CARPAL TUNNEL SYNDROME: INFORMATION
Carpal tunnel syndrome is a condition which is characterised by irritation or entrapment of the median nerve.
This nerve can get entrapped at various sites along its course down the upper limb and each site is specific with regards to the clinical presentation, i.e. pronator teres syndrome, anterior interosseous nerve entrapment and carpal tunnel syndrome.
With carpal tunnel syndrome, the median nerve is entrapped as it passes through the osteofibrous tunnel created by the transverse carpal ligament and small carpal bones of the wrist. Within this tunnel, the median nerve can become compressed directly from fractures or dislocation. More commonly, the patient has a history of prolonged repetitive wrist and finger use, whereby swelling or thickening of the overused tendons is thought to decrease the space for the passage of the nerve into the wrist. Additional factors which may contribute to the development of this condition include diabetes and pregnancy. Carpal tunnel syndrome is the most common peripheral nerve entrapment encountered.
The lower part of the median nerve supplies the first and second lumbricales along with the muscles of the thenar eminence, namely the abductor pollicis brevis, opponens brevis and flexor pollicis brevis. The median nerve also supplies sensation to the thumb and radial side of the index finger, second finger and half of the third finger (see below).
With carpal tunnel syndrome, patients report tingling in the median nerve distribution of the hand (see above) which is often worse at night. There is also often a complaint of clumsiness and, in severe or prolonged cases, there may be weakness in the muscles which are supplied by the median nerve in the hand.
Specific neurological and orthopaedic tests confirm the diagnosis of this condition. In addition, referral may be required for specific nerve conduction studies. In the clinic setting, various tests can be utilised include Phalen’s, reverse Phalen’s and Tinel’s tests. A positive finding for these tests are often the reproduction of the tingling in the median nerve distribution. It is also necessary to carry out a full assessment of the neck as if there is some irritation from the lower nerve roots that exit the neck (C6), which may also give rise to, or contribute to, tingling in the distribution of the median nerve.
Once the diagnosis has been established, patients are often advised to modify any activities which are contributing to this complaint, such as reducing the amount of computer usage or improving their ergonomic set up to reduce the stress on the finger and wrist flexors. A splint may also be advised.
(The list of conditions given above and subsequent explanations are intended as a general guide and should not be considered a replacement for a full medical examination. Furthermore, we do not purport to treat all the conditions listed. Should you wish to discuss any of these conditions with our chiropractors, please do not hesitate to phone the clinic on 020 7374 2272 or email enquiries@body-motion.co.uk).
Our team of chiropractors and massage therapists are on hand to answer any questions you may have, so get in touch today via enquiries@body-motion.co.uk or on +44 (0)20 7374 2272.
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