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PT Corner with Kristin Williams

Carpal Tunnel

By Kristin Williams

Nov 15, 2021

With more people working from home and online than ever, I wouldn’t be surprised if we see an uptick in the number of carpal tunnel syndrome (CTS) cases worldwide. CTS is the compression of the median nerve as it passes through a fibrous tunnel at the wrist into the hand, resulting in pain, numbness, tingling, and weakness along the distribution of that nerve. It is the most common nerve entrapment syndrome, accounting for 90% of all entrapment neuropathies. Given that it is made worse by prolonged extension of the wrist, one can understand why activities such as using a mouse and typing would aggravate symptoms of CTS.

 

Developing CTS is often multifactorial, involving occupational, social, and environmental risk factors. The most common risk factors include genetic predisposition, history of repetitive wrist movements, obesity, autoimmune disorders, and pregnancy. CTS is 10 times more common in females than males and usually occurs between the ages of 40-60 years. It is most often caused by a combination of compression and traction at the wrist. With compression, there is a cycle of increased pressure > obstruction of blood flow > increased swelling > compromise to the microcirculation of the median nerve > compromise of nerve function > lesions in the nerve itself > inflammation of the surrounding connective tissues and tendons passing through the tunnel > further compression of the nerve. Repetitive traction and wrist motion can only exacerbate symptoms, further injuring the nerve.

 

Sensory nerve fibers are often affected before motor fibers, resulting in early symptoms of pain, numbness, and tingling. These symptoms will present along the distribution of the median nerve, which includes the thumb, index finger, middle finger, and half of the ring finger (closest to the thumb). Pain can also radiate up into the arm. As the disease progresses, motor nerve fibers are affected, causing hand weakness, decreased fine motor skills, and atrophy of the muscles of the thumb. Autonomic nerve fibers can also be affected, causing temperature changes in the hand. 

 

In the early stages, symptoms are most often present at night when lying down and decrease during the day. Symptoms at this stage can often be relieved by shaking the wrist and hand. As the nerve entrapment progresses, symptoms will also be present during the day, especially with repetitive wrist and hand activities. In more advanced cases, the symptoms can be constant. As CTS is progressive, permanent median nerve damage can result. However, almost 90% of mild to moderate cases respond to conservative management.

 

Three simple tests to check for CTS include:

  1. Carpal Compression Test – most reliable – done by applying firm pressure directly over the carpal tunnel for 30 seconds. The test is positive if pain, numbness, tingling, or other symptoms are reproduced.
  2. Phalen Test – aka “Reverse Prayer” – Fully flex the wrists, placing the backs of the hands together for one minute. A positive test is when the symptoms are reproduced.
  3. Reverse Phalen Test – aka “Prayer Test” – Fully extend the wrists, placing the palms of the hands together for one minute. A positive test is when the symptoms are reproduced.

 

As I stated above, conservative treatment of CTS is highly successful in a lot of cases. Initially, just modifying movements or positions that provoke the symptoms is key to breaking the compression cycle. Increasing aerobic activity, mobilizing the upper thoracic spine, stretching tight muscles of the cervical spine and thoracic outlet, strengthening the shoulder girdle, and gliding the median nerve can also help decrease aggravating factors of CTS. I’ve created a short video that can be found on our LYT Yoga® YouTube channel with simple exercises you can do to help relieve the symptoms of CTS, so check out the link below! Until then, I’ll see you on the mat!

 

 

 

Xoxo,

Kristin

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