CTS is a fairly common condition which affects the wrist, hand, and fingers. It occurs when the Median Nerve, which gives sensation to much of your hand, becomes irritated. This often occurs at the level of the CT, a small space in your wrist where the nerve (and a number of other tendons) passes through. With repetitive use, excessive vibration, and/or direct trauma, the nerve can become compressed within this space, irritating it and reducing its ability to work properly – which typically causes changes to grip strength and sensation.
Typical symptoms include tingling, pins and needles, numbness, and/or pain which broadly affect the whole hand. Significant cases may cause reductions in the ability to use the hand; with clumsiness, reduced grip strength, and reduced dexterity occasionally reported.
CT is common in labourers or people who otherwise use their hands in a repetitive fashion or in unusual positions. It is also very common in new mothers, due to the complex hormonal changes which occur during pregnancy. Although these are common presentations, the underlying mechanism is an excess of pressure on the Median Nerve, therefore, any repetitive or unaccustomed activity can cause CT, such as typing on a keyboard, a new gym routine, prolonged heavy gripping, or even sleeping with your arm in an unusual position.
A thorough assessment by your Physiotherapist is warranted if you begin experiencing any of these symptoms, as CT can be managed very well through a combination of education, exercise, and some manual therapy – as per the advice of your therapist.
The main goal of physiotherapy treatment is to first allow the nerve to settle by identifying tasks that clearly bother it. This can be achieved by interventions such as splinting and/or taping to help offload the nerve. Manual therapy for the surrounding structures can also be helpful as these are often stiff and possibly affecting the nerve. Your physiotherapist will also be able to advise on your posture or technique which might be bothering the nerve and how to modify them.
When the nerve (and your symptoms) has settled, the next step is to gradually increase the strength and load tolerance of your wrist, hand, and arm, so you can get on with said tasks. This also reduces the chances of it coming back. This is achieved by prescribing a personalised exercise program which usually includes a combination of:
A thorough assessment by your Physiotherapist is warranted if you begin experiencing any of these symptoms. Carpal Tunnel Syndrome, especially in the earlier stages, can be managed very well through physiotherapy.
CT often takes 6-12 weeks to resolve, however, it can take longer in older people, new mothers, and in those with a long history of symptoms. Most patients make excellent progress with Physiotherapy treatment only, but in some circumstances, a simple surgery to relieve the pressure on the CT may be useful.
Tennis Elbow, or more specifically, Lateral Epicondylalgia, is the most common condition affecting the outside of the elbow. It occurs primarily when you overuse the muscles of your forearm, which help extend your wrist and fingers, giving you a strong grip. Frequently, this occurs after a period of very heavy or unaccustomed gripping, such as tennis or squash, manual labour, or martial arts.
It is worth noting that Tennis Elbow is distinct from Golfer’s elbow – which is a similar condition fundamentally, but affects the inside of the elbow and a different series of tendons on the front of your forearm. These changes the treatment we will perform so it’s important to get this diagnosis right.
The muscles of your forearm which give strength to your grip are attached to bone by a series of tendons that all come from a point on the outside of your elbow. This tendon bundle lies slightly above and a few inches below your elbow joint. Due to the way these tendons disperse load, it is often this region specifically which becomes inflamed or irritated after heavy use, which leads to the typical complaint of outside elbow pain with gripping tasks and direct pressure.
Whilst pain with gripping is the most common complaint of Tennis Elbow, people may also have pain with elbow or finger extension, and/or wrist flexion. In poorly managed cases, people may also experience a loss of grip strength or intermittent pins and needles – which is often due to an irritation of the nearby Radial Nerve – which requires slightly different treatment.
Tennis elbow is characterised as a tendinopathy, due to the fact the fundamental issue is an overload of tendon tissue. Tendon, which attaches muscle to bone, is unique in that it heals very slowly and only when appropriately loaded – which is why rest generally doesn’t help in the long-term. What often helps the most is a combination of short-term pain relief strategies, followed by a period of deliberate strengthening exercises. In some cases, when symptoms don’t improve over several months of Physiotherapy treatment, a steroid injection may be considered. Surgery is rarely required, but does occasionally happen in rare cases.
Tennis elbow can be tricky to manage, primarily because it is difficult to avoid using your hands. It can be very hard for any other treatments to help if you are constantly aggravating your symptoms by doing too much!
Therefore, the aim for physiotherapy treatment in the short to medium term is to identify the movements and activities that are most obviously causing your symptoms and find ways to modify them.
This is combined with other treatments to help reduce pain and improve your function in the short term and includes:
Typically, Tennis Elbow takes 1-3 months to resolve, but this timeframe can extend even to 6 months in older-aged people or those with a longstanding history of symptoms.
Therefore, self-management is the most important skill early on that your Physiotherapist can teach you as its difficult for this condition to improve without modifying the painful tasks. When the pain has improved, we would then introduce a tailored exercise program with a combination of the following depending on your needs:
Both CTS and Tennis Elbow can be painful and frustrating problems to live with. If after trying to implement the exercises and advice above, you are still struggling ten consider coming in to see us at one of our 4 physiotherapy clinics across Scotland.
We remain open for face-to-face sessions as physiotherapy is considered an essential service. If you are struggling with any issues as a result from working from home, it can be beneficial to get yourself an individualised assessment and plan (including hands-on treatment) to figure out a way forward!
We are also running remote consultations – these can be really helpful if you are looking for an individualised home office assessment! We can subsequently advice you on the types of changes or modifications that might suit you. You can expect the same level of service as a face-to-face appointment, with a thorough assessment and an individualised treatment plan (minus the hands-on of course).
Written by Jesse Coad 🇦🇺