What is carpal tunnel syndrome (CTS)?
Carpal tunnel syndrome (CTS) is a common condition that causes pain, numbness and tingling in the hand and arm. The condition occurs when one of the major nerves to the hand, the median nerve is squeezed or compressed as it travels through the wrist. This can often be confused and mistaken for cervical radiculopathy and must be thoroughly assessed in order to deliver the most effective management and treatment.
What is the carpal tunnel?
The carpal tunnel is where the median nerve crosses under the transverse carpal ligament, yet above the carpal bones, and is surrounded by tendons (see diagram below).
What are the symptoms of carpal tunnel syndrome?
Symptoms of carpal tunnel syndrome include numbness, tingling, burning and pain, primarily into the thumb, index, middle and ring fingers, but is often described by the patient as being in the tips of all digits. The symptoms are usually worse when sleeping, and patients can occasionally wake with their whole hand feeling completely numb.
Symptoms can also worsen with direct pressure over the carpal tunnel, such as during activities such as cycling or if resting wrists on a desk or wrist support while typing. The pain and tingling sensations might go into the forearm and shoulder, and occasional shock-like sensations can also radiate into these areas.
Symptoms can also include weakness in grip strength, which results in clumsiness, where patients often describe dropping items, having difficulty braking while riding, or finding fine motor skills, including fastening buttons, onerous.
Discussions around any neck or shoulder problems is hugely important and can lead to more specific and effective management and treatment. If the symptoms are similar but are distributed into the little and ring fingers this is usually compression of the ulnar nerve.
What causes carpal tunnel syndrome?
The causes of CTS are usually positional or activity-driven, but can be hereditary and related to other health conditions including diabetes, rheumatoid arthritis and thyroid imbalance. CTS is very common during pregnancy where hormone changes occur, causing swelling that increases the pressure on the median nerve at the carpal tunnel.
Activities that involve repetitive hand or wrist motions, particularly those with extreme wrist flexion or extension can irritate the tendons in the wrist causing swelling, which also increases the pressure on the median nerve. Sustained wrist positions or pressure directly at the carpal tunnel whilst cycling or resting wrists on desk or wrist support when typing will cause compression of the median nerve at the carpal tunnel and therefore ergonomics should be thoroughly assessed.
How can carpal tunnel syndrome be treated?
The sooner treatment is started the better the outcome for CTS. The treatment includes wearing a wrist splint when sleeping for a minimum of 6 weeks, nerve gliding exercises, neck and shoulder exercises and activity modification. Activity modification strategies would include ergonomic advice on bicycle and/or at workstation to reduce compression at the carpal tunnel.
Tips for managing carpal tunnel syndrome when cycling
Can you prevent carpal tunnel syndrome?
Prevention for CTS includes sleeping with your wrists in neutral (straight) and avoiding end-range wrist flexion and extension for prolonged periods. Reduce excessive and repetitive wrist motions and sustained heavy gripping, but when necessary take regular rests from these activities. Monitor any health conditions that are directly linked with developing CTS.
Alex Gregory is a specialist hand physiotherapist with Six Physio Moorgate