Carpal Tunnel
What is Carpal Tunnel?
You've probably already heard about carpal tunnel syndrome (CTS) and its effect on different occupations, like computer programmers and assembly line workers. Maybe you even know someone who has CTS or you yourself are suffering from it. But what exactly is CTS, and how do you keep from getting it?
Carpal tunnel syndrome is a condition that may be caused by repeatedly performing stressful motions with your hand or holding your hand in the same position for long periods of time. CTS is classified as a cumulative trauma disorder, an ailment that attacks the body's musculoskeletal system. The musculoskeletal system is made up of muscles that pull on tendons and move the bones at joints. The joints are held together by ligaments. Carpal tunnel syndrome specifically affects the sensitive nerves of, and the blood supply that feeds, the hands and wrists.
Carpal tunnel syndrome has been around for a long time. Meatpackers began complaining of pain and loss of hand function in the 1860s. Back then, these complaints were largely attributed to poor circulation.
But the nature of work has changed over the years. Today, more jobs are highly specialised and require use of only a small number of muscles repeatedly. With the growing numbers of people using computers and keyboards, plus the focus on better health care for workers, carpal tunnel syndrome is of real concern to both employers and the health care professions.
Recent studies have shown that carpal tunnel syndrome, like all other cumulative trauma disorders, is on the rise while other workplace injuries have leveled off. Many companies are turning to physical therapists for help in designing and implementing health promotion and injury prevention programs to protect their employees from CTS.
This article explains what carpal tunnel syndrome is and the role physical therapists play in treating this debilitating disease and in educating people about possible risk factors. It also tells you how you can avoid CTS both at work and at home.
What are the symptoms?
People with CTS usually experience feelings of numbness, weakness, tingling, and burning in their fingers and hands. If not treated, the symptoms may escalate into acute, persistent pain. CTS can become so crippling that people can no longer do their work or even perform simple tasks at home. At its most extreme, carpal tunnel syndrome forces people to undergo surgery and miss many days of work, or prevents them from working at all because their hand functions are permanently impaired.
How can Physical Therapy help?
Physical Therapists with specialised training in cumulative trauma disorders and ergonomics have been working in industrial and corporate settings for many years to meet the health care needs of America's workforce. They work closely with employers to educate employees about CTS - what causes it and how to avoid it through proper use of the musculoskeletal system. Physical Therapists can target and correct poor work habits and improper work designs, such as tools, furniture, equipment, and work space. They also can assess the risk potential of an individual and determine if that person is physically unsuited for a particular job.
Among their many responsibilities, Physical Therapists teach health awareness and job safety. A typical education program includes exercises employees can do at work and at home, adjustments to the overall work environment and individual work stations, plus early detection of symptoms to avoid painful and costly surgery.
What your evaluation will entail?
An extensive evaluation will be conducted and will include Rehabilitative Ultrasound Imaging (RTUI) of your wrist and forearm to image the median nerve. This is the nerve which is compressed in those with carpal tunnel.
Further tests will include:
- Tinel's Test
- Phalen's Test / Sign
- The Carpal Tunnel Release Maneuver
- The Monofilament Test
Tinel's Test
This is performed by tapping the wrist over the median nerve. If it causes an electric shock-like sensation to spread over the median nerve distribution — into the thumb, index, and middle finger — it is positive.
Phalen's Test / Sign
Phalen's sign or the wrist flexion test is performed by having the patient drop both wrists into flexion with fingers and thumbs extended for 60 seconds. If the digits "fall asleep" the test is positive.
The Carpal Tunnel Release Maneuver
This test has two positions. In the first, the palm is held face up and the big knuckles are squeezed gently together for 30 seconds. In the second, the palm is turned downwards and the index and little fingers are flared out for 30 seconds. CTS is indicated if symptoms are relieved with either maneuver.
The Monofilament Test
The Monofilament Test is a specialised sensory test that measures touch sensation by pressing plastic filaments of varying thicknesses on the patient's fingertip. Sufferers with severe carpal tunnel syndrome aren't expected to feel anything except the thicker filaments on affected digits, but might feel the thinnest on the unaffected ones. It has a very high correlation with EMG but can also indicate cervical Radiculopathy.