Carpal Tunnel

What is it?

Carpal tunnel syndrome is a condition affecting one of the main nerves in the wrist area. The carpal tunnel is a space created by the natural arch of the wrist bones. A thick band called the transverse carpal ligament creates a roof to the tunnel. This means that the size of the tunnel cannot change, as the bones and ligament act like solid walls. Nine tendons that bend the fingers and thumb and the median nerve pass through the tunnel. The median nerve provides sensation to the skin of the thumb, index and middle fingers, as well as half of the ring finger. The nerve also provides the communication line to the muscles at the base of the thumb. ^[1]

There is unfortunately no exact single cause that causes carpal tunnel syndrome. The condition CTS may result from a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself. Sometimes, irritated tendons can thicken or swell, which can narrow the tunnel and compress the median nerve. In many cases, no single cause can be identified. A few basic and often common causes include the following:

• Anatomical changes and differences: (The carpal tunnel opening is too narrow)
• Some people may have smaller than average carpal tunnel size, which could run in families
• Women, on average, have smaller carpal tunnel size than men and are more likely to develop carpal tunnel syndrome
• Bones and joints could change shape over time due to diseases such as osteoarthritis or trauma to the wrist
• Swelling and inflammation: When tissues in and around the carpal tunnel swell up, they could press on the median nerve. Swelling and inflammation could result from:
• Frequent, repetitive movements with the hands
• Extending or flexing the wrist for long periods of time
• Rheumatoid arthritis and other conditions that cause inflammation in the joints
• Hormonal or metabolic changes (for example, menopause, pregnancy or thyroid imbalance)
• Other factors:
• Other conditions or injuries of the wrist (for example, strain, sprain, dislocation or break)
• Obesity ^[3]

Splints: Wearing a resting splint can help prevent the symptoms occurring at night, or a working splint can be useful if your symptoms are brought on by particular activities. Your doctor or physiotherapist can advise on where you can be fitted with a splint. ^[4]

You should use the exercises below for at least 6–8 weeks to help prevent symptoms returning.

Rest your elbow on a table, arm pointing up, wrist straight.

Gently bend your wrist forward at a right angle and hold for 5 seconds.

Straighten your wrist.

Gently bend it backwards and hold for 5 seconds.

Do 3 sets of 10 repetitions. ^[4]

Place your palm on the table and lift the fingers up.

Place your other hand across the knuckles at 90º and push down as the bottom hand tries to pull up.

You should feel the muscles of your forearms contracting.

Swap hands and repeat. ^[4]

Keeping your arm straight in front with your palm facing down, gently bend your wrist down.

Use the opposite hand to press the stretching hand back towards your body and hold for 15–30 seconds.

Straighten your wrist.

Gently bend the stretching hand backwards and use the opposite hand to pull the fingers back.

Hold for 15–30 seconds.

Do 3 sets with each wrist. ^[4]

Start with your fingers held out straight.

Gently bend the middle joints of your fingers down toward your upper palm and hold for 5 seconds.

Do 3 sets of 10 repetitions. ^[4]

Holding a light weight (e.g a tin of beans), stretch your arm out in front with your palm down.

Slowly bend your wrist upward, and then return to the starting position.

Do 3 sets of 10 repetitions.

Gradually increase the weight you hold ^[4]

Squeeze a rubber ball and hold for 5 seconds.

Do 3 sets of 10 repetitions. ^[4]