Carpal Tunnel Syndrome

What is it? What causes it?

Is manual treatment or surgery the answer?

If you are wondering if this is you....

Symptoms include:

* Numbness, tingling and pain in the palm, index and middle fingers. Occasional burning pain can refer into the forearm.

*Often in the dominant hand, fingers can FEEL swollen, though there are not.

* A weakness in the hand, clumsiness, or difficulty gripping.

* Symptoms are often worse at night.

What is it?

Within the front of the wrist area there is a tunnel made up of a transverse carpal ligament across the top, and several carpal bones creating the horse shoe shape underneath.

Inside the tunnel there is a bundle of nine tendons and one nerve called the median nerve. This nerve supplies the palm and fingers (named above), as well as some significant tendons controlling your thumb.

Carpal Tunnel Syndrome is thickening and swelling of these tendons due to inflammation in this area or/and fluid retention.

This thickening causes compression on the median nerve and therefore gives you the symptoms in the areas that the nerve supplies.

What causes it?

Generally overuse (typing) or repetitive manual labour creates inflammation in the tunnel.

Extreme movements of the wrist into full flexion or extension aggravate as they increase the pressure in the tunnel, as does exposure to vibration.

Certain conditions increase the chances of Carpal tunnel aggravation due to an increase in fluid retention. This includes pregnancy, rheumatoid arthritis, hypothyroidism, diabetes and connective tissue disorders.

Treatment:

Firstly make sure you have the correct diagnosis!

This may sound strange but I have often seen this misdiagnosed in clinic. Often people have opted for surgery intervention in the hope of some, or any relief. However, this relief is short lived as the cause of the symptoms were not from Carpal Tunnel Syndrome alone.

Options:

Splinting at night as well as avoiding the aggravating factors such as repetitive use and extreme wrist movements. This splint keeps your wrist straight during the night and therefore eases the pressure off this area. This will take 4-6 weeks for a noticeable change to occur. Painkillers may help to manage the pain however if you continue to do the things that aggravate, the relief will only ever be temporary.

Surgical decompression or steroid injection often have a similar effect to painkillers, the relief is immediate, though this can be short lived. This is often not helped by the fact that surgery is sometimes used as a quick fix, if the repetitive strain/overuse is not stopped for an adequate amount of time to allow recovery, it will return. Plus there will be a an initial period of time directly after the surgery that you WILL have to rest.

This injury is usually a sign of overwork so it can be hard to put in place or accept that you need to rest!

During the surgery the ligament that lies across the top is cut to relieve the pressure on the nerve within the tunnel. This can be relatively successful if there are no other associated factors (such as the body compensating elsewhere), as well as a clear reduction in any irritating factors.

Any use of a steroid is aimed to reduce inflammation in the area it has been exposed to, this, if you are lucky and is exposed to the right area, will produce temporary relief. If the cause of the irritation persists, this syndrome will rear it's ugly head again as soon as the steroid has worn off. This can range anywhere from two to six months.

Manual Therapy

Through the many people I have seen in clinic, surgery appears to have very limited results, however as I mentioned before the diagnosis is often misled which leads to conflicting results.

In clinic often a 'teamwork' approach is best to treat this condition. Often this irritation has built up over time so as frustrating as it is, there isn't a quick fix.

The most effective way to recover is a combination of (you) reducing the aggravating factors and a series of (me/osteopath) semi-regular treatments to reduce the pressure and inflammation in this area.

Increased pressure can occur in the wrist if other areas of the body are not functioning optimally. For example, a shoulder or neck restriction would force other areas, such as the wrist, to compensate. Your Osteopath will be able to detect this.

In addition, a recent research paper produced some fantastic results supporting the use of manual therapy for carpal tunnel syndrome. A comparison was made between a range of people who had manual therapy and a range who had surgery. This comparison was set over 4 years! These results found little benefit from surgery to the use of soft tissue and nerve releasing techniques (Fernández-de-las-Peñaset al 2020).

In summary...

Alongside a detailed case history, your Osteopath can carry out particular tests, to determine firstly, if Carpal Tunnel Syndrome is your diagnosis, and secondly, to assess the body and its function as a whole.

Surgery can be successful if the correct diagnosis and advice is followed, however, research and my own experience supports the use of manual therapy to achieve the same results long -term.

If something more complicated is occuring, your Osteopath can also help if a referral to a specialist is needed through your GP.

Until next time,

Emma

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