Carpal Tunnel Syndrome
Carpal Tunnel Syndrome Carpal Tunnel Syndrome (CTS) also called median nerve compression is a very common injury to the hand and wrist that causes numbness and tingling. More than 3 million cases of Carpal Tunnel Syndrome are reported each year in the United States . The carpal tunnel is a passageway from your wrist to your hand that consists of bones, tendons, ligaments, and the median nerve. The median nerve that passes through this tunnel is responsible for delivering sensations to the thumb, index finger, middle finger, and the thumb side of the ring finger . The pathology of this injury is believed to be due to compression, entrapment, or irritation of the median nerve. Anything that may cause a reduction in the narrow space of the carpal
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tunnel will result in an increased pressure on the nerve thus results in the numbness and tingling sensation felted with carpal tunnel syndrome. Although very common most cases of carpal tunnel syndrome are idiopathic. Although many cases have been linked to pregnancy, obesity, wrist trauma, and overuse in the hand or wrist. Because it is so common it is seen often in athletes, in fact it is the most common peripheral neuropathy compression injury. CTS is most often seen in sports that require a lot of hand and wrist motions such as tennis, racquetball, and badminton. Females are also more susceptible to the injury as well as people over the age of 31. The most common symptoms of CTS are numbness and tingling of the middle finger, index finger, and thumb. Numbness with never be felt in the little finger. Other symptoms include weakness of the fingers, loss in grip strength, and radiating pain to the forearm and possibly the proximal area of the shoulder. CTS is a chronic injury that normally begins as numbness that periodically arises and as day, weeks, or even months pass the numbing sensation becomes more frequent and less tolerable. Although it is rare, it can be an acute injury in which a direct trauma to the median nerve causes severe pain and numbness. The treatment for this case is normally surgery. The symptoms of this injury are gradual and many athletes report having the numbness and tingling during the night and mornings. In the early onset, the numbness and tingling may arise during the activities which aggravate the injury but subside when activity stops. As the injury progresses, the symptoms become constant and begin to affect daily life activities . Many cases of CTS develop in intensity much further than they should, because many people ignore the symptoms.
The earlier the diagnosis, the better. If diagnosis goes unnoticed, athletes compensate for the pain by unknowingly altering the way they use their hands and wrist. For instance, a tennis player may hold the racquet a different way or change the rotating motions in their wrists to compensate for the discomfort they may be feeling. This unknowing change in hand and wrist use can lead to further problems in the arm and neck. The initial short term goals for CTS is to decrease the numbness and pain, and to decrease swelling and inflammation. These goals will be accomplished by placing the patient in a splint at 15 degrees extension. This position leaves the carpal tunnel in the most open position, thus allowing restoration of maximum circulation to the median nerve. The reduction of inflammation on the median nerve can be achieved by the use of NSAIDS, and modalities may also be used to relieve numbness and inflammation to the affected …show more content…
area. The long term goals for CTS is the complete disappearance of paresthesia felt in the hand and wrist. Increasing the ROM may also be effective in preventing the reoccurrence of CTS as well as wrist stretching. An increase in muscle strength around the wrist may also be beneficial if CTS caused muscle atrophy in the wrist or thenar eminence of the hand. Returning to physical activity that may have initiated the irritation of the nerve without the presence of numbness and tingling. In order to treat CTS there are several modalities one may use. The use of therapeutic ultrasound is the most used and most effective modalities in terms of pain relief and reduction of inflammation. Other modalities include: ice pack, ice water immersion, cold whirlpool, and paraffin bath. Modalities such as the ice pack, ice water immersion, and cold whirlpool, and ultrasound non-thermal would be used during the initial treatment to help reduce inflammation in the carpal tunnel. Paraffin bath would not be ideal to use in the beginning of treatment when inflammation is still present because the presence of heat could actually increase the inflammation. This is because the heat from the paraffin bath would dilate blood vessels thus leading to an increase blood supply to the wrist which would cause irritation and increased inflammation. Cyrotherapy is best when treating any condition in its early/acute treatment stages so an ice pack could be applied to both the ventral and dorsal aspects of the wrist for 20 minutes four times a day for the first 1-2 weeks. Application of ice pack is effective because it can target the entire affected area in one treatment. Cold water immersion may also be used to treat CTS symptoms in the acute treatment stage. Another option would be cold water immersion should be completed for 15-20 twice a day for the first 1-2 weeks. Cold water immersion, like ice packs also are beneficial in treating the whole area but cold water immersion can also be accompanied with ROM exercises to decrease the likelihood of CTS reoccurring. Lastly, a cold whirlpool would also be beneficial in the acute stages of treatment because like CWI and ice packs, a cold whirlpool will also decrease circulation, metabolism, tissue stiffness, inflammation, and pain. Treatment with a cold whirlpool should last about 10-20 minutes with the temperature at about 50-60 degrees Fahrenheit. Frequency of treatment is 1-2 times daily for 1-2 weeks. Therapeutic ultrasound may as be used in the acute stages of treatment if the treatment has non-thermal effect, as thermal effects could cause more harm than good. Ultrasound should be applied to the dorsal aspect of the wrist right along the carpal tunnel. Treatment should last for 15 minutes. For the most beneficial effects, ultrasound should be applied to the carpal tunnel for 15 minutes with a frequency of 1 MHz and an intensity of 1.0 W/cm^2, at a pulsed mode 1:4 or duty cycle at 20% (2) To get optimal results clinician should apply ultrasound moving the sound head approximately 3-4 cm/second. Moving the soundhead too quickly will not be as effective and will not give you the desired results. The use of a paraffin bath may also be beneficial as it can relieve pain temporarily. Treatment should involve dipping the entire effected area in the bath, letting the wax harden and reapply 10 times. Once complete, a bag is placed over the area and let the paraffin wax heat the area for 20 minutes. Treatment may be applied 2-3 times daily after inflammation has decreased. There are contraindications one has to consider before the use of these modalities.
For the use of paraffin bath, contraindications for this treatment include: hypersensitivity to heat, cannot be applied to infections, rashes, and lesions or burns and new scars. As for the use of ice packs some contraindications to consider are open wounds and Raynaud’s Disease. Lastly, the contraindications for therapeutic ultrasound are vascular insufficiency, thrombophlebitis, pregnancy, pacemaker, malignancy, and infection. . If used properly these modalities will show much improvement and pain relief in a quick period of time activities. In addition to these modalities; rest, stretching, and exercises play a key role in a complete successful recovery. Rest is a major component when it comes to any injury. As for CTS abstaining from every activity that elicits pain is key to recovery. It’s simple, if it hurts, don’t do it. Although too much rest can have negative effects and complicate recovery. Resting too long can cause muscle loss and muscle stiffness. Once the pain and numbness has reduced one may continue onto stretching, and
exercises. Some very beneficial stretches include: the prayer stretch, wrist flexor stretch, and the wrist extensor stretch. All three of these stretches target the carpal tunnel and can help relieve pressure and prevent reoccurrence of the injury. The prayer stretch is performed by placing both hands together in a prayer like manner just below your chin and by slowly lowering them to your stomach or until you feel a mild to moderate stretch. Hold the stretch for 15-30 seconds and repeat 3-4 times daily. The wrist flexor stretch is performed by extending your arm with your palm facing up and pulling down on your hand until a mild to moderate stretch is felt. Hold for 15-30 seconds and repeat 2-4 times daily. Lastly, the wrist extensor stretch is performed by extending your arm with your palm face down and pulling your hand until a mild to moderate stretch is felt in the forearm. Hold for 15-30 seconds and repeat 2-4 times daily. In addition to stretching some exercises can help promote healing and reduce likelihood of re injury. One exercise is to clench the wrist with the 3rd and 4th fingers extended at draw 5 clockwise and counterclockwise circles with the two fingertips. Another beneficial exercise is to clench the fist and then fan out the fingers, repeat 5 times daily. Following these guidelines will help relieve the signs and symptoms seen with carpal tunnel syndrome.
tunnel will result in an increased pressure on the nerve thus results in the numbness and tingling sensation felted with carpal tunnel syndrome. Although very common most cases of carpal tunnel syndrome are idiopathic. Although many cases have been linked to pregnancy, obesity, wrist trauma, and overuse in the hand or wrist. Because it is so common it is seen often in athletes, in fact it is the most common peripheral neuropathy compression injury. CTS is most often seen in sports that require a lot of hand and wrist motions such as tennis, racquetball, and badminton. Females are also more susceptible to the injury as well as people over the age of 31. The most common symptoms of CTS are numbness and tingling of the middle finger, index finger, and thumb. Numbness with never be felt in the little finger. Other symptoms include weakness of the fingers, loss in grip strength, and radiating pain to the forearm and possibly the proximal area of the shoulder. CTS is a chronic injury that normally begins as numbness that periodically arises and as day, weeks, or even months pass the numbing sensation becomes more frequent and less tolerable. Although it is rare, it can be an acute injury in which a direct trauma to the median nerve causes severe pain and numbness. The treatment for this case is normally surgery. The symptoms of this injury are gradual and many athletes report having the numbness and tingling during the night and mornings. In the early onset, the numbness and tingling may arise during the activities which aggravate the injury but subside when activity stops. As the injury progresses, the symptoms become constant and begin to affect daily life activities . Many cases of CTS develop in intensity much further than they should, because many people ignore the symptoms.
The earlier the diagnosis, the better. If diagnosis goes unnoticed, athletes compensate for the pain by unknowingly altering the way they use their hands and wrist. For instance, a tennis player may hold the racquet a different way or change the rotating motions in their wrists to compensate for the discomfort they may be feeling. This unknowing change in hand and wrist use can lead to further problems in the arm and neck. The initial short term goals for CTS is to decrease the numbness and pain, and to decrease swelling and inflammation. These goals will be accomplished by placing the patient in a splint at 15 degrees extension. This position leaves the carpal tunnel in the most open position, thus allowing restoration of maximum circulation to the median nerve. The reduction of inflammation on the median nerve can be achieved by the use of NSAIDS, and modalities may also be used to relieve numbness and inflammation to the affected …show more content…
area. The long term goals for CTS is the complete disappearance of paresthesia felt in the hand and wrist. Increasing the ROM may also be effective in preventing the reoccurrence of CTS as well as wrist stretching. An increase in muscle strength around the wrist may also be beneficial if CTS caused muscle atrophy in the wrist or thenar eminence of the hand. Returning to physical activity that may have initiated the irritation of the nerve without the presence of numbness and tingling. In order to treat CTS there are several modalities one may use. The use of therapeutic ultrasound is the most used and most effective modalities in terms of pain relief and reduction of inflammation. Other modalities include: ice pack, ice water immersion, cold whirlpool, and paraffin bath. Modalities such as the ice pack, ice water immersion, and cold whirlpool, and ultrasound non-thermal would be used during the initial treatment to help reduce inflammation in the carpal tunnel. Paraffin bath would not be ideal to use in the beginning of treatment when inflammation is still present because the presence of heat could actually increase the inflammation. This is because the heat from the paraffin bath would dilate blood vessels thus leading to an increase blood supply to the wrist which would cause irritation and increased inflammation. Cyrotherapy is best when treating any condition in its early/acute treatment stages so an ice pack could be applied to both the ventral and dorsal aspects of the wrist for 20 minutes four times a day for the first 1-2 weeks. Application of ice pack is effective because it can target the entire affected area in one treatment. Cold water immersion may also be used to treat CTS symptoms in the acute treatment stage. Another option would be cold water immersion should be completed for 15-20 twice a day for the first 1-2 weeks. Cold water immersion, like ice packs also are beneficial in treating the whole area but cold water immersion can also be accompanied with ROM exercises to decrease the likelihood of CTS reoccurring. Lastly, a cold whirlpool would also be beneficial in the acute stages of treatment because like CWI and ice packs, a cold whirlpool will also decrease circulation, metabolism, tissue stiffness, inflammation, and pain. Treatment with a cold whirlpool should last about 10-20 minutes with the temperature at about 50-60 degrees Fahrenheit. Frequency of treatment is 1-2 times daily for 1-2 weeks. Therapeutic ultrasound may as be used in the acute stages of treatment if the treatment has non-thermal effect, as thermal effects could cause more harm than good. Ultrasound should be applied to the dorsal aspect of the wrist right along the carpal tunnel. Treatment should last for 15 minutes. For the most beneficial effects, ultrasound should be applied to the carpal tunnel for 15 minutes with a frequency of 1 MHz and an intensity of 1.0 W/cm^2, at a pulsed mode 1:4 or duty cycle at 20% (2) To get optimal results clinician should apply ultrasound moving the sound head approximately 3-4 cm/second. Moving the soundhead too quickly will not be as effective and will not give you the desired results. The use of a paraffin bath may also be beneficial as it can relieve pain temporarily. Treatment should involve dipping the entire effected area in the bath, letting the wax harden and reapply 10 times. Once complete, a bag is placed over the area and let the paraffin wax heat the area for 20 minutes. Treatment may be applied 2-3 times daily after inflammation has decreased. There are contraindications one has to consider before the use of these modalities.
For the use of paraffin bath, contraindications for this treatment include: hypersensitivity to heat, cannot be applied to infections, rashes, and lesions or burns and new scars. As for the use of ice packs some contraindications to consider are open wounds and Raynaud’s Disease. Lastly, the contraindications for therapeutic ultrasound are vascular insufficiency, thrombophlebitis, pregnancy, pacemaker, malignancy, and infection. . If used properly these modalities will show much improvement and pain relief in a quick period of time activities. In addition to these modalities; rest, stretching, and exercises play a key role in a complete successful recovery. Rest is a major component when it comes to any injury. As for CTS abstaining from every activity that elicits pain is key to recovery. It’s simple, if it hurts, don’t do it. Although too much rest can have negative effects and complicate recovery. Resting too long can cause muscle loss and muscle stiffness. Once the pain and numbness has reduced one may continue onto stretching, and
exercises. Some very beneficial stretches include: the prayer stretch, wrist flexor stretch, and the wrist extensor stretch. All three of these stretches target the carpal tunnel and can help relieve pressure and prevent reoccurrence of the injury. The prayer stretch is performed by placing both hands together in a prayer like manner just below your chin and by slowly lowering them to your stomach or until you feel a mild to moderate stretch. Hold the stretch for 15-30 seconds and repeat 3-4 times daily. The wrist flexor stretch is performed by extending your arm with your palm facing up and pulling down on your hand until a mild to moderate stretch is felt. Hold for 15-30 seconds and repeat 2-4 times daily. Lastly, the wrist extensor stretch is performed by extending your arm with your palm face down and pulling your hand until a mild to moderate stretch is felt in the forearm. Hold for 15-30 seconds and repeat 2-4 times daily. In addition to stretching some exercises can help promote healing and reduce likelihood of re injury. One exercise is to clench the wrist with the 3rd and 4th fingers extended at draw 5 clockwise and counterclockwise circles with the two fingertips. Another beneficial exercise is to clench the fist and then fan out the fingers, repeat 5 times daily. Following these guidelines will help relieve the signs and symptoms seen with carpal tunnel syndrome.