Lately in the clinic I’ve had a few people ask me what could be causing the numbness, tingling or shock-like pains in the palm of their hands.
Everyone seems to be busy using their hands at work, in the garden or on the orchard at the moment, which could explain the influx of these complaints.
If these symptoms are often aggravated at night as well as with work, it could be carpal tunnel syndrome.
This syndrome is caused from compression of the nerve (median nerve) within the carpal tunnel. However, this can be caused in a multitude of different ways—thickening of the tendons or ligaments within the tunnel, bone abnormalities or swelling are probably the most common causes.
This is usually the result of overuse through repetitive hand tasks in prolonged awkward wrist postures. Pregnancy, diabetes, arthritis and obesity are also factors that can predispose to compression and damage to this nerve.
If you turn your hand up and look at your palm, the carpal tunnel is the area just before the palm turns into the wrist. The bottom and sides of the tunnel are formed by the bones in your hand and wrist. The top is closed in by a ligament that stretches from one side to the other. Running through this tunnel are tendons, small muscles and of most interest to us, the median nerve.
Managing carpal tunnel syndrome can definitely be frustrating. The most important step is identifying the specific activities responsible for your symptoms and then modifying them. This could be through supporting your wrists in a straightened position, taking regular short breaks, incorporating varied wrist and hand positions within the task or even stopping the activity all together. This really does require a lot of discipline but is crucial if you are going to make a difference.
It is common for symptoms to be aggravated at night due to wrist positions you adopt while sleeping. Bracing your wrist in a straightened position at night may help to alleviate this. Your local pharmacy is likely to stock a suitable brace, however it’s best that the brace holds your wrist in a straightened position, rather than being bent.
The goal of physiotherapy is to promote smooth nerve and tendon movement within the carpal tunnel, as well as promote wrist range of motion and alleviate any inflammation or scar tissue contributing to pressure within the tunnel. In persistent situations, surgery is sometimes indicated. This involves decompression of the median nerve by cutting and releasing the ligament that forms one side of the carpal tunnel.
Carpal tunnel syndrome is often misdiagnosed due to the range of other conditions that can cause similar symptoms in the hand. The median nerve originates at the neck and can therefore commonly be affected by the joints and muscle at the spine and shoulder. For this reason, it is always important to have your condition assessed by your doctor or physiotherapist to ensure an accurate diagnosis and treatment plan.