Carpal tunnel syndrome
Brad Walker explains the causes, symptoms and treatment of carpal tunnel syndrome.
Carpal tunnel syndrome (CTS) is a relatively common complaint in individuals that perform constant and repetitive motions of the hand and wrist. Any athlete that plays a sport that requires them to repeatedly grasp something while the wrist joint is twisting and turning are at a high risk of developing the complaint. Sports that have a high incidence of CTS sufferers include most racquet sports, handball, swimming, bodybuilding, rowing, golf, archery and rock climbing. However, any sport that involves the use of the wrist and hand can cause the condition.
What is CTS?
Carpal tunnel syndrome is a compression neuropathy in which the median nerve that runs from the forearm to the hand becomes entrapped in the region of the wrist. This entrapment means that the thumb and the first three fingers, and the majority of the palm, can, and often do, become numb. The median nerve also supplies limited movement to the thumb through the "Thenar" muscles (the lump at the base of the thumb) and so the condition normally causes partial paralysis of the thumb.
Anatomy of CTS
As already mentioned, carpal tunnel syndrome is caused by the entrapment and compression of the median nerve. This nerve runs from the forearm to the hand where it branches to supply innervations to the thumb and the first two fingers. As it traverses the wrist area, the nerve passes through the carpal tunnel, which is composed of the carpal bones and the transverse carpal ligament. The carpal bones make up the base and sides of the tunnel so that a semicircular shape or valley is formed. Stretched across this, much like a bridge that crosses the valley is the tough transverse ligament. The median nerve, along with nine tendons that give the thumb and fingers movement, passes through the tunnel and into the hand. The carpal tunnel is a rigid structure, and the inner space is fixed and very confined.
Causes of CTS
Carpal tunnel syndrome is ultimately an inflammatory disease. So any sport or pastime that is repetitive in its actions can cause either the muscles or the wrists' tendons to become irritated and inflamed. In addition to the median nerve, a set of nine tendons also run through the carpal tunnel. When the protective linings, or synovial sheaths, become swollen and inflamed, this puts excessive pressure on the tendons and the median nerve because of the limited amount of space within the tunnel. Other ways in which the pressure becomes increased is when the tough transverse carpal ligament becomes swollen and when a bone fracture or break causes oedema or the build-up of fluids. When the median nerve becomes compressed because of the excess pressure in the carpal tunnel, the nerve signals that are usually transmitted through the nerve become slowed, ultimately resulting in abnormal sensations in the affected hand, i.e. numbness, pins and needles or tingling, burning feeling.
Symptoms of CTS
The majority of the symptoms felt by sufferers of carpal tunnel syndrome are ultimately due to the entrapment of the median nerve. Common symptoms include:
Athletes need to warm up the wrist area before they engage in any serious training to reduce the risk of carpal tunnel syndrome. Isometric strength exercises (these are exercises where the muscles are contracted, but the limbs do not move) warm the wrists and nearby areas up and strengthen the muscles and improve blood flow. Below are a few exercises that will help to strengthen the wrist and reduce irritation.
These simple exercises should be practiced each day if one of the sports mentioned above is regularly performed. One thing to avoid is extreme flexion and extension because excessive flexion doubles the pressure applied to the median nerve, whereas extension virtually triples it. Only perform warm-up and strength exercises as far as it feels comfortable; pushing things too far can result in the condition you are trying to prevent.
Because it is often inflammation of the tendon sheaths that cause carpal tunnel syndrome, flexibility exercises that reduce pressure on the tendons should also be practiced. Several sports mentioned in the introduction cause the muscles of the forearms to tighten, which can then cause pressure on the tendons. Thus stretching exercises that reduce the tension in the forearms will help to prevent carpal tunnel syndrome.
CTS is a soft tissue injury of the muscles and tendons around the wrist joint and therefore, should be treated like any other soft tissue injury. Immediately following an injury, or at the onset of pain, the R.I.C.E.R. regime should be employed. This involves Rest, Ice, Compression, Elevation, and Referral to an appropriate professional for an accurate diagnosis.
The R.I.C.E.R. regime must be implemented for at least the first 48 to 72 hours. Doing this will give you the best possible chance of a complete recovery. As part of the R.I.C.E.R. regime a night splint that provides support to the wrist and keeps it in a straight line (i.e. the position that applies the least pressure to the median nerve can be useful). If the symptoms persist, it may be worthwhile keeping the wrist splint on during the day so that there is a much lower chance of further aggravating the injury. The next phase of treatment (after the first 48 to 72 hours) involves several physiotherapy techniques. The application of heat and massage is one of the most effective treatments for speeding up the muscles and tendons' healing process.
Once most of the pain has been reduced, it is time to move onto the rehabilitation phase of your treatment. The main aim of this phase is to regain the strength, power, endurance and flexibility of the muscles and tendons that have been injured.
Medication is also commonly prescribed in cases where the pain in the wrist and hand is quite severe. The most widely prescribed family of drugs for carpal tunnel syndrome is the non-steroidal anti-inflammatory such as ibuprofen. These work by reducing the pain and acting on the underlying cause of the condition, the inflammation. Occasionally this type of drug is not enough, and so a corticosteroid can be injected directly into the carpal tunnel. This provides virtually instant relief from the common symptoms.
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About the Author
Brad Walker is a prominent Australian sports trainer with more than 15 years of experience in the health and fitness industry. Brad is a Health Science graduate of the University of New England and has postgraduate accreditations in athletics, swimming and triathlon coaching. He also works with elite level and world champion athletes and lectures for Sports Medicine Australia on injury prevention.