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Carpal Tunnel Syndrome is the pathology of the 21st century
Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and affects around 5% of the general population. This pathology has been perceived as the most common cause of sick leave, decreased productivity, and personal financial losses and not surprisingly results in high medical and non-medical costs. (Feng et al., 2021). Since smartphones have recently come to be used more frequently than computers in daily life, various adverse effects of smartphones have appeared. A study by Al Shahrani E. et Al Shehri N. (2021) showed that people who spend lots of time on their smartphones and computer/s are more prone to develop annoying carpal tunnel symptoms.
What are the symptoms?
Carpal tunnel symptoms consist mainly of pain and numbness and tingling typically in the thumb, index and middle finger. It sometimes results in muscle wasting, diminished sensitivity and loss of fine motor skills in the affected hand. On the other hand, exist other pathologies like arthritis, sprained wrist, tendinopathy of flexors and cervical radiculopathy. All these can mimic pain similar to carpal tunnel syndrome.
How to handle it?
While carpal tunnel syndrome is often progressive, patients may get better without the need for surgery treatment that hlas to be always considered as the last resort option due to its complications. Carpal tunnel surgery is one of the most frequently performed hand operations. However, patients often experience worsening or no change in symptoms after the intervention. According to the article of Kaehr (2010), the failure rate for carpal tunnel surgery is over 50%. In that same article, one study showed that half of the people who reported having CTS symptoms received carpal tunnel surgery. Of those, only five per cent actually needed carpal tunnel surgery — the other 45% could have been treated more conservatively - for example with high-intensity laser and exercises for carpal tunnel syndrome.
Corticosteroid injections in carpal tunnel syndrome are used daily to relieve symptoms. They work well in about half of patients. But they are not without risk. Side effects include weakening tendons and bone degeneration (steroid-induced osteoporosis). (Chen et al., 2015). The well-known solution is also a wrist brace for carpal tunnel syndrome. Braces for carpal tunnel can relieve temporary pain in patients. The problem is when wearing a carpal tunnel splint, the joint does become stiff, and hence, some exercises are needed to regain motion and strength.
Treatment of carpal tunnel syndrome
Treatment of carpal tunnel syndrome should always be conservative. Patients need to perform exercises regularly focusing on wrist and finger mobility and neurodynamics to restore movement and function of the median nerve. The postural aspect has also to be addressed when treating a patient with carpal tunnel symptoms. Physiotherapy for carpal tunnel symptoms includes techniques to decrease levels of pain, swelling and oedema and to increase soft tissue mobility in the carpal tunnel area.
High-Intensity Laser
A High-Intensity Laser improves Carpal tunnel syndrome symptoms and it’s considered an effective tool for this pathology (Hojjati et al., 2020) Therapists relieve acute symptoms with High-Intensity laser thanks to its anti-oedema, analgesic and anti-inflammatory effects. In subacute and chronic states we also take advantage of the thermal effect produced in the tissue and thus loosen the adhesions produced by the overuse of the area.
BTL High-Intensity Laser can be also used on the specific site of the compartment syndrome where the median nerve runs from the forearm into the palm of the hand and becomes ‘stuck’ - concretely entrapment at the elbow between the two heads of pronator teres (pronator teres syndrome) and under the flexor retinaculum (carpal tunnel syndrome) and also in the site of thoracic outlet syndrome - pectoralis minor muscle, subclavius and scalene muscles. The high-Intensity laser can be also used together with the neurodynamics technique to restore median nerve movement and function by loosening adhesions.
