Computers, whether they may be PCs, laptops, or tablets, are already a staple of our everyday lives. Even before the community quarantines forced us to work from home, or our children to transition to purely online learning, we were already spending a good chunk of our time using them. Ergonomics was already a buzzword pre-pandemic, but its importance was highlighted more when people started to experience injuries related to faulty workstation set-ups at home. Some of the more common complaints were headaches, neck and back pains, and numbness and pain on the hands and wrists. Today, we’ll be discussing about carpal tunnel syndrome, one of the common causes of wrist and hand pain.
What is carpal tunnel syndrome?
Carpal tunnel syndrome (CTS) is a common condition when the median nerve is compressed inside the carpal tunnel at the wrist. The carpal tunnel is formed by bones and ligaments on the palm side of our wrist. The median nerve, which provides sensation on the palm side of the thumb, index, middle, and half of ring fingers and innervates muscles of the thumb, commonly gets compressed when there is an increased pressure or narrowing in the carpal tunnel.
What causes CTS?
The bones and ligaments forming the carpal tunnel do not expand. Thus, any narrowing of its dimension or increase in its contents will lead to an increase in pressure, which in turn leads to compression of the median nerve. Some of the common causes of this would be:
- Maintaining faulty positions and repetitive flexing movements of the hands and wrists for prolonged periods. Examples of these are typing, using a computer mouse, and machine work.
- Forceful and stressed motions of the wrists and hands
- Autoimmune disorders such as rheumatoid arthritis
- Swelling due to fractures or trauma to the wrist
- Fluid retention due to pregnancy or menopause
- Presence of a cyst or tumor in the carpal tunnel
What are the symptoms of CTS?
Symptoms of CTS may include:
- Tingling sensation, numbness, or pain on the first three fingers of the affected hand
- Weakness in your hand and trouble holding things
- Feelings of being shocked in your fingers
Onset of CTS symptoms is usually gradual. Maintaining a steady grip such as holding a phone or steering wheel could sometimes aggravate symptoms felt by the patient. Shaking or flicking of the hands often helps relieve the tingling sensation. In more severe cases, the numbness could be more constant, and they may also feel burning pain. As the disorder further progresses, it could lead to weakness and atrophy of muscles of the hand. This starts to be evident when the patient becomes clumsier and drops things due to weakness in pinch or grip strength.
What are the risk factors for CTS?
You are more at risk for developing CTS is you belong to any of these categories:
- Females aged 40-60 years old
- Employed in industries requiring repetitive and forceful wrist and hand motions
- Have a fractured or dislocated wrist
How do I know it is CTS?
The basis for carpal tunnel syndrome diagnosis are electromyography and nerve conduction studies. Clinical provocative or special tests such as the Tinel’s sign and the Phalen’s test, while not confirmatory to determine CTS, could help rule out other diagnoses and are used to warrant diagnostic procedures.
How can a physiotherapist help me?
Your physiotherapist will give you a therapy plan addressing your concerns depending on how your symptoms have progressed. This may include:
- Modifications of your activities and of your workplace. It is beneficial for a patient with mild symptoms of CTS to do a simple task or activity alteration in the work practice. Examples are taking adequate and frequent rest and doing a variety of wrist and hand movements.
- Soft tissue, carpal bone, and median nerve mobilization could also help in relieving mild to moderate symptoms.
- Using an appropriate splint to immobilize the wrist could also address mild to moderate symptoms. This may also help the patient have feedback on the position of his/her wrist especially when working.
- Posture assessment could also be done since nerves that pass through the neck could also be impinged when maintaining static, poor postures for prolonged periods. This may also cause numbness and tingling sensations in the hand.
If you are experiencing symptoms of CTS and ignore them, these symptoms can last a long time and may get worse. They could also go away, and then come back. It is important that you see your doctor and physiotherapist early to avoid irreversible nerve and muscle damage to your hands.
Written By: Janina Labao, graduated from University of the Philippines, Manila in 2008. She’s one of the pioneer physical therapists of a top tertiary hospital in Taguig. Experienced in handling children with developmental concerns having worked in a pediatric therapy center. Prior to joining Prohealth, she was also an itinerant physical therapist mainly to elderly patients with neurological and musculoskeletal cases.
