Carpel Tunnel Syndrome – Runner’s 10K Threshold

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Carpel tunnel is an incredibly painful physical problem and in the 1980/ early 90’s many doctors in the UK would not recognize it as a physical ailment. This meant the failure to accept the illness resulted in no particular effective treatment. Researchers carried out extensive investigations which swung the medical profession around to recognition and treatment. If you have any of these symptoms mentioned here in the article, you should follow the advice and also visit your doctor.

What is Carpel Tunnel Syndrome?

Carpel tunnel syndrome exhibits a periodic loss of sensation in the fingers/hand, tingling and burning and a consistent pain which increases and decreases in waves. Notably, sufferers describe it as the type of pain from which you do not get relief, even when you need to sleep. Many people describe the pain as equal to having both an earache and toothache pain located in your hand, wrist and at times the arm.

Symptoms of Carpel Tunnel Syndrome

Carpal tunnel to many suffers appear more noticeable when a person tries to settle at night, this might be because we are less active and more focused on how we feel physically. Different people have reported that laying on their side with the arm extended forward can bring some relief from pain but as with many diseases, the signs of CTS and methods for pain relief can vary between different people. Generally, the majority of symptoms occur in the hands, fingers, and wrist but examples do exist in what might be more severe examples of pain radiating up the arm as far as the shoulder. Depending on the severity the symptoms can vary but the factor which remains constant is that this illness is very painful.

Here are some of the reported symptoms but with this problem and depending on the severity there may be additional signs.

  • 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 with 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 come up with opinions which often vary country to country, for example in the USA it is suggested that sufferers are in the age group from 30 up to 60, in the UK some studies suggest the factor is not about age but more about lifestyle and the type of work a person is doing. Of particular interest are people who spend long hours every day working on a computer keyboard.

  • 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 the 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 the 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 a 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

Physiotherapist:

  • Known as Tinel”s test, this means tapping on the wrist till you hit the affected part of the median nerve when a sharp uncomfortable pain is noticed this will confirm that this is CTS. How effective this diagnosis can be is down to the skill, knowledge and medical know-how of the person carrying out the examination. The examiner will ask you to do additional activities such as bending your wrist for around 60 seconds to see if this action produces more symptoms.
  • 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 is 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 are. 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 clarify 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 with 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 action?

 

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 for performing the surgery;

a) The 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 to 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 afterward 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 outweigh the risks and patients should consider taking this surgery if other treatments have failed. Surgeries result 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 a successful recovery. Most have reported complete relief from pain and other symptoms. Some therapists recommend recovery patients to wear a  wrist to regulate the 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 the treatment of the carpal tunnel syndrome. Beyond the many benefits of 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 treat 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 corticosteroids are the most common drugs used in joint and tissue injections. Corticosteroids can also be administered using ultrasound to guide the drug to the carpal tunnel. Corticosteroids 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 (pyridoxine) 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 norepinephrine 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 brace at night also helps to relieve pressure and pain.
7. Patients with 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 include 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 involve 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 stimulates the body to produce its own natural painkillers. 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 help in reducing pain and increasing the grip of the hand. Some physiotherapists include the use of ultrasound therapy where they concentrate heat on the affected part of the hand which helps to reduce pain as well as induces 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 the air. Bad posture makes it harder to breathe as 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 help 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 kneecap is in line with the ankle on the right foot.
Step 3: On an 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 on 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 hands 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 an inhalation, lift through the top of the sternum to lengthen the front torso. On an exhalation, twist your torso to the right keeping the left buttock as close to the floor as possible.  Be sure to keep the tailbone 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. The 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 being 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
The tarsal tunnel is a painful condition which is caused by damage to the tibial 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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