Carpel Tunnel Syndrome – Runner’s 10K Threshold

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What is Carpel Tunnel Syndrome?

Carpel tunnel syndrome is referred to as not  feeling your hand, scratching and other problems in your hand that are as a result of pressure in the carpal tunnel. The carpal tunnel is the place where the median nerve and other tendons run from your forearm to your hand. The median nerve on the other hand controls movement of your thumb and the adjacent three middle fingers except the last small finger.

Symptoms of Carpel Tunnel Syndrome

The symptoms of Carpal tunnel are mostly noticeable at night. Just like most diseases, the symptoms of carpal  tunnel syndrome differ from person to person but the most common symptoms of the syndrome  are;

  • Experiencing tingling- the tingling can occur in your thumb, middle fingers but not on your  last small finger, numbness, weakness or pain in their fingers, difficulty grabbing items.
  • As the  symptoms progress, some people have more difficulty grabbing items, wasting away of the  muscles at the base of the thumb, some people might also not be able to tell between hot and cold  items.
  • Swelling also is common in patients of the disease. Feeling the need to shake out your  hand, dryness of the skin, burning sensation, experiencing an electric like shock and clumsiness  of the hand when grabbing on an object are also other symptoms to look out for.

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Causes of Carpel Tunnel Syndrome

Studies have shown that the disease is common in adults of between 30 to 60 years. It can be as a  result of various activities;

  • Repetitive strain injury and tendon inflammation caused by movement of your hand in the same direction e.g. using the computer. When someone performs keying activities without using their wrists end up becoming bent and this increases the angle of bend which leads to irritation of tendons and tendon sheaths.

  • Use of vibrating tools such as hand drills.
  • Alcohol abuse.
  • Bone fracture.
  • Presence of tumor in the wrist.
  • Pregnant mothers are at a higher risk of acquiring Carpal tunnel syndrome as a result of the body accumulating excess fluids during pregnancy.
  • Injection of steroids into your body.
  • Use of steroids during pregnancy.
  • Hormonal factors-this cause the hands to swell abnormally.
  • Abnormal neurodynamics-change in motion of the way your nerves move through the spine can contribute to scar tissue, tight muscles.
  • Overweight people are also at a high risk of developing the Runners Carpal syndrome.
  • Conditions such as diabetes or arthritis increase the occurrence of the syndrome.
  • Workplace factors- based on the type of work that you engage in day to day.

Risk Factors

  1. Health problems that can cause pain such as broken bones or arthritis.
  2. Sex-women are at a higher risk of getting CTS. Pregnant mothers, those taking pregnancy control pills at the greatest risk.
  3. People who perform jobs which require repeated motions of the hands e.g. secretaries.
  4. Smoking- it may contribute to CTS by regulating the amount of blood flowing to the median nerve.
  5. Wear and tear of the hands which is absolutely normal

Diagnosis

Visiting a qualified physiotherapist to examine your symptoms can help clarify if you are indeed  suffering from the carpal tunnel syndrome. There are various tests that are carried out to  diagnose the disease. Some of the tests that are carried out include;

  • Tinel’s test which involves finding a focal point on your wrist where you can tap the median nerve. Presence of the CTS syndrome is characterized  when someone experiences a sharp pain which originates from the  from the wrist down to the hand  phanel’s test which is done by bending the hand downwards  all the way and count 60 seconds. Presence of CTS syndrome is characterized by not feeling your hand, tingling or weakening of the hand.
  • Compressing the median nerve in the Carpal tunnel. This is done by using thumbs to press on the median nerve on the Carpal tunnel. Presence of the CTS syndrome is shown by not feeling your hand or tingle in your arm.
  • Performing a hand grip test on your non-dominant hand to check  the strength of the grip. If the grip is not strong enough, this may be an indication of the presence of CTS syndrome.
  • Electromyography- used to check the health of the muscles and nerves controlling the muscles. It is done by converting the electrical  signals that are transmitted by moving neurons into values that can be used by an expert to measure the normal functioning of the neurons.

Nerve conduction velocity which is used to examine how fast electrical signals pass through a person’s nerves which is conducted by placing surface electrodes on the skin at various points used to stimulate the nerves. Negative results are  observed to identify if the person is suffering from the condition or not.

X-ray pictures are also used to determine whether there are any abnormal structure of the bones  that is noticeable. If there is, then more tests are carried out. EMG/ NCS tests are also carried out  to determine how good the coordination between is nerves and muscles tissues is. Ultrasound can  also be used. An MRI test is used to show the anatomy of the wrist in full.

 

Physical examination  of the hands, shoulders, wrists and arms and a medical history can help clarity if the condition  exists in your body. In case your examiner may need more clarification, then he may advise you  to take a blood test.
Carpal tunnel biopsy– this is a more invasive procedure used for testing for the presences of the  syndrome. A small tissue is removed from the carpal tunnel and several tests done on that  particular tissue to determine if one is suffering from the syndrome and to what extent. It is done  by disinfecting and numbing a small area in the wrist and a small cut is made and a small tissue  is taken out.
Blood tests– done by drawing blood from a patient and testing for carpal tunnel.

 

 

Treatment of  Carpel Tunnel Syndrome

Treatment is carried out if the preventive measures that were put in place have not worked  effectively. The type of treatment will be determined by the extent of the syndrome. Before any  treatment can begin, it is important you take the following considerations into your mind;

  1. The name of the procedure or test
  2. Reasons for having the procedure.
  3. Results you expect to compare the outcomes.
  4. Risks and benefits of the procedure.
  5. Whether you can deal with possible side effects.
  6. When to have the test or procedure.
  7. The person and qualifications of the person who will do the procedure.
  8. Any existing alternatives to the test or procedure.

The cost of the procedure and does the cost justify the cost?

 

SURGERY It is one of the ways used to mitigate the condition. Surgery is used when there is  nerve damage or Carpal tunnel has persisted for a long time or the patient does not  respond to other methods of treatment. Surgery is done by cutting a ligament around the  wrist which helps in reducing pressure on the median nerve. After surgery, some physical  therapy in most cases may be used to help regain the proper working of the hand.

You  can use a series of twists at night and during the day to help you reshape your tissues.  Practicing good ergonomics is another way to keep the condition at bay. Apart from  always ensuring the work you are doing is always in front of you, keep a good posture  and do a series of exercises during well timed breaks. People suffering from the condition  are also advised to visit a qualified psychologist who will help them through a series of  exercises, massage therapy to kick start natural body healing process. These techniques  increase blood flow and unclogging of nerves and other tissues. Recovery depends on an  individual as well as the extent of the surgery.  There are different techniques of  performing the surgery;

a) Endoscopic surgery-the therapist uses a tool that looks like a telescope with a  camera attached to it. The camera is used as eyes of the surgeon to enable him see  through to the carpal tunnel. The surgeon then cuts the ligaments through the  wrist or hand. In the first weeks or months after the surgery, patients may  experience pain which will afterwards disappear. If the pain persists, it is  advisable to consult your doctor.

b) Open surgery-involves opening up the hand and making an incision to help view  the carpal tunnel and other organs. It is done by operating on the carpal ligament  to enable the median nerve to have more room for the median nerve. It is done  within one day with the patient requiring doses of anesthesia to reduce the pain.  The anesthesia wears off in a few hours. The operation helps to relieve the  pressure off the hand. Open surgery results in an open wound which must be well  taken care of and must be dressed well and cleaned regularly to prevent infection.  There are many disadvantages that come as a result of the procedure: it is risky, it  takes more time for patients to recover as opposed to physical therapy. The  operation should be done a few months after diagnosis of the disease for better  results. It should be considered in patients who have visible symptoms of the  disease. Patients experience relief for their pain some even as early as the first  night after the surgery is performed. The benefits outweighs the risks and patients  should consider taking this surgery if other treatments have failed. Surgeries  results in various side effects; decreased in the grip of a person’s hand, nerve  damage, infection of the infected area, pain and stiffness. It is also impossible to  use the hand that was operated on before the hand completely heals off.

c) Post-operative recovery– complications from the CTS surgery are very rare with  95% of patients making successful recovery. Most have reported complete relief from  pain and other symptoms. Some therapists recommend recovery patients to wear a  wrist to regulate movement of that hand to prevent further injury which might  prolong the healing time. Gentle hand exercises or physiotherapy are also done to  help regain normal functioning of the hand. For those considering surgery, they  should be ready to part with 5000 to 10000 us dollars.

 


2. Non-surgical therapy is one of the best treatment for the disease and it is a good  alternative to surgery. It is also called manual therapy. It should be the first therapy used  in treatment of the carpal tunnel syndrome. Beyond the many benefits over surgery,  manual therapy is a good cost savings method. Therapy is focused mainly on the neck  and median nerves. It is also important to focus the therapy on the shoulders, elbow,  forearm, wrist and fingers. It helps in reducing the pain. It can be used to treatment the  syndrome even if it has persisted for a long time. Off all patients treated by physical  therapy, only 15 to 20 % require surgery. Surgical methods are risky with patients who  have undergone surgery require another surgery to correct the condition. There are many
ways physiotherapy can be carried out. Some of those ways include;

  1. Exercises to enhance smooth bone movement and stretching the carpal ligaments to open up the carpal tunnel in case of any blockage.
  2. Hand movement exercises.
  3. Exercises to help stretch the muscles and soft tissues.
  4. Exercises of the spine to correct any referral or double crush syndromes.
  5. Exercises to increase the grip of the hand,strengthening the thumb and forearm exercises to increase the strength and  grip of the hand.
  6. exercises for the limbs, wrist and hand strengthening.
  7. Posture correction, fine movement and hand exercises to increase the coordination of muscles.Therapy has numerous benefits;
    1. Helps in dealing with long lasting pain.
    2. Reducing sensitivity in nerves.
    3. Helps in resuming the normal use of your hands.

     

3. Use of joint and tissue injections- this are carried out to reduce pain or infection in a  joint or soft tissue. The needles are used to administer medicine or used to get rid of  excess fluids. Lidocaine and anti-inflammatory medicines such as cortisteroids are the  most common drugs used in joint and tissue injections. Cortisteroids can also be  administered using ultrasound to guide the drug to the carpal tunnel. Cortisteroids help in  reducing pressure in the median nerve which helps in reducing inflammation and pain.  The drugs are more effective when injected as opposed to when they are taken orally.
Some common side effects of using this drugs include;

  1. Irritation and swelling of the tissues
  2. Tendon rupture.
  3. Muscle damage.

4. Non-steroidal anti-inflammatory drugs (NSAIDs) are also used in treating the disease.  Examples of these drugs include aspirin, Ibuprofen, naprosyn, ketoprofen Admit, Motrin  IB help in reduction of pain. Vitamin B6 (pyridoxin) is also administered in doses of 2  ML. It helps in restoration of the normal functioning of the respiratory system.  Antidepressants are also used in small doses to help deal with the pain. They work by  affecting the concentrations of neurochemicals. They affect the brain concentrations of  neropinephrine and serotonin. New antidepressants with few side effects have been  developed. They include Duloxetine (Cymbalta) and Milnacipran HCL (Savella) savella  is approved by FDA. Opiate analgesics are another class of drugs used when the pain is
too much. Oxymorphone is very common because it lacks CYP enzyme which means it  does not interact with the metabolism helps in avoiding adverse side effects.
5. Ice heat therapyice your wrists for 10 to 15 minutes once or twice in an hour. It helps  in dealing with the pain as a result of pressure or swelling of the median nerve. It helps in  treating the syndrome.
6. Wearing a wrist braces at night also helps to relieve pressure and pain.
7. Patients of the carpal tunnel syndrome are also advised to reduce their movement which  may cause more pain. Applying ice, using magnets, using acupuncture and good ways to  deal with the pain.
8. Maintaining a healthy diet is also a good way to deal with CTS. You should consider  taking a lot of anti-inflammatory foods. These includes ingesting a lot of vegetables,  foods rich in omega 3 , drinking lots of water, foods high in Vitamin B, and a lot of fresh  juices.
9. Acupuncture– Acupuncture is a technique which was originally used by the Chinese  people which involves the insertion of extremely small needles through your skin which  targets specific organs of the body which helps in relieving pain as well as stress. It is  mostly used after a medical diagnosis. It is believed acupuncture simulates the body to  produce its own natural pain killers. It does this by stimulating blood flow to the specific  body parts. It is recommended that someone one undergoes several sessions of  acupuncture for better results. It will help deal with the pain from CTS.
10. Targeted massage– concentrating massage on the areas experiencing pain will help deal  with that pain as well as relieving pressure from the hand. It helps in restoring good grip  in a hand.
11. Use of tens machine-it helps in easing pain associated with CTS.
12. YOGA

Yoga is also used for stretching and strengthening the joints that helps in reducing pain and  increasing grip of the hand. Some physiotherapists include use of ultrasound therapy where they  concentrate heat on the affected part of the hand which helps to reduce pain as well as induce  natural healing Yoga specialists have found out that limited breathing can be another cause for  the carpal tunnel syndrome. You should make sure you breathe in as much as possible and
breathe without closing in air. Bad posture makes it harder to breathe well as the ribs are  restricted. Yoga helps you correct bad posture, helps to adjust your alignment, helps you focus  on your breathing and helps deal with stress which could make CTS worse. There are particular  yoga exercises that helps stretch your joints in the upper body. There are a couple of yoga  exercises that work well for people with CTS;

I. WARRIOR II POSE– the exercises steps are illustrated below.
Step 1: standing at a mountain pose, exhale, keep your feet at 3 to 4 feet apart, with your arms  parallel to the floor, reach them to the sides, shoulder blades, palms down
Step 2: turn both your feet out at an angle of about 90 degrees until the heels slightly touch each  other. Turn your left thigh outward so that the knee cap is in line with the ankle on the right foot.
Step 3: On exhalation, bend your left knee over the left ankle, with the right foot parallel to the  floor. Anchor this movement of the left knee by strengthening the right leg and pressing the right  heel firmly to the floor.
Step 4: with your arms parallel to the floor and ensuring not to lean your torso to your left thigh,  keep your torso long and shoulders directly over the pelvis. Press the tailbone slightly towards  the pubis. Twist your head to the left and look over at your fingers.
Step 5: Count for 30 seconds to 1 minute before switching to the reverse side. Try doing the  yoga poses with a series of modifications. As you get used to the exercise, be sure to deepen the  pose until you cannot stretch any further.

II. SALUTATION POSE– It is a good way to improve awareness of your body. It is done  by following the following steps;
Step 1– While sitting in a comfortable position, raise your hands such that your thumbs rest  slightly on your sternum.
Step 2: Press the hands together making sure your dominant hand does not dominate the other hand. If this happens, ease that hand making sure you do not increase the pressure of the other  hand.
Step 3: Bowing your head slightly, draw the crease toward the center of your head. Lift your  sternum towards your thumbs and lengthen along the back of the armpits making the elbows  heavy.
Step 4: Hold the salutation pose for about 5 minutes. Take short breaks before resuming.  Deepen the pose as you progress and try to discover the roots of the ands as you perform this  exercise. The exercise packs a lot of benefits; reducing strength and anxiety, helps in calming the  brain, helps in self- awareness, and helps with the flexibility of the hands.

III. BHARADVAJA’S TWIST

Step 1: sit in a comfortable preferably padded place with your legs straight in front of you. Lift  your right buttock slightly bend your knees and lift your legs to the left. Lay your feet on the  floor outside the left hip with the left ankle resting in the right arc.
Step 2: On inhalation, lift through the top of the sternum to lengthen the front torso. On  exhalation, twist your torso to the right keeping the left buttock as close to the floor as possible.  Be sure to keep the tail bone close to the floor in order to keep the lower back long.
Step 3: place your left hand under your right knee and bring your right hand to the floor just  beside your right buttock. Pull your left shoulder slightly making sure your press shoulder blades  against your back as you continue to twist the chest to the right.
Step 4: Turn your head either to the right or left and looking over your shoulder, look at your  feet.
Step 5: On every inhalation, lift yourself slightly towards the sternum using the fingers placed on  the floor to push yourself upwards. Be sure to hold the pose for between 30 seconds to 1 minute.  Try the exercise with different variations of poses. Be sure to repeat the steps switching the feet.  Try deepening the pose of that exercise by varying the positions. The exercise comes with a wide  range of benefits. It helps in stretching the spine, shoulders and hips, massaging the abdominal organs, relieving pain, treating the carpal tunnel.

Prevention

There are many ways of preventing the chances of acquiring the Syndrome and this depends on  the hazards that one is exposed to. People who work in an environment where the activities they  are constantly involved in of Carpal tunnel syndrome should carry out some simple workouts  wherever they are to make sure they reduce their risk of contracting the syndrome. Some of this  activities include but not limited to;

  1. Practicing good office ergonomics– refers to the way the office is arranged including the desk, computer, paperwork and the position you are going to sit as you carry out your work. These consists of keeping your hands and wrists in line with your forearms, center your work in front of you without touching your legs, hold your elbow close to your sides, avoid leaning on your wrists, taking short breaks to do some exercises. Using different tools with less vibration can also help.
  2. Also try interchanging the tools so that your hand is not used to one motion of movement. Experiment also with different ways of holding the tools as well as interchanging the tools.
  3. Using splint wrists is another good way to prevent yourself from the Carpal tunnel. They help in making your palms straight when you are experiencing pain.
  4. Good arrangement of the workstations and keyboard helps in creating a conducive environment to work and also helps in proper placing of the hands as someone works. Wresting your wrists on a support structure helps prevent bad wrist postures.
  5. Nerve gliding exercises- this are done to help the median nerve move properly

EXERCISES FOR PREVENTING THE CARPAL TUNNEL SYNDROME

You should take care to ensure the stretches and movements do not cause you any pain or make  you uncomfortable.

  1. Warm up stretches-rotate your arm clockwise or anticlockwise as many times as possible and be sure to switch your hands and distribute the same amount of time. Stretch your fingers out then relax them stretch them again and repeat a number of times for better results.
  2. Prayer stretch- done by lowering your hands towards your chest line keeping your hands as close to your stomach as possible. While holding your palms together, stretch until you feel a mild to moderate stretch to your forearms.
  3. Wrist flexor stretch- with your arm facing down and palm facing up, bend your hand towards the floor, bend your wrist downwards and use your other hand to push your wrist down further. Hold that position for a few minutes then switch your hands
  4. Wrist extensor stretch-with your palm facing downwards, bend your wrist with your hand pointing towards the floor. Use your other hand to bend your wrist further until you feel a mild to moderate stretch. Hold that position for a few minutes then switch your hands.

RUNNER’S CARPAL TUNNEL VERSUS TARSAL TUNNEL SYNDROME
Tarsal tunnel is a painful condition which is caused by damage to the tibia nerve or its nerves due  to the pressure as it passes through the tarsal tunnel. Both runner’s carpal tunnel and tarsal tunnel  syndrome are caused by pressure as the nerve pass through the carpal and tarsal tunnels  respectively. The symptoms of both conditions are also similar. Diagnosis is done by trained  personnel.

INCIDENCE OF CTS
Carpal tunnel has the capability to reoccur even after treatment. Surgery is one of the treatments  chosen after this happens. There are things an individual can do to prevent the CTS from  reoccurring. They include; keeping your wrist in a neutral position, using your whole hand to  grab whole objects as opposed to just using fingers, when typing, keep your wrists straight and  hands a little higher than the wrists, switch your hands as much as possible.

Conclusion

Carpal tunnel is a disease that has been in existence for many years but has in the recent years  received more attention from many media sources. It is a disease that is affecting many people due to the kind of lifestyle we live. People who do not maintain a good posture while working  are at a higher risk of getting the disease. Recent research has made it possible to diagnose the  condition early enough some even enabling self-test which makes it possible to choose the best  suitable method of treatment. Patients should consult a doctor in order to help them come up  with the best treatment as well as guide them through the healing process.

The best cure for any  disease is prevention and it is best to take all the necessary steps to prevent one from contracting  the disease. Maintaining a healthy lifestyle, eating well, avoiding drug abuse, good office  ergonomics and taking regular breaks to do some few exercises are some out of the many ways  that exist for one to prevent one from the disease. If all these prevention techniques fail, then one  can use the various methods to treat the disease. Carpal tunnel is a disease that can be mitigated  by treatment. Patients should only accept treatment from qualified personnel.

Disclaimer: Seek consultation with a medical physician or healthcare provider before any treatment. The information contained in the article while from credible references does not replace professional medical advice.

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