Crisis Plan Series
Carpal tunnel syndrome
Carpal tunnel syndrome is a debilitating condition due to insufficient space for the median nerve in the carpal tunnel at the front of the wrist. Common causes are fluid retention (accumulation) in the tunnel such as in rheumatoid arthritis and in pregnancy. It is also common in post-fracture (broken bone in the wrist) and soft tissue injury within the wrist as a result of joint stiffness, soft tissue swelling, thickening and tightness. Repetitive strain as a result of prolong use of the computer is becoming a more major cause of such condition.
The most common advice of rest and splinting with a brace is not often possible due to our patients' busy life-style these days. With many manipulative treatment techniques available, we now suggest more proactive treatment approach to stretch and mobilize the wrist to increase room in the carpal tunnel of the front of the wrist. If seen early, especially before any neural (nerve) deficit appears, prognosis (forecast) of recovery without operation is good.
If the cause of injury is repetitive strains, advice on modifying the activities should be taught, such as positioning of the keyboard and mouse, how to wring the wet towel and breaks from the activities. The flexor retinaculum (a band of tough tissue in front of the wrist) is often thick and tight. Localized deep friction massage to the thick and tender spots should be applied. It can be stretched effectively by extending (backward bending) the carpal (wrist) bones. The inter-carpal (within the wrist) joints could be stiff and painful and should be mobilized with specific manipulative techniques. The wrist joint as a whole could be mobilized, especially into extension (backward bending) with gliding techniques. The forearm flexor (front) muscles and tendons should be stretched. Deep massage may be required to relief tightness along the flexor muscles. Gentle elbow and wrist mobility exercises especially into extension (backward bending) should be encouraged. The aim of treatment is to 'open' up the carpal tunnel to minimize pressure on the median nerve. The goodness of such treatment approach is that the patients themselves could perform most techniques for self-treatment and for prevention.