Physiotherapy of the carpal tunnel syndrome

 

The carpal tunnel syndrome is a too common problem among middle-aged people, almost everyone knows someone who’s had its symptoms. In this article, I’ll go through the physiotherapy of the carpal tunnel syndrome, this article is suitable for both clients and my colleagues as well.

The carpal tunnel syndrome is a syndrome in which the median nerve (N. Medianus) is compressed in the carpal tunnel, under the transversal ligament. The median nerve is a part of the plexus brachialis, which begins from the lower part of the cervical spine. The cause for the carpal tunnel syndrome isn’t really “too tight nerve” or tight muscles, it’s the tightness of the transversal ligament of the wrist.

 

The symptoms

 

The symptoms of the carpal tunnel syndrome are

  • Numbness and tingling of the thumb, the index finger, the middle finger, and the medial part of the fourth finger.
  • Ache around the palm, wrist and sometimes the entire upper limb
  • The hand and fingers feel clumsy
  • Problems with tasks that require fine motor skills, such as buttoning up a jacket
  • Weakness in grabbing and lifting objects

The carpal tunnel syndrome usually begins little by little and the symptoms get stronger gradually. Some jobs or hobbies which stress the wrist area could affect the onset of the syndrome, such as continuous trembling, repetitive wrist movement, and movements that diverge from the normal alignment of the wrist. At the end of the pregnancy there can also be symptoms of carpal tunnel syndrome, but in that case the symptoms disappear after the baby is born. LINKKI Obesity and some diseases such as arthritis, diabetes, and kidney deficiency predispose a person to the carpal tunnel syndrome.

 

Physiotherapy

 

Physiotherapy is always a primary choice for the treatment of carpal tunnel syndrome. If physiotherapy isn’t effective enough with the symptoms of the syndrome, the surgical options will be considered. Physiotherapy will focus on instructing stretching-exercises and using the wrist-splint, but also manually treating the upper limb (massaging).

 

The stretching-exercises

 

The stretches aim to stretch the ligaments of the wrist, especially the transversal ligament since the median nerve is compressed under it. So if the physiotherapist tells you to do these exercises, but you don’t feel them on the muscles of your upper limb, that’s okay! You don’t need to feel the stretches in your muscles, many people just have tightness in those muscles, so they feel it anyway.

There are two different stretches for the syndrome, you should repeat them both 3 times a day. You should keep the stretch for 10 seconds and repeat it 5 times at each exercise session. Here is a link to the instructions.

 

The wrist-splint

 

The idea of the wrist-splint is to prevent the wrist from leaning to the sides to a “bad” position so that there would be as much room as possible for the median nerve. The wrist-splint is usually instructed to use during the night-time since many people with this syndrome tend to sleep their wrist under the body or the wrist twisted to a side, which can lead to worse symptoms. The splint keeps the wrist in a better position for the night.

You should really pay attention to the optimal use of the splint since you can even make the symptoms worse by using the splint wrong. The splint should never compress the wrist especially from the medial side so that the medial nerve won’t be compressed even more.

 

Treating of the upper limb

 

The upper limb treating aims to optimize the function of the nerve of its entire length, not just around the wrist. As mentioned earlier, the plexus brachialis begins from the lower part of the cervical spine and the medial nerve apart from the plexus. The physiotherapist treats manually the upper limb from the palm to the neck following the path of the nerve. This means, that practically the physiotherapist massages the palm, wrist, forearm, upper arm, and pectoral area.

 

When the physiotherapy isn’t enough

 

When talking about the carpal tunnel syndrome, good results can be achieved with the help of physiotherapy. Especially if the symptoms haven’t lasted for long and are mild, the prognosis of the syndrome is good. If the symptoms have been strong from the very beginning, the prognosis isn’t that great. 

If the desired results of the physiotherapy weren’t achieved, the surgical options will be considered. The surgery is a harsh action from a physiotherapists’ point of view, so the conservative rehabilitation should be operated as well as possible! It’s about the motivation of the client: the stretching-exercises MUST BE DONE and the wrist-splint MUST BE USED, it’s not enough that the client does the exercises “when remembered or feel like doing them”.

We professionals can help the client with our knowledge and instructions as well as we can, but at the end of the day, the rehabilitation and getting better is ALWAYS about the client and his/her motivation.