It is a condition due to compression of the median nerve as it travels through the wrist at the carpal tunnel. Inside the carpal tunnel are tendons that bend the fingers and thumb, and the median nerve. The median nerve supplies the sensation to the palm side of the thumb, index, middle and some of the ring finger. It innervates the thenar eminence muscles and two lateral lumbrical muscles.
Major risk factors for carpal tunnel syndrome are being female, middle aged and obese. Pressure on the median nerve can come from swelling or anything that makes the carpal tunnel narrower. For example – oedema from pregnancy, swollen tendons, fractures, repetitive wrist movement, rheumatoid and osteoarthritis, and diabetes.
The main symptoms are pain, numbness, and tingling, in the thumb, index finger, middle finger, and some of the ring finger. Symptoms are usually worse at night. Pain may extend up the arm. Weak grip and pinch strength may occur after a long period of time due to thenar muscle wasting. Patients may also report clumsiness.
- Pins and needles, numbness and/or pain in medial nerve distribution of hand
- Decreased grip strength
- Phalen’s Test
- Tinel’s Test
- Nerve conduction studies
As soon as symptoms appear
- Sensory evaluation
- Release pressure on median nerve through splinting for mild to moderate symptoms
- Activity modification education and postural advice
- Nerve gliding and tendon gliding exercises
Night splinting with wrist in neutral
- Education to prevent re-aggravation
- Range of motion, tendon and nerve gliding exercises
- Scar and oedema management
- Pain management