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Hand and Wrist Pain

Carpal tunnel syndrome

Carpal Tunnel Syndrome is when the median nerve gets trapped or squeezed in the wrist as it works its way down the front of the forearm from the elbow to the fingers. The wrist is a gutter of 8 bones that is formed into a tunnel by a layer of connective tissue over the top. Inside this tunnel various structures pass through from the forearm to the hand including the tendons that flex the fingers, some blood vessels and the median nerve.

The median nerve is one of many nerves in the arm. It supplies power to some of the muscles in the hand and also sensation to the thumb, index finger, middle finger and half the length of the ring finger on each hand.. When the space inside this tunnel is compromised the median nerve is squeezed and this results in pain and pins and needles in the thumb and 2 and a half fingers of the hand.

The nerve can be squeezed if there is an increase of swelling in the area such as fluid retention in pregnancy or if there is a tendonitis and inflammation. The nerve can also be squeezed if the carpal tunnel itself starts to narrow if there is some arthritis or wear and tear in the bones or if the wrists are extended / bent back for long periods of the day when typing or using a mouse. The connective tissue covering the bones can also shorten as we get older and this may be the cause.

Most people with carpal tunnel syndrome complain of pins and needles in the hand and fingers especially in the morning and this may even wake them at night. The hand or hands often feel heavy and numb and they will have to shake them out to “get them going in the morning”. The symptoms may also be aggravated throughout the day if there is a build up of pressure in the wrists for any of the reasons mentioned above.

In order to treat carpal tunnel syndrome the main cause needs to be established. In an office environment incorrect keyboard or mouse use can be a very significant factor. Adjusting the hand, wrist and forearm position so that the hand is in a relaxed and neutral position allows all the structures to pass through the carpal tunnel with the greatest of easy. If you are unsure of how to achieve this contact a Chartered physiotherapist who can arrange a work station assessment for you.

If sleeping is the biggest problem wrist splints can be useful which help keep the wrist in a neutral position overnight so that the median nerve does not get squeezed during the night if you bend your wrist while you sleep. However, if localised swelling is the source of the problem, such swelling is often worse at night and splints may be of limited use. If swelling is a factor then the source of that swelling needs to be address either with appropriate medication as prescribed by your GP or a steroid injection by a specialist.

Physiotherapy can help to identify the correct diagnosis and cause of the problem and may also be able to treat the source of the problem. If all else fails there is a simple surgical procedure which can release the pressure in the tunnel and “fix” the problem.

Remember that carpal tunnel syndrome is not the only cause of pins and needles in the fingers and a thorough assessment is necessary to establish the correct diagnosis.

Arthritis

We have all heard of the expression wear and tear and all to commonly it is used as the answer to many aches and pains. This may very well be true but it is not a diagnosis. Our bones are a living tissue and are constantly being re modelled. If we stress the bone more than its ability to recover from this stress the bone will start to show signs of strain and fatigue which can result in a change to the surface of the bone.

Relatively minor stress to the bone is often classified as wear and tear. If this stress is as a result of trauma, such as a fall where there is bone pain but no fracture, it may be a bone bruise. Stress from repeated weight bearing on the joints may cause wearing of the cartilage covering the bones, leading to wear and tear / osteoarthritis, which can progress into inflammatory arthritis.

People are fearful of the word arthritis, but there are many different types. Generally speaking when people talk of arthritis they usually mean osteoarthritis (OA) or wear and tear arthritis. OA in itself can broadly be broken down into hereditary arthritis as a result of significant family history and secondary arthritis as a result of over use and progressive wear and tear. A classic example of secondary OA would be a professional footballer who develops wear and tear arthritis in their knees as a result of the stresses and strains of training daily and competitive matches on top of injuries to the knees through out their career.

If there is a family history of OA, such as a close relative needing a joint replacement it would be sensible to discuss various do’s and don’ts with the physiotherapist or your GP to help look after your joints for the future.

On the other hand we are all susceptible to the normal ageing process and the stresses and strains to our joints that it involves. If you are involved in any activity that requires repeated and sustained weight bearing on the joints you may be prone to wear and tear or bone strain.

Examples of this in the workplace may be osteoarthritis of the base of the thumb with prolonged use of the hand in lifting, grasping, pulling, pushing etc. This may result in a painful and swollen joint that’s stiff and sore to begin with but often settles down as the day progresses only to get sore again when rested.

When the joint is going through an active phase or is inflamed it is important to allow relative rest. Try to stop the activity that is producing the pain before the pain begins. This may involve typing for only ten minutes at a time, before giving the hand or joint involved a rest for 2 minutes and resuming typing again. This is better than typing for 30 minutes and then requiring a rest for 10-15 minutes. This example can be followed for any joint with some minor wear and tear. It is important to understand the limitations of the area affected and stay within them.

A physiotherapist will be able to advise you on what activities may be irritating the joints and may also be able to treat any pain and swelling by mobilisation of the joints and various modalities at their disposal. They will also be able to show you how best to strengthen the joint and prevent relapses.

Spinal Physiotherapy
& Sports Medicine Clinic
124 Gilbert Rd, Cambridge, CB4 3PD