Know your Injuries – Part 7: Carpal Tunnel Injuries
Dr Meenakshi (P. T.) with a Master’s Degree in Sports Physiotherapy is Gāyo Fitness Academy’s (Hon.) Senior National Faculty and Assessor in Sports Medicine, Sports Medical Rehabilitation and Exercise Therapy. Her impressive work experience includes working her Asst. Professorship in Department of Physiotherapy, P.D.M University Bahadurgarh (Haryana) and practice as Sports Physiotherapist in Sports Authority of India National Boxing Academy, Rohtak. She has attended to India’s world-class women’s boxing teams. She is currently attached to SAI, Lucknow.
She can be contacted at firstname.lastname@example.org. Dr Meenakshi will write regularly on exercise and sports injuries management.
Dr Meenakshi presents the early management of Carpal Tunnel injuries in Part 7 of her Sports Injury Management Series.
Carpal Tunnel Syndrome is a common injury in the wrist region.
It is caused by pressure on the median nerve. The carpal tunnel is a narrow passageway surrounded by bones and ligaments on the palm (anterior) side of the hand. When the median nerve is compressed, symptoms can include numbness, tingling, and weakness in the hand and arm.
The complex anatomy of the wrist, health problems and possibly repetitive hand motions can contribute to carpal tunnel syndrome. In the gym, allowing the weight of the barbell or dumbbell to bend the wrist (flex or extend) is a common cause of this injury.
Proper treatment usually relieves the tingling and numbness and restores wrist and hand function.
Dr Meenakshi breaks down her explanation in terms of –
- first aid
- basic rehab movements
Carpal tunnel syndrome symptoms usually start gradually and include –
- Tingling or numbness in the fingers or hand. Usually the thumb and index, middle or ring fingers are affected, but not the little finger. You might feel a sensation like an electric shock in these fingers.
- The sensation may travel from the wrist up the arm. These symptoms often occur while holding a steering wheel, phone or newspaper – or, weights in the gym. These may wake you from sleep.
- Many people “shake out” their hands to try to get relief from their symptoms. The numbness may become constant over time.
- You may experience weakness in the hand and drop objects. This may be due to the numbness in the hand or weakness of the thumb’s pinching muscles, which are also controlled by the median nerve.
Carpal tunnel syndrome is caused by pressure on the median nerve.
The median nerve runs from the forearm through a passageway in the wrist (carpal tunnel) to the hand. It provides sensation to the palm side of the thumb and fingers, except the little finger. It also provides nerve signals to move the muscles around the base of the thumb (motor function).
Anything that squeezes or irritates the median nerve in the carpal tunnel space may lead to carpal tunnel syndrome. A wrist fracture can narrow the carpal tunnel and irritate the nerve, as can the swelling and inflammation caused by rheumatoid arthritis.
In weight training, the exerciser must be aware of the correct technique of gripping the barbell or dumbbell.
Many times, there is no single cause of carpal tunnel syndrome. It may be that a combination of risk factors contributes to the development of the condition.
Risk increases with –
- Contact sport
- Throwing sports
- Cardiovascular problem that reduces blood circulation
- Medical history of bleeding
- Poor muscle condition
- Poor nutrition
- History of previous injury
Multiple factors have been associated with carpal tunnel syndrome. Although they may not directly cause carpal tunnel syndrome, they may increase the risk of irritation or damage to the median nerve. These include –
- Anatomic factors. A wrist fracture or dislocation, or arthritis that deforms the small bones in the wrist, can alter the space within the carpal tunnel and put pressure on the median nerve.
- Ganglion cysts. They are lumps that typically develop around the tendons or joints of your wrists or hands. These lumps are noncancerous and typically go away on their own. However, they can be painful, especially if a cyst presses on a nerve. The location of the cyst can sometimes hinder joint movement. Ganglion cysts can grow from a pea-size shape to up to 2.5 cm in diameter. They are typically round and are filled with fluid. If your cyst causes problems, your physician might suggest trying to drain it with a needle. Removing the cyst is an option. However, in most cases, these cysts go away on their own, and treatment is not necessary.
- Carpal tunnel syndrome is generally more common in women. This may be because the carpal tunnel area is relatively smaller in women than in men.
- Nerve-damaging conditions. Some chronic illnesses, such as diabetes, increase the risk of nerve damage, including damage to the median nerve.
- Inflammatory conditions. Rheumatoid arthritis and other conditions that have an inflammatory influence can affect the lining around the tendons in the wrist and put pressure on the median nerve.
- Some studies have shown a link between carpal tunnel syndrome and the use of anastrozol (Arimidex), a drug used to treat breast cancer.
- Being obese is a risk factor for carpal tunnel syndrome.
- Body fluid changes. Fluid retention may increase the pressure within the carpal tunnel, irritating the median nerve. This is common during pregnancy and menopause. Carpal tunnel syndrome associated with pregnancy generally gets better on its own after pregnancy.
- Other medical conditions. Certain conditions, such as menopause, thyroid disorders, kidney failure and lymphedema, may increase the chances of carpal tunnel syndrome.
- Workplace factors. Working with vibrating tools or on an assembly line that requires prolonged or repetitive flexing of the wrist may create harmful pressure on the median nerve or worsen existing nerve damage, especially if the work is done in a cold environment. Several studies suggest that it is the use of the mouse and not the use of a keyboard, that may cause this syndrome among computer users. Of course, there has not been enough quality and consistent evidence to support extensive computer use as a risk factor for carpal tunnel syndrome, although it may cause a different form of hand pain.
Prevention is better than cure! The precautions to be taken are common to all sports and exercise injuries. But it is worth reminding the reader!
- It is essential to engage in a physical conditioning that involves appropriate strength and flexibility building movements prior to playing sports.
- Stretch the arm muscles as also the tendons prior to physical activity.
- Improve functional movement and dynamic stability of the wrist joints.
- Try to be in shape to play your sport; don’t play your sport to get in shape!
You can minimize stress on the hands and wrists through these suggestions –
- Reduce your force and relax your grip. If your work involves a computer keyboard, for instance, hit the keys softly. For prolonged handwriting, use a thicker pen with an oversized, soft grip adapter and free-flowing ink. Adjust the height of the chair so that you do not have to strain your shoulders, elbows and wrists. Keep your keyboard at elbow height or slightly lower.
- Take short, frequent breaks. Gently stretch and bend hands and wrists periodically. Alternate tasks when possible. This is especially important if you use equipment that vibrates or that requires you to exert a great amount of force. Even a few minutes each hour can make a difference.
- In weight training, watch your form. Avoid bending your wrist all the way up or down. A relaxed middle position is best. Use training gloves with wrist supporting straps.
- Improve your posture. Incorrect posture rolls shoulders forward, shortening the neck and shoulder muscles and compressing nerves in the neck. This can affect the wrists, fingers and hands, and can cause neck pain.
- Keep your hands warm. You’re more likely to develop hand pain and stiffness if you work in a cold environment.
Follow the P.R.I.C.E. drill –
- Protect the injured part, not allowing any further damage.
- Rest the injured part.
- Apply ice or cold treatment for 15-20 minutes.
- Compression: use of mild to moderate pressure to the injured area with bandages / crepe bandages is advisable.
Current international standards have replaced P.R.I.C.E. with P.O.L.I.C.E.
- P – Protection of injured part
- O/L – Application of Optimal load (local injury factors) / Training load
- C.E. – as mentioned earlier (ice + compression+ elevation)
To help ease the symptoms of carpal tunnel syndrome, you may want to put ice on your wrist or soak it in an ice bath. Try it for 10 to 15 minutes, once or twice an hour.
You can also gently shake your wrist or hang it over the side of your bed for pain that wakes you up at night.
Some experts suggest you put your hand in warm water, around 100 F, then gently flex and extend your hand and wrist. Try it 3-4 times a day.
Follow up on First Aid
See your physiotherapist and / or medical doctor if you have signs and symptoms of carpal tunnel syndrome that interfere with your normal activities and sleep patterns. Permanent nerve and muscle damage can occur without treatment.
Nutrition plays a big role in the recovery process and the injured person must consult a certified sports nutritionist.
Exercises to prevent injuries and strengthen the hamstrings
Dr Meenakshi (P. T.) recommends these rehab exercises to help recover from Carpal Tunnel Syndrome related injuries.
Exercises to Help Carpal Tunnel
- Wrist Rotations
- Finger Stretch
- Thumb Stretch
- Prayer Stretch
- Wrist Flexor Stretch
- Wrist Extensor Stretch
Medial glides and tendon glides are some other rehab techniques that should be administered by your physiotherapist.
She cautions: A gentle pulling feeling is OK, but you should not feel any sharp pain when performing these exercises. If you do feel a sharp pain, stop doing that exercise immediately and contact your doctor or physical therapist.
Expect more in this informative and useful series of videos by Dr Meenakshi! You can also read a more detailed blog in this connection on www.gayofitnessacademy.com