Similar to rotator cuff problems, most people have heard of carpal tunnel syndrome but many aren’t really sure what it is or what can be done about it. Upper limb injuries are so common that I’ll be able to keep it as a theme for another column or two, and I hope I help shed some light on these conditions that affect many of us.

The carpal tunnels are anatomical structures that we each have two of; one at each wrist. The carpal tunnel is formed by a fibrous band that runs across the underside of the wrist. Its function is to hold in various structures at the wrist, much like the cuff of a sleeve. Without it, when you fully flexed your wrist to your forearm, the tendons would extend from your fingers to your elbow, and not be held in neatly at your wrist. Underneath the carpal tunnel run a number of flexor tendons and the median nerve. The “syndrome” occurs if the carpal tunnel becomes injured or inflamed which impinges upon the median nerve, with specific and predictable effects felt in the hand. These effects can include tingling or numbness in the underside of the thumb, index and middle fingers as well as weakness or clumsiness in gripping.

The carpal tunnel becomes injured or inflamed by assault on or overuse of the area, and this is often caused by repetitive strain associated with computer work. The likely insult is the repetitive micro-movements used when clicking mouse buttons or typing on modern keyboards, while the wrist is held in an extended position where the carpal tunnel is pulled taut. Since these subtle movements are a relatively new phenomenon – the large, more forceful strokes required for using an old typewriter, for example, seem to be less of an insult – the frequency of carpal tunnel syndrome (CTS) has increased in modern times. Of course, there are many different ways to cause similar irritation to this area, ranging from needlework to using a jackhammer.

When symptoms of CTS appear, they can often be offset simply by altering wrist position at work so that they are not cocked into extension or flexion, and gently stretching the area. Icing the underside of the wrist will help to minimize the inflammation occurring there. When the problem is more persistent or prolonged, treatments such as night splints or manual therapy including myofascial release (ART®) can be quite effective. For severe or stubborn cases, surgery can be performed, where the carpal tunnel is cut to the release the pressure. As always, surgery is a last resort, and scar tissue build-up afterwards can be another source of impingement so it’s always advisable to try conservative treatments first. It is important, however, to have the condition properly diagnosed, as wrist, hand or arm symptoms can be due to various causes other than CTS. For example, symptoms that involve the entire hand or areas above the wrist implicate structures other than the carpal tunnel, and this must be differentiated with a careful diagnosis.

In an upcoming article I’ll discuss two other common upper limb complaints: tennis and golfers’ elbow. Like carpal tunnel syndrome and rotator cuff problems, these repetitive strain injuries can be very disruptive to daily life, but may be more common -- and more treatable -- than you realize. With proper diagnosis, there are various treatment options that can get you out of pain and functioning like normal again.