By Bronwyn Muldoon

Redstone Review

LYONS – As a physical therapist I see injuries in all parts of the body. Most people who come in without seeing a doctor usually generalize their problem: for example they state my knee hurts, or my shoulder hurts when I do this particular movement. These patients usually don’t come in and state that their meniscus hurts or that the Teres minor muscle of their rotator cuff is injured. But people who have hand problems typically label their pain as carpal tunnel.  While carpal tunnel does account for a significant amount of hand problems, it is commonly diagnosed incorrectly.

Carpal tunnel is a very specific injury involving the median nerve. While many causes of carpal tunnel are unknown, it typically occurs from repetitive motion and repetitive use. Some common conditions that can lead to carpal tunnel include obesity, pregnancy, hypothyroidism, arthritis, diabetes, and trauma.  Symptoms classically include numbness and tingling in the hand, mainly the thumb, first and second fingers, pain at night, and weakness in the hands, mainly with gripping and/or picking up small objects.  Carpal tunnel can occur in one or both hands simultaneously.

Carpal tunnel syndrome got its name from the carpal bones that make up the wrist joint. The eight bones form a ring (tunnel) where nine tendons and the median nerve run through. The tendons that form in your forearm are responsible for the majority of mobility in your fingers. When we use our hands, these tendons move.  If the movements cause stress in the tendons, which can happen from overuse, the tendons swell, thus putting pressure on the nerve.

How do you know if you have carpal tunnel? There are two tests that help determine if the median nerve compression is from your wrist. Since the nerve pain can also be due to compression from the cervical spine or from the brachial plexus around your shoulder, a comprehensive assessment of the cervical and the shoulder areas should be performed by a health professional. If these areas are not cleared, one will believe they have carpal tunnel and will not receive the correct treatment. Once the neck and shoulder have been ruled out for nerve compression, the following two tests should be performed.

The first test is the Phalens test: place the back of each hand back to back and have your fingers positioned down towards the floor (opposite of the prayer position). If you do this and you

experience numbness or tingling within 30 seconds than the test is positive.

The second test is the Tinels test: this test requires you to tap over the median nerve in the wrist. The tapping should occur directly in the middle of your wrist, at the crease. If the tapping causing numbness and tingling in your hand, than the test is positive.

Both tests do not have to be positive for a confirmation of carpal tunnel syndrome; however when the cases are severe, both will elicit a positive response typically within five seconds.

If you have carpal tunnel there are few things that you can do. One of the first things to do is to look at your activities throughout the day and try to identify what position or activity is causing the stress. Once identified, ask yourself whether this activity can be modified or broken into segments through out the day.

Wearing a wrist brace will help calm down the tendons as it will limit your activity level. When the tendons aren’t used as much, they will not become as inflamed, and thus not put pressure on the nerve. Most people wear the braces when they sleep, which relieves their symptoms.

Exercises for strengthening are very useful. When muscle testing, it is common to find shoulder weakness in patients with carpal tunnel. When the shoulder muscles are weak, people tend to overuse their forearm and hand muscles. Strengthening the shoulders and forearm areas helps relieve the symptoms.

As for treatment modalities, ultrasound and electrical stimulation can be beneficial. Surgery can also be performed if conservative treatment does not relieve your symptoms. If you would like more information, please contact your healthcare professional.

Bronwyn Muldoon is a physical therapist and the owner of Lyons Physical Therapy on High Street. She is celebrating the 11th anniversary of her office in Lyons.

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