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Carpel Tunnel Syndrome: What is it?

Jan 25, 2021

The carpel tunnel is a narrow, rigid passageway of ligament and bone that is found at the base of the hand. It houses the median nerve, which is a mixed sensory and motor nerve that runs from the end of the brachial plexus (located at the root of your neck) through the forearm to provide sensation and feedback to the thumb and first three fingers. Carpel tunnel syndrome is one of the most common peripheral nerve entrapment disorders in the upper limb and occurs when the median nerve becomes compressed or squeezed at the wrist. This kind of injury is most commonly caused by sudden trauma to the wrist, such as a sprain or fracture, that causes swelling. Other common causes include an overactive pituitary glad, an underactive thyroid gland or rheumatoid arthritis. This compression on the median nerve leads to symptoms including feelings of pain, numbness and tingling in the hand and arm.

When treating carpal tunnel syndrome, it is important to begin as early as possible once symptoms start. Non-surgical treatments can assist in making the problem go away if you’ve only experienced mild to moderate symptoms that come and go for less than 10 months.

Exercise Rehabilitation:

Range of motion and nerve gliding exercises have been shown to be the most effective in improving pain, pressure pain threshold, and overall function in patients with carpel tunnel syndrome.  Nerve gliding (also referred to as nerve flossing or neural gliding) is a stretching technique that takes areas of the body through specific ranges to help target and free up injured nerves and improve mobility.

Evidence shows that symptoms should begin to improve within two weeks of consistent daily nerve gliding exercises. After six to eight weeks, it is expected to feel no tightness or pain within your affected wrist.

 

Other Non-Surgical Therapy:

  • Splinting: Most common initial treatment is to wear a splint at night. A splint will stabilize the wrist and minimise pressure on the median nerve allowing a period of relative rest from movements that may increase symptoms.
  • Prescription medication: Corticosteroids or the drug Lidocaine can be prescribed and injected directly into the wrist or taken orally to relieve pressure on the median nerve.
  • Alternative therapies: Yoga has been shown to reduce pain and improve grip strength in people with carpel tunnel syndrome. Better joint posture may decrease intermittent compression, and blood flow may be improved to decrease ischemic effects on the median nerve.

 

James McNally (BSc – GradDipClin Exercise Physiology)

Workers’ Compensation Specialist

References:

Ruth Ballestero-Perez, Gustavo Plana-Manzano, Alicia Urraca-Gesto, Flor Romo-Romo, Maria de Los Angeles Atin-Arratibel, Daniel Pecos-Martin, Tomas Gallego-Izquierdo, Natalia Romero-Franco. (2016). Effectiveness of Nerve Gliding Exercises on Carpel Tunnel Syndrome: A Systematic Review. Journal of Manipulative and Physiological Therapeutics , 40 (1), 50-59.

NK Visweswaraiah. (2013). Yoga for Occupational Health and Rehabilitation. Indian Journal of Physiology and Pharmacology , 57 (5), 20-21.

National Institute of Neurological Disorders and Stroke. (2020). Carpel Tunnel Syndrome Fact Sheet. Retrieved from: https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/carpal-tunnel-syndrome-fact-sheet

 

Stretching and mobility benefits

18 Apr, 2024
Stretching and mobility exercises are indispensable components of both injury prevention and recovery strategies. Incorporating dynamic stretches before physical activity can help prepare the body for movement by increasing blood flow to muscles and enhancing joint flexibility. This dynamic warm-up routine primes the muscles and connective tissues, reducing the risk of injury during subsequent activity. Furthermore, static stretches, performed after physical activity, helps alleviate muscle tension and improve flexibility, thereby minimizing the likelihood of strains and tears. In the realm of injury recovery, stretching and mobility exercises play a crucial role in rehabilitation protocols for individuals recuperating from various musculoskeletal injuries. Following an injury, muscles can become tight and weakened due to disuse or trauma. Gentle stretching exercises aid in maintaining or restoring flexibility, preventing muscle atrophy and contractures. Additionally, targeted mobility exercises assist in restoring range of motion and functional movement patterns, allowing individuals to gradually regain strength and flexibility while reducing the risk of re-injury. Moreover, stretching and mobility exercises promote tissue healing by improving circulation to the injured area. Increased blood flow delivers essential nutrients and oxygen to damaged tissues, facilitating the repair process and reducing inflammation. By incorporating a comprehensive stretching and mobility routine into their regimen, individuals not only safeguard themselves against future injuries but also expedite their recovery journey, enabling them to return to their activities with greater resilience and confidence. Mariah Adolphus Workers Compensation Specialist (AEP, ESSAM) Exercise Rehabilitation Services ‑ WA

Meet a Team Leader at AB

05 Apr, 2024
Hey, my name is Blake, and I am an Exercise Physiologist, Workers Compensation Specialist and Clinical Team Leader at Absolute Balance. I graduated from Edith Cowan University in 2015 after completed my Bachelor of Science (Exercise Science and Rehabilitation). I grew up on a farm Northeast of Perth past Gingin with my parents and two brothers, both of which are back working on the farm, which has been in our family for generations. My love for sport and interest in the human body initially prompted me to complete my Bachelors in Exercise and Sports Science, and my initial thoughts on a career were either Physiotherapy or Phys Ed Teacher. However, this quickly changed when I commenced my first Exercise Physiology unit in my Sports Science degree as it opened my eyes to exercise rehabilitation, and how important it was to individuals with injuries. Having experienced multiple injuries personally playing football (AFL), basketball and tennis, I can fully empathise with how much injuries can impact your life. Being an EP and being in a role where I can make a positive and meaningful impact on individual’s lives who have sustained an injury is extremely important to me. This doesn’t only extend to the patients I see, but also the team members I lead within Absolute Balance. I guide a team of five in the Northeast region at Absolute Balance, assisting them with their own patients and leading them to grow as Exercise Physiologists and individuals. Although it has its challenges, leadership is extremely rewarding and has helped me grow both personally and professionally. Whilst I am not at work, I am spending my time at the gym, at football training and games during February-September (or in the car travelling to and from comes with the gig of country football), spending time with my wife and our dog Otis. I spend the other half of my weekend manicuring my lawn and watching good shows and sports. Blake Cocking Workers Compensation Specialist ‑ Team Leader North East (AEP, ESSAM) Exercise Rehabilitation Services ‑ WA

Pain in my lower back!

22 Mar, 2024
Does your spine look like the picture on the left or does it look more like the one on the right? As Exercise Physiologists, we often see all sorts of presentations of the spine and in this blog, we will be covering a condition known as ‘lordosis’. More specifically, we will be focusing on the lower or ‘lumbar’ aspect of the spine, which is where we see this condition commonly. What is Lordosis? Normally, the spine is naturally curved forward a little bit which helps with shock absorption and supports optimum posture but in lordosis there is an inward exaggeration of the spinal curve which can be felt on the outside as a deep dip in the lower back. Who does it affect? Simply put, anyone of any age group can develop lordosis and it is most seen in people who are pregnant, as a hereditary condition in children and adults with obesity or reduced bone density are at a higher risk of development of this condition. What is the cause? A common cause for lordosis includes poor posture as a result of weak core muscles and muscular imbalances which can be attributed to the modern-day lifestyle where we are sitting more than ever. Other causes include conditions such as osteoporosis, spondylolisthesis, kyphosis and as previously mentioned, obesity. What are the symptoms? An obvious symptom of lordosis is lower back pain. As you can see in the photos above, there is a higher risk of complication involving entrapment of a nerve when there is excessive spinal curvature leading to increased compression of the spinal vertebrae. Although sometimes lordosis can be asymptomatic and a person can go about their daily lives without too much of an issue, in more serious cases, those affected can potentially experience lumbar radiculopathy or sciatica, where there is compression of the exiting lumbar nerve roots and lead to symptoms which can be described as burning, tingling, radiating pain, paraesthesia and numbness in one or more uncommonly, both legs. How is it treated by an Exercise Physiologist? As they say, prevention is better than cure and to reduce the risk of potential future development of lordosis, maintenance of a healthy weight and engaging in core-strengthening exercises will assist with reducing the pressure placed on the spine as well as maintaining proper posture. However, if you are somebody who is already experiencing back pain as a result of lordosis, it is never too late to engage in physical therapy to improve pain-free range of movement, flexibility and mobility of the spine. Posture can also be improved significantly with strengthening of the appropriate musculature in the trunk, hips and lower limbs and addressing compensatory patterns that may have developed over time. For example, when a person spends a significant amount of time in a seated position, the muscles in the lower or lumbar aspect of the back can become excessively tight from trying to support and stabilise the spine. Additionally, muscle groups such as the hamstrings, glutes and abdominals become weak and inhibited, contributing to poor biomechanics. Physical therapy has been proven to be highly effective by taking a conservative approach to manage symptoms and improve function. With adherence to an appropriate rehabilitation programme an injured worker will have a higher chance of returning to work as well as a return to normal activities. Chris Chen Workers Compensation Specialist ‑ Innovation Team Leader (AEP, ESSAM) Exercise Rehabilitation Services ‑ WA
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