Sunday, November 19, 2017

understanding the carpal tunnel

What is the carpal tunnel? Many clients have wrist pain here, but aren't quite sure what the structure looks like, or the pathology of Carpal Tunnel Syndrome.
carpal bones: scaphoid, lunate, triquetral, pisiform, trapezium, trapezoid, capitate, hamate

The carpal tunnel is comprised of the 8 carpal bones (bones of the wrist) the transverse carpal ligament and the flexor retinaculum (a fibrous sheath of tissue that covers the joint to offer it more integrity). The median nerve and tendons of the muscles of the fingers and palm pass through the carpal tunnel. When the tendons are inflamed from over-use or repetitive use, they swell under the carpal tunnel, pressing on the median nerve.

I often recommend icing or an ice bath for the wrist and hands. And, stretching:

If it becomes a prolonged and severely aggravated complaint, your primary care provider might offer these treatment suggestions:

Cortisone (steroid) shot: This is an injection of the steroid -cortisone- into the joint space. It aims to reduce the chronic inflammation, beginning anew a healing process for these chronic injuries. Recovery with this treatment can be felt immediately to a week or so, and the effects can be felt for months to even years -especially when the source of aggravation is removed or amended.

Physical Therapy: A PT can provide many manual treatments, and often help to address the daily habits that might be aggravating this particular injury. By stretching. strengthening, and either avoiding or altering certain activities, pain can be reduced and recovery can occur.

Surgery: Surgery for carpal tunnel syndrome is a minor surgery, where a small incision is made in the transverse carpal ligament, which alleviates the pressure on the median nerve. The incision is then stitched back up. There is often a very small scar from the incision which, as almost all scar tissue, improves with massage to decrease the buildup of fibrous tissue. You may feel relief immediately, or within a few weeks or months. Recovery time from the surgery will take a few weeks before you can return to regular, rigorous use of your affected wrist.

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