Carpal Tunnel Syndrome

Carpal Tunnel Syndrome

What is Carpal Tunnel Syndrome (CTS)?

The word ‘Carpal’ comes from the greek word Carpus which means ‘wrist’. Surrounding the wrist is a band of tissue, the body’s own wrist  support, called the Transverse Carpal Ligament. Between this ligament and the ulna and radius is a tight space known as the carpal tunnel. Within this tunnel is the median nerve which receives sensation from the thumb, index and middle fingers of the hand.

CTS is the term given to any condition that causes reduced space within the tunnel, compressing the median nerve and causing pins & needles and numbness into the palm, thumb, index and middle fingers.

 What causes Carpal Tunnel Syndrome?

 Any condition that causes pressure on the median nerve at the carpal tunnel can cause the syndrome.

 The following are just some examples:

 ·       Obesity (increase in adipose tissue in area around wrist)

·       Arthritis (inflammation around the wrist joint / transverse ligament)

·       Diabetes (change in blood flow to the hands / circulation affects)

·       Pregnancy or Menopause (water retention)

·       Repetitive Strain Injuries (RSI) (RSI can lead to inflammation of the joints or soft tissue)

 Most people would first experience the symptoms of CTS during the night as we tend to sleep with the wrists flexed. The common history of a sufferer is frequently waking in the night to shake out the hands & wrists because of tingling. With an increase in symptoms the client is likely to suffer from CTS during the day, usually as a result of repetitive or sustained wrist flexion.

Who is at risk of Carpal Tunnel Syndrome?

 Women are approximately 3 times more likely to develop CTS than men, potentially because the tunnel itself is anatomically smaller in most women. More often the dominant hand is the first to become symptomatic and as such there is also high correlation with activities / work that involves repetitive use of wrist flexion, i.e. production line work, sewing, manufacturing, etc.

How is Carpal Tunnel Syndrome diagnosed?

 The classic tests for CTS are:

·       The TINEL test – the clinician would repeatedly tap the client’s wrist crease over the median nerve – the test is positive if the client reports tingling in the fingers

·       Phalen’s test – the clinician asks the client to hold their forearms upright, point the fingers down (flexing the wrists) and placing the backs of the hands together – this test is positive if symptoms are reproduced within 1 minute.

·       Scans – further investigations in the form of MRI or Ultrasound scans can also demonstrate any occlusion within the tunnel or damage to the median nerve.

Pilates and Carpal Tunnel Syndrome

 Specific treatment for Carpal Tunnel Syndrome should begin as early as possible in order to avoid a significant build up and the need for surgical intervention. Early intervention would usually involve avoiding activities that are causing the symptoms, wearing a splint to keep the wrist in extension and using ice over the affected area.

 Research has been conducted on several modalities to treat CTS and one that has consistently proven effective is exercise rehab and specifically Yoga! Research shows that strengthening exercises for the forearm and wrist and mobilisation exercises for the neural pathways can help to reduce symptoms and prevent reoccurrence.

 As a Pilates teacher it would be worth considering work in a neutral wrist alignment during the acute phase, i.e. avoiding prolonged wrist flexion and loading in that position as with prone lumbar extension work and 4-point.

 In my experience, as with most ailments, it is always worth checking further along the line and in this case considering the client’s cervical spine and scapula positioning whilst in the CTS provoking posture may lead you on the way to designing a programme of repair!

 Basic correction of alignment from the cervical spine to the scapula through to the wrist with all exercises will help to strengthen the upper line and further reduce the onset of CTS in these clients. Consider flowing arm movement exercises from the cervical spine to the end of the fingertips to encourage the natural glide of the neural tissue. By incorporating this in their repertoire and more importantly, educating them on why it is essential, the client is less likely to either develop further symptoms or suffer from it again.

 Finally, consider any external variables that could be influencing the presence of CTS in your clients. As with all tissue mobility vitamin balance and hydration are crucial!