Carpal Tunnel Syndrome

1What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome (CTS) is the most common nerve compression syndrome of the upper extremity. It is caused by compression of the median nerve as it passes through the carpal tunnel into the hand. Common symptoms include pain, tingling and numbness, primarily affecting the thumb, index and middle fingers. In severe cases, there may be evidence of atrophy of the thenar muscles and associated grip and pinch weakness. Symptoms are usually worse at night and during aggravating day time activities such as typing, driving and when using tools that produce vibrations.

Eitiology:

Median nerve compression occurs in the carpal tunnel because there is too little space or too much pressure within the tunnel, resulting in decreased blood flow to the nerve. Pressure within the tunnel normally increases when the wrist is bent forward or backwards. Repetitive bending of the wrist can lead to inflammation of tendons that share the same tunnel as the median nerve, contributing to nerve compression. Prolonged congestion within the nerve results in intermittent disturbance in nerve conduction that ultimately, if not treated, results in permanent damage to the nerve.

2Non operative treatment:

At Hand Works, we strongly believe in the importance of appropriate early intervention and treatment to minimize the risk of a potentially long term disability, and reduce the need for more invasive surgical intervention. For most cases of CTS, we recommend that conservative management is trialed for at least 3-4 months before considering surgical intervention. Non-operative treatments include orthosis fabrication, education and activity modification. A wrist orthosis is used to rest the inflamed structures and to minimize intra-tunnel pressures on the median nerve. Wrist orthoses are often advised to be worn nocturnally and during day time tasks that involve repetitive wrist movements. At Hand Works we have various options of orthoses available to cater to each individual’s needs. We are able to fabricate customised thermoplastic orthoses, provide pre-fabricated wrist braces, and we also sew customised soft neoprene wrist braces.

1Post-operative management:

Once a patient has undergone surgical release of the carpal tunnel, post-operative hand therapy is crucial in assisting them return to their normal function and occupation in a timely manner. At Hand Works, we are able to provide patients with comprehensive post-operative care from removal of sutures, wound and scar management, home exercise programs, strengthening and work hardening programs and sensory re-education.