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Do You Have Numbness and Tingling in Your Hands? You May Have Carpal Tunnel.


Carpal Tunnel syndrome (CTS) is a common nerve injury that is estimated to occur in 3-4% of the general population. It is the most common entrapment neuropathy in the upper extremities, and occurs when the median nerve is compressed as it travels through carpal tunnel in the wrist.

This injury often occurs in repetitive work/ sport related activities, such as: typing, writing, driving, use of vibrating tools, or holding a phone for a prolonged period of time. There are many risk factors associated with CTS including: arthritis, obesity, pregnancy, age, etc. Women are also three times more likely than men to have CTS.


Common signs and symptoms include:

· A dull ache/pain in the hand, forearm, or upper arm

· Paresthesias (numbness and tingling) in the median nerve distribution of the hand.

o Median nerve distribution: palmar aspect of the thumb, index, middle, and ½ of the ring fingers.

· Night pain

· Morning hand/wrist stiffness that may persist throughout the day

· Pain with sustained arm/hand positions

· Poor/weak grip, wrist and forearm strength

o Difficulty holding objects, opening jars/bottles, flexing the wrist, pronating the forearm etc.

· Atrpohy of the thenar eminence


Physical therapists can help by starting with a detailed evaluation. The median nerve is one of multiple nerves derived from the brachial plexus in the cervical spine that travels down the arm and into the hand. Performing a physical examination of the neck, shoulder, elbow and wrist/hand are all important aspects of the evaluation. Along with clearing joints up the chain, physical therapists may check for neural tension, muscle strength, palpation for tenderness and use special tests to properly determine a patients impairments.


Physical therapy treatment and interventions can help address a patient’s impairments, and return a patient to their job or sport without pain or limitations. Treatment may include: soft tissue mobilization, joint mobilization, stretching/ strengthening for the upper extremities, and modalities. Physical therapist can also help educate patients on activity modification, use of assistive devices such as night splints, ergonomics, and posture. From treatment, a physical therapist can help to reduce pain, decrease myofascial restrictions, improve flexibility and increase strength.



References:

1. Uchiyama S, Itsubo T, Nakamura K, Kato H, Yasutomi T, Momose T. Current concepts of carpal tunnel syndrome: Pathophysiology, treatment, and evaluation. J Orthop Sci. 2010;15(1):1-13. doi:10.1007/s00776-009-1416-x.

2. Wipperman J, Goerl K. Carpal tunnel syndrome: Diagnosis and management. Am Fam Physician. 2016;94(12):993-999. doi:10.1017/CBO9781107415324.004.

3. Goodman, Catherine and Snyder T. Differential Diagnosis for Physical Therapists: Screening for Referral. 5th ed. St. Louis, Missouri: Elsevier Inc.; 2013.

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