Carpal Tunnel Syndrome: Median Nerve Compression

Our hands are a complex collection of bones, muscles and ligaments, from the tips of our fingers to the nerves in our wrists. The wrist is a crucial part of our hands when it comes to everyday actions like lifting, moving or simply gesturing, as it bears the weight and transfers the power from our arms.

Uneven or excessive pressure exerted by the wrist joint on the nerves in the hand can lead to tingling and a numbness sensation in the hand and arms. This condition is called Carpal Tunnel Syndrome.

Mild cases of carpal tunnel syndrome usually resolve by themselves, however, if untreated the condition often grows progressively worse and can lead to long term degeneration including pain and rigidity.

In chronic cases, the patient experiences intense pain and stiffness of the hand and arms. The mobility of the joint is severely impacted and can have debilitating effects on a patient’s quality of life.

 Causes Of Carpal Tunnel Syndrome (CTS)

Carpal tunnel syndrome occurs when uneven or excessive pressure is applied to the middle hand nerve (commonly known as the median nerve). The tunnel that holds the nerves and blood vessels is constricted, leading to a build-up of pressure. Some of the more common factors that lead to the development of this condition include:

• Malformations in the wrist and an innate narrowness of the carpal tunnel from birth.
• Inflammation and swelling of the surrounding soft tissue that leads to sustained pressure.
• Frequent and repeated movements that lead to overstraining of the wrist. For example, typing at a keyboard all day, writing with a pen/pencil for extended periods, and domestic work like cleaning/washing.
• Accidental trauma or injury to the forearm, wrist or hand.
• Obesity, diabetes or thyroid disorders which could lead to fluid buildup in the soft tissue. This leads to increased pressure on the median nerve.
• Presence of a growth or tumour in the Carpal Tunnel.
• Hormonal changes can lead to the inner skin of the joint to swell. This is especially common in women during pregnancy.

Carpal Tunnel Syndrome Symptoms

Some of the more common symptoms of Carpal tunnel syndrome include:

• Tingling and numbness sensation in the hands and arms.
• Initially symptoms of pain and discomfort show up during strenuous activities and after long periods of inactivity like a long night’s sleep.
• A recurring sensation of hands “falling asleep”.
• In chronic cases, the joint becomes stiff and mobility is severely restricted.

Reduced functioning and permanent paralysis are fairly significant risks due to degeneration and it is highly advised that patients seek immediate medical attention if the symptoms of carpal tunnel syndrome are experienced. Early treatment is essential to prevent such issues from occurring.

Diagnosis Of Carpal Tunnel Syndrome

A medical professional begins with a complete patient history and a physical examination of the elbow. This provides critical information about the risk factors to the patient as well as allowing for a study of the progression of the condition.

Functional and provocation tests are conducted to measure the nerve conduction speed of the median nerve and can be conducted by a GP.

Sophisticated imaging technology like X-Rays and Ultrasound can be used to get more information about the spatial conditions of the joint.

Treatment For Carpal Tunnel Syndrome (CTS)

Treatment for Carpal Tunnel syndrome depends entirely on the progression of the disease. Providing ample support and stabilisation to the joint can help treat any damage done to the wrist. Early intervention is the best course of action to prevent degeneration and permanent nerve damage.

Immobilisation

Immobilising the wrist through the night and preferably through the day has proven effective to manage the symptoms of the condition, best done with a brace. This allows the wrist to rest and heal quicker.

Rehabilitation And Physiotherapy

• Regular physiotherapy helps with targeted muscle training and is a proven effective treatment path. The physiotherapy exercises can help promote reorganization of the muscles and are the most effective option to curb the disease.
• Encouraging healthy proprioception and strengthening of the muscles in the wrist helps prevent long term degeneration.
• Regular targeted exercises as instructed by a doctor or physiotherapist can help maintain the mobility and effective functioning of the joint and is highly recommended.

Prescribed Painkillers

Painkillers such as Ibuprofen or Panadol can be used to help alleviate pain and discomfort in patients. Pain, however, is a crucial indicator of the injury. Painkillers merely mask the pain without addressing the underlying condition. These should only be used when directed by a doctor, and not for any extended periods.

Wrist Brace And Support

A medical wrist brace or splint will help reduce the pain and discomfort patients experience by taking pressure off the joint. Wearing a Bauerfeind wrist brace like the ManuTrain or ManuLoc helps minimise the chances of injury and deterioration by providing enhanced stability, proprioception and comfort. This is not found in simple neoprene sleeves and braces and is instrumental in a speedy recovery.

Surgical Intervention

Operative surgery is considered in severe cases where symptoms are persistent, and all conservative treatments have been exhausted. In chronic conditions, a surgeon can perform operative surgery on the carpal ligament surrounding the carpal tunnel.

This also allows the surgeon to clear any constricting tissue and relieve the median nerve. Patients have reported alleviation and in some cases elimination of symptoms post-operation, however this is a last resort and carries with it more risk than any other treatment.

Carpal Tunnel Syndrome Wrist Braces & Supports

Medical wrist braces like the ManuTrain and the ManuLoc are perfect for both everyday conservative and post-operative care, making them ideal for anyone suffering from Carpal Tunnel Syndrome, regardless of their stage.

The ManuTrain Wrist Support features a removable plastic stay, running along the underside of the wrist, which can help provide greater stability to the wrist when needed. This stay can be used to further prevent wrist movement, without full immobilisation. An additional velcro strap can be used to further enhance the stabilisation and compressive effect of the ManuTrain.

Unlike the ManuLoc (below), two contoured gel massage pads are featured in the ManuTrain. These gel pads help to relieve strain and pressure off the nerves and blood vessels in the wrist.

The ManuLoc wrist brace stabilises the wrist and takes the pressure off the median nerves with its lightweight splint stays and anatomic contour.

This allows the soft tissue to heal and greatly reduces swelling. The brace effectively immobilises the joint and prevents further irritation of the inflamed or damaged tissue.

The ManuLoc is designed to be particularly comfortable during physiotherapy, increasing the effectiveness of any therapy, and fits in with any treatment plan.

The brace can be freely taken off and put back on easily, even with one hand, and still allows full movement of the fingers and thumb. The breathable and comfortable material makes it perfect for everyday use.

In most cases the ManuTrain Wrist support would provide adequate pain relief. If you have severe symptoms and require the brace to minimise movement we would recommend the ManuLoc.