Thursday, June 11, 2015

Carpal tunnel syndrome

Carpal tunnel syndrome occurs when the median nerve is compressed at the wrist. The median nerve originates from cervical  spinal nerves and controls movement and sensation to the palmer side of the hand, thumb, and fingers. The carpal tunnel, a narrow passageway in the wrist, is formed by bones on the bottom and sides and a ligament which composes the top of the tunnel. The tunnel also contains nine tendons that are connected to the bones and muscles of the hand. Under various circumstances these tendons may swell and enlarge causing compression of the median nerve against the ligamentous roof which results in the symptoms experienced in carpal tunnel syndrome.
Numbness and a “pins and needles” sensation are the most common symptoms. Most often the thumb, index, and middle fingers are involved. Symptoms are often worse upon waking or during activities that involve flexing and extending of the wrist. As the syndrome worsens, decreased grip strength makes it difficult to perform tasks with the involved hand.
Due to the fact that the median nerve emerges from the neck, it is important that the patient be thoroughly assessed to determine that the symptoms are not coming from a nerve entrapment (pinched nerve) in the neck, shoulder, or forearm.
Phalen's test helps diagnose the problem, with compression of dorsal aspects of hands the numbness and tingling sensation aggrevates. Other test would include tinel's sign, X-ray to rule out bony abnormalities and EMG and NCV to determine the extend and detrimental  effect of nerve compression.

Physiotherapy treatment would comprise of modalities that includes US and IFT, stretching of median nerve (this also reduces the chances of double crush syndrome). Exercises would include reverse phalen's maneuver ( i.e namaste pose, with elbow and wrist at 90-90 position and shoulders resting by the sides) and strengthening of musculatures around the wrist. Tendon gliding exercises are also very helpful in increasing the mobility of tendons in the tunnel.