|Carpel Tunnel Syndrome
Carpal Tunnel Syndrome (CTS) is a common condition that can often be disabling and significantly interfere with regular work or recreational activities. The carpal tunnel is an anatomical compartment located at the base of the wrist. Nine flexor tendons and the median nerve pass through the carpal tunnel that is surrounded on three sides by the carpal bones that form an arch. The nerve and the tendons provide function, feeling, and movement to some of the fingers. The finger and wrist flexor muscles including their tendons originate in the forearm at the medial epicondyle of the elbow joint and attach to the Metacarpal and phalangeal bones of the fingers and thumb. The carpal tunnel is approximately as wide as the thumb and its boundary lies at the distal wrist skin crease and extends distally into the palm for approximately 2 cm.
It is common for the nerve to be compressed and irritated at other structures as well, particularly at the elbow and forearm, which will mimic carpal tunnel syndrome. It is essential to determine at which specific site the nerve is being entrapped because treatment at the wrong site will be ineffective and prolong the injury.
Regardless of the location of entrapment, excessive tension in the surrounding muscles will put pressure and tension on the surrounding nerves, resulting in a loss of blood flow to the nerve and surrounding soft tissues. Over time the health and function of the nerve will be affected and lead to symptoms such as pain, numbness, tingling, and weakness in the wrist and hand. It is important to address any soft tissue thickening at the Carpal Tunnel as well as any tight muscles in the forearm and shoulder.
It is essential to conduct a full examination from the shoulder to the hand to determine the specific location of compression that is responsible for the symptoms. Once the specific location of compression is found treatment must be directed at this area. If there are multiple areas of compression all areas must be addressed. Remedial Massage and Physiotherapy are effective tools to address the scar tissue that can compress and irritate the nerve, and release this compression to restore the health and function to the nerve. Home stretches and advice is commonly required to speed recovery and prevent future recurrences.
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