Carpal tunnel syndrome

Carpal tunnel syndrome is the most common illness pf the peripheral nervous system, that is when the median nerve is under pressure in the area of the carpal tunnel.

Risk factor of formation of this syndrome can be hormonal changes (disorder function of the thyroid gland, hormonal anticonception, pregnancy, menopause), metabolic illnesses (diabetes mellitus II), inflammatory rheumatic illnesses (rheumatoid arthritis), condition after trauma of the upper extremities, pathological processes in the carpal tunnel (ostephytes = bony projection), overloading the arms at work (working with computer, playing on a musical instrument, being exposed to vibrations). It occurs more frequently by women in middle age. One of the symptoms is tingling while resting in 1-4 fingers of the hand, the pinky finger doesn't tingle. Shaking the arm usually brings a relief. The pain can even wake people up from sleep. When the fingers come in contact with something, the person usually looses feeling in the fingers. Another symptom can be pain in the wrist. It can lead to disrupted function in the thumb, and the muscle strength is also lowered. In a final stadium the muscles are too weak. This syndrome can be diagnosed thanks to EMG, examining the axons (nerve fibres). Complication can be Sudeck's syndrome, that is when the hand hurts excessively, or is swollen and stiff, the skin has changed color and is sweating more than normally.

Therapy

Conservative therapy

Prevention - if your profession is physically demanding, it is optional to prevent formation of this syndrome by regular stretching of the muscles of the wrist, hand and cervical spine and reconsider to use ergonomic tools
In the starting phase of the illness - the goal of the therapy is to reduce the painfulness, affect the function of the muscles, which are supplied with median nerve, improving blood supply, affecting sensitivity and improving the function of the joints of the hand

  • Peaceful regime - not overloading the upper arm + changed habits at work and avoiding stereotypical activities
  • Positioning - it is recommended to wear orthosis during the night in a neutral position of the hand (bigger bend in the wrist is not ideal in order to relieve the median nerve from pressure)
  • Cryotherapy - cooling compresses are applied in order to reduce the swelling and lower the pain
  • Application of kinesio tape - in order to lower swelling and painfulness
  • Techniques of the soft tissues and massage - relieving the muscles of the hand, wrist, forearm, shoulder and nape
  • Stretching the muscles of the hand, wrist, forearm, shoulder and nape
  • Mobilizing the small joints of the hand, carpal bones, elbow, shoulder and cervical spine
  • Using analgesics (lowering the pain) and antiphlogistics (lowering inflammatory changes)
  • Application of corticoids with anesthetics into the carpal tunnel - it is closely related to risks (application outside of carpal tunnel, application into the blood vessel, with frequent application damage of the muscle tendons occurs)

If the conservative treatment is unsuccessful, doctors usually step to outpatient surgical treatment, using laparoscopic or classical incision. The surgeon will cut into the transverse carpal ligament but won't cut it completely, that will lead to release of the structures. After the surgery recurrence of the problems cannot be completely excluded.

After surgery

  • The hand is after the surgery immobilized with bandage or a short gypsum cast for better healing, and after the cast is removed, the patient will most likely be recommended to wear orthosis over night in order to strengthen the wrist
  • Positioning - lifting the arm in order to prevent formation of swelling
  • Taking care of the scar after removing the suture after 7 - 10 days - pressure massage of the scar, massage ball
  • Manual lymphatic drainage for regeneration of the lymphatic system
  • Recovering the function of the hand, mobility of the fingers and training to hold things, and increasing the mobility of the wrist
  • Relaxing and stretching exercises for the muscles of the hand and forearm
  • Mobilizing techniques for the smaller joints of the hand, carpal bones, elbow, shoulder and cervical spine
  • Strengthening techniques - after a month it is ideal to start to gradually burden the hand
  • Exercising with neurophysiological basis for better coordination of the muscles of the whole arm
  • Preventive measures - avoiding to overload the hand with repetetive stereotypical movements
  • Taking the vitamines from the group B for better regeneration of the nerve
  • Full burden after 3 months since surgery!

EXERCISE TUTORIALS

Návody 1 - obrázek
This exercise is suitable for stretching the flexors of the wrist and fingers. If you will exercise regularly, you will prevent any overloading of these muscles, and pain on the inner side of the elbow.
Návody 2 - obrázek
This exercise helps to strengthen the flexors of the fingers and wrists. It is ideal as prevention against pain in the inner side of the elbow and generally against muscle overload which bend your wrists and fingers.
Návody 3 - obrázek
You will strengthen the extensors of your hand and forearm in the wrist area. This exercise serves as prevention against pain in the inner side of the elbow and generally against muscles overload which extend your fingers and wrists.

EXERCISES WITH NEUROPHYSIOLOGICAL BASIS

Návody_2 1 - obrázek
This exercise is ideal for straightening the spine and head, activation of the core muscles and for strengthening the muscles of the shoulder blades and shoulders.
Návody_2 2 - obrázek
This exercise is ideal for straightening the spine and head, activation of the core muscles and for strengthening the muscles of the shoulder blades and shoulders.
Návody_2 3 - obrázek
This exercise is ideal for straightening the spine and head, activating the core muscles and stabilize the pelvis, hip joints, shoulders and shoulder blades.

EXERCISES FOR THE CERVICAL SPINE

Návody_3 1 - obrázek
Concept of this exercise comes from a physiotherapeutic method McKenzie. This method is effective against back pains, when the intervertebral discs are damaged, cervical spine pain, tingling in typical neurological involvement and other cases. Thanks to this exercise the pain intensity is lowered, the nerve irritation is transferred from the limbs towards the spine and there is also an increase in the movement range.
Návody_3 2 - obrázek
This is a manual how you can help yourself when your neck is stiff. It will effectively relax muscles in the neck area, back, muscles around scapulas and short extensors around head and neck. Exercise is also optional to perform if you suffer from migraines and headaches.
Návody_3 3 - obrázek
This exercise is optional especially for stretching and relaxing your neck muscles. You can perform it almost anywhere. If you're in your car, don't hesitate and stretch yourself. Thanks to this easy and effective exercise you will relax your neck muscles, trapezius and shoulder blade muscles. Exercise is effective for example against migraines or unpleasant headaches. This exercise can help you from acute pain, but it's also great as a prevention against blocked cervical spine.