although CTS is relatively common, there is not as much known about the cause as you would expect. It is what you would describe as a multi-factorial condition i.e. multiple factors affect and contribute to it. This can include certain illness e.g. Diabetes but also things like arthritis, genetic disposition, hormonal dysfunction e.g. problems with Thyroid function, Pregnancy and also repetitive strain. For example take rheumatoid arthritis where it is believed the inflammation in the fingers/hand fills the tunnel creating less room for the nerve and for the compression to take place. In Pregnancy it is sometimes though that again it may be due to the increased swelling, but there are cases of women who get CTS from the very early stages of pregnancy (even from conception!) so perhaps there are other factors at play here too. Women tend to be more likely to get CTS given the tunnel is typically smaller than in men and there is evidence that people who work with power tools are more likely to suffer the symptoms of CTS ……. and on the list goes. What is for certain is that tension in the tendons of the forearm flexors can add to this pressure which is going to exacerbate the problem and cause further pressure in an already pressured space.
How can Soft Tissue Work help?
I typically find in my own practice that CTS most commonly presents in four types of clients – Golfers, Office Workers, Manual Labourers and Pregnant Women.
In the case of the Golfers, Office Workers and Manual Labourers I see a common problem – overuse of the shoulder, chest and forearms, whether that be from how they are striking the ball, from the vibrations of the power tools or by typing at a computer for long hours. The muscles of the wrist and forearm have become shortened, congested and restricted. It’s rare this problem is isolated to the forearms and a wider examination and assessment may also highlight issues right up to the shoulder girdle, neck and spine. Working with massage and other soft tissue techniques to relieve muscular tension and to restore balance & function to the affected joints may help relieve the symptoms of CTS. In addition with the right homecare it can help to correct the dysfunction in your movement that may be at the root cause of the problem.
In the second case where fluid and inflammation are at play like in the cases of pregnancy or even arthritis related CTS there may still be some muscular tension. Flushing through the hand, wrist and arms can help to drain any excess fluid, to create space between the bones of the hands and wrist to give relief to these symptoms.
As with all imbalances in the body, if we are looking for a long term solution we need you the client to do some work too. Depending on the outcome of the assessment I would advise a number of stretches for the wrist, forearms and shoulders. In addition, I may look to increase grip strength but with strength there must also be flexibility. There is even research proving that yoga can more effective in relieving the symptoms of CTS than a wrist splint!
Work with your client to recognise the activities that exacerbate the problem. Identify, modify and try to reduce the actions causing any imbalance you have identified. Finally, do not continue any exercise that causes pain and ensure you keep your therapist and/or doctor informed.
NOTE: As with any medical condition it is important to work under the guidance and direction of your client’s medical team. In many cases the doctor will recommend that soft tissue work can help with the problem but in some cases depending on the extent of the condition surgery or injections may be required.
Nurse Led CTS Intervention: http://frontlinefirst.rcn.org.uk/blog/entry/nurse-led-carpal-tunnel-service-reduces-waiting-times-and-costs/
Repetitive Strain Awareness – CTS – http://www.rsi.org.uk/pdf/carpal_tunnel_syndrome.pdf
Effect of Setup Configurations of Split Computer Keyboards on Wrist Angle – http://ptjournal.apta.org/content/81/4/1038.abstract
Yoga and CTS – http://www.ncbi.nlm.nih.gov/pubmed/9820263
Some Eye Opening Statistics on CTS! http://www.repetitive-strain.com/national.html