Carpal tunnel syndrome is one of the most common disorders of the upper limb, affecting around 5% of the population in developed countries (AAOS, 2010). Left untreated it can be debilitating causing sensory loss and in some cases paralysis.
So what do we know?
Clinical approaches are guided by research findings. A multimodal approach to conservative management is adopted initially and often has positive results. Commonly NSAIDS in conjunction with soft tissue release techniques, median nerve glides and splintng have all demonstrated beneficial outcomes. If pain persists, ultrasound guided cortisone can be useful. If symptoms are still ongoing surgical options may be indicated.
The key message we see in clinical practice is that it is important for the patient to understand the factors contributing to their carpal tunnel syndrome. If identified early, aggravating activities, tension and biomechanics can be addressed, treated and preventive strategies implemented for life.
Below is an outline of just some of the treatment options available for carpal tunnel syndrome.
Tendon and nerve gliding exercises
Ayse et al (2009) discussed tendon and nerve gliding exercises to relieve symptoms. 'Stretching adhesions and increasing the distance between the median nerve and transverse carpal ligament, decreases oedema and compression within the carpal tunnel.' They found that 71% of patients treated with a conservative program plus tendon and nerve gliding exercises became asymptomatic compared with 48% of patients treated with a standard conservative treatment at 11 months.
Local steroid injections
In a randomised, open, controlled trial by Ly-Pen et al, looked at 163 subjects with carpal tunnel syndrome. Subjects were split into two groups, half had surgery and the other steroid injections. The injection group had better outcomes at 3 months in regards to pain and paraesthesia. Results were identified at 6 months and 12 months.
Numerous studies have found that splinting of the wrist in a neutral position improves symptoms and hand function in patients with carpal tunnel syndrome. O'Connor et al (2012) reports that patients using a splint are likely to express improvement almost four times more than patients who receive no treatment.
Carpal bone mobilisation
Trials by Tal-Akabi and Rushton (2000) found that mobilisation of the carpal bones reduced pain from carpal tunnel syndrome in patients by an average of 31%.
Studies by Ebenbichler et al (1998) suggest that ultrasound treatment for carpal tunnel syndrome results in better sensation and self-reported improvement after seven weeks of treatment when compared to placebo. In their investigation, good or excellent results were stated by 76% of ultrasound patients compared with only 23% of sham treated wrists.
Carpal tunnel release is the most hand and wrist surgery performed in developed countries (O'Connor et al, 2012). A study by Javik et al (2009), investigated post surgical outcomes finding 73% of patients in the surgical group had successful outcome at twelve months as opposed to 33% in the non-surgical group.
Body Leadership Australia Principal Physiotherapist, Paul Trevethan, shows viewers how to relieve carpal tunnel symptoms.
For more information about how Body Leadership can help you relieve carpal tunnel symptoms please do not hesitate to contact us on 07 3847 8040 or inquire online here.