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Carpal Tunnel

Have you noticed numbness or tingling in your fingers while sleeping or after working long hours? Do you feel the need to shake your hand or rub your palm? You may be experiencing Carpal Tunnel Syndrome (CTS), the most common peripheral neuropathy in the body.

The Carpal Tunnel is a small tunnel on the palm side of the wrist that has ten structures running through it, and one ligament or “roof” of the tunnel, called the transverse carpal ligament. Nine of these structures are tendons that bend the fingers, while the last structure is the median nerve. The median nerve can become entrapped by “increased pressure in the tunnel, median nerve microcirculation injury, median nerve connective tissue compression, and synovial tissue hypertrophy” (Aboonq, 2015). While doctors and researchers previously thought CTS was caused by one’s vocation and work habits, genetic predispositions are now commonly accepted as a contributing factor. 

There are two main treatment options for CTS. For mild-moderate cases of CTS, conservative management is recommended. Conservative management of CTS includes a specific combination of neural and tendon gliding, manual techniques, splinting, oral drugs, electrotherapy and injections prescribed by a Doctor and your occupational therapist (del Barrio et. al., 2018).  In severe cases, it is often treated surgically. If surgery is indicated, the transverse carpal ligament will be cut to allow for more space for the median nerve and flexor tendons. This can be done endoscopically or with an “open” technique. 

The median nerve has the most pressure placed on it in extreme positions of wrist flexion and extension (bending forward and backward). The median nerve has the least amount of pressure when the wrist is neutral. If it is difficult to sleep or work with the wrist neutral, a splint may be indicated. 

If you have any questions or concerns, please feel free to consult with our hand therapists at Proactive.

References:

Aboong, M. S. (2015). Pathophysiology of Carpal Tunnel Syndrome. Neurosciences, 20 (1), 4. 

del Barrio, S. J., Gracia, E. B., García, C. H., de Miguel, E. E., Moreno, J. T., Marco, S. R., & Laita, L. C. (2018). Conservative treatment in patients with mild to moderate carpal tunnel syndrome: A systematic review. Neurología, (English Edition)33 (9), 590-601.

About the Author - Erin Rasmussen

Erin grew up in Washington State and graduated from Washington State University with a Bachelor of Science degree in Kinesiology. During her undergraduate education she worked in the Exercise Performance and Physiology Lab, where she gained a deep understanding of anatomy, physiology and human biological function. Erin later moved to California and received her Master of Occupational Therapy degree at University of St. Augustine in San Marcos.  Erin discovered her passion for working with upper extremity diagnoses and conditions at her first clinical rotation at an outpatient hand therapy clinic. During her free time, she enjoys spending time with her pug (chancho), going to the beach and practicing yoga.