Carpal tunnel syndrome
Description of carpal tunnel syndrome

The median nerve can be compression in several places as it extends down the arm, from its cervical root to the fingertips. The most common site of compression is in the wrist of the flexor retinaculum, in which the nerve passes superficially alongside 9 tendons from flexor muscles to the fingers. The condition can occur in two ways – either the content of the carpal tunnel increase and take up more space, or the tunnel itself becomes smaller. As there is already little space under normal conditions any form of infection will quickly interfere with the median nerve. This means that inflammation of the tendons or tendons in the surrounding area, an incorrectly healed fracture of carpal bones or any infection can cause consequent symptoms of carpal tunnel syndrome. The syndrome is a “female disorder” where approx. 7 out of 10 affected are women between the ages of 50 and 60 years of age.

Symptoms of carpal tunnel syndrome
  • Possible sensation of sleeping fingers (“ants in your arm”).
  • Possible numbness in the hand.
  • “Flick sign” (shaking hands to “wake them up”).
  • Possible pain in the shoulder region (“proximal pain”).
  • Possible “clumsiness” – easy to drop things especially in the morning.
  • Possible tenderness in the forearm.
  • Disturbed night sleep due to pain / sleeping sensation.
  • Possible atrophy of thenar muscles.
Examination for carpal tunnel syndrome
  • Analysis / Inspection / Palpation / ROM Test of Force and Movement Passive and Active.
  • Cervical / neck compression test.
  • Palpation of the forearm muscles.
  • Tinel’s test by flexor retinaculum.
  • Phalen’s test.
  • Bottle test.
  • Allan’s test (blood supply to hand).
  • Flexor digitorum superficialis test.
  • Flexor digitorum profundus test.
  • Sensitivity test (two-point test).
  • Ask about metabolic diseases e.g. diabetes.
  • Ask about possible pregnancy – hormonal changes.
Treatment of carpal tunnel syndrome
  • Rest – should be in a brace where the hand is held in neutral position.
  • Use the same brace both day and night.
  • Exudatives for immediate relief of pressure on the nerve.
  • NSAID – almost always necessary.
  • Ultrasound (continuous / pulsating), 3 Mhz, 0.5-1.5 W cm2.
  • Kinesiology tape.
  • K-Laser.
  • Cryotherapy when the symptoms are the worst (ice massage for 9min.).
  • Traumeel gel or tablets (2 tabl. 3 g. daily for 9 days)