CARPAL TUNNEL SYNDROME
 

Carpal Tunnel Syndrome (CTS) is a common entrapment neuropathy, characterized by compression of the median nerve as it passes through the carpal tunnel at the wrist. The carpal tunnel is a narrow passageway in the wrist formed by bones and ligaments, through which the median nerve and several tendons pass. Compression of the median nerve within this tunnel results in symptoms such as numbness, tingling, weakness, or pain in the hand and wrist, particularly affecting the thumb, index, and middle fingers (1).

We at Benphysio do provide this service in all our outlets in Oval Damansara, Bangsar, Puchong, KL Ampang, Cheras and Giza KD. We specialized in hands-on physiotherapy to treat the problem.

Signs and Symptoms

Numbness and Tingling:

• Location: Typically affects the thumb, index finger, middle finger, and half of the ring finger.
• Pattern: Often occurs during activities such as gripping or holding objects, or at night.
• Distribution: May radiate up the arm towards the shoulder in severe cases (2).

Pain and Discomfort:

• Location: Predominantly felt in the palm of the hand and wrist.
• Characteristics: Can range from dull aching to sharp or burning pain.
• Aggravating Factors: Pain often worsens with repetitive hand movements or prolonged use, especially in activities that involve flexing or extending the wrist (2).

Weakness and Muscle Atrophy:

• Effects: Weakness in the affected hand can make it difficult to perform tasks that require fine motor skills, such as buttoning a shirt or gripping small objects.
• Muscle Changes: Long-term compression of the median nerve can lead to muscle wasting (atrophy) in the thumb muscles (3).

Paresthesia:

• Definition: Abnormal sensations like pins and needles, tingling, or a feeling of "electrical shocks" in the fingers and hand.
• Timing: Paresthesia may be intermittent initially but can become more constant as the condition progresses (2).

Night Symptoms:

• Common: Many people with CTS experience symptoms, particularly numbness and pain, at night.
• Reason: Nighttime symptoms often result from sleeping with wrists bent or from fluid accumulation in the wrists during rest (4).

Physiotherapy Assessment

1. Tinel's Sign: Tapping over the median nerve at the wrist to elicit tingling or numbness.

2. Phalen's Test: Wrist flexion for up to 60 seconds to reproduce symptoms.These tests are well-established in clinical practice for diagnosing CTS. (Reference: Descatha et al., 2013)

3. Grip Strength Assessment: Measuring grip strength using a dynamometer.Grip strength assessment is useful for quantifying muscle weakness associated with CTS and monitoring treatment progress. (Reference: Bhattacherjee et al., 2012)

4. Sensory Testing: Assessing two-point discrimination or using Semmes-Weinstein monofilaments to test sensory thresholds.Sensory testing helps in objectively assessing sensory deficits in the median nerve distribution. (Reference: Huisstede et al., 2007)

5. Electrodiagnostic Tests: Nerve conduction studies (NCS) and electromyography (EMG) are conducted by specialists but are essential for confirming CTS diagnosis.These tests measure nerve conduction velocities and detect muscle denervation, providing objective data on nerve function. (Reference: Padua et al., 2016)

6. Functional Tests: Using standardized assessments such as the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire.Functional tests and questionnaires help in quantifying functional limitations and assessing treatment outcomes in CTS patients. (Reference: Atroshi et al., 2000)

Physiotherapy Management

• Manual Therapy: Manual therapy techniques such as joint mobilizations and soft tissue mobilizations are used to improve wrist and hand mobility and reduce symptoms of CTS.

•  Nerve Gliding Exercises: These exercises aim to improve median nerve mobility and reduce nerve compression within the carpal tunnel.
• Strengthening Exercises: Strengthening the muscles of the hand and forearm can improve overall function and reduce strain on the wrist.

Ready to say goodbye to pain and embrace a healthier, happier you? Visit Benphysio for expert physiotherapy services designed to transform your life.

Again, we at Benphysio do provide this service in all our outlets in Oval Damansara, Bangsar, Puchong, KL Ampang, Cheras and Giza KD. We specialized in hands-on physiotherapy to treat the problem. Feel free to call us to make an appointment to get your problem diagnosed by our physiotherapists and fixed via hands on physiotherapy. We are available at Oval Damansara, Bangsar, Puchong, KL Ampang, Cheras and Giza KD.

Created by: Divya (Oval Damansara)

References:

1. American Academy of Orthopaedic Surgeons. Carpal Tunnel Syndrome. Available online: https://orthoinfo.aaos.org/en/diseases--conditions/carpal-tunnel-syndrome/
2. American Academy of Orthopaedic Surgeons. Carpal Tunnel Syndrome. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/carpal-tunnel-syndrome/
3. Papanicolaou GD, McCabe SJ, Firrell J. The prevalence and characteristics of nerve compression symptoms in the general population. J Hand Surg Am. 2001;26(3):460-466.
4. Katz JN, Simmons BP. Clinical practice. Carpal tunnel syndrome. N Engl J Med. 2002;346(23):1807-1812.
5. Descatha, A., Huard, L., Aubert, F., Barbato, B., Gorand, O., Chastang, J. F., & Roquelaure, Y. (2013). Meta-analysis on the performance of the initial clinical examination in the diagnosis of carpal tunnel syndrome. Scandinavian Journal of Work, Environment & Health, 39(5), 491-502.
6. Bhattacherjee, M., Coulson, N. E., & Barfield, W. R. (2012). Evaluation and treatment of carpal tunnel syndrome. Primary Care: Clinics in Office Practice, 39(2), 203-216.
7. Huisstede, B. M., Randsdorp, M. S., Coert, J. H., Glerum, S., & van Middelkoop, M. (2007). Diagnostic value of physical tests for isolated chronic unilateral proximal and distal radioulnar joint instability and distal radioulnar joint instabilities: a systematic review. Archives of Physical Medicine and Rehabilitation, 88(8), 1030-1038.
8. Padua, L., Coraci, D., Erra, C., Pazzaglia, C., Paolasso, I., Loreti, C., ... & Caliandro, P. (2016). Carpal tunnel syndrome: clinical features, diagnosis, and management. The Lancet Neurology, 15(12), 1273-1284.
9. Atroshi, I., Gummesson, C., Johnsson, R., Ornstein, E., & Ranstam, J. (2000). Diagnostic properties of nerve conduction tests in population-based carpal tunnel syndrome. BMC Musculoskeletal Disorders, 1(1), 10.