Carpal tunnel syndrome

Achy hand with numbness or weakness

The carpal tunnel is a structure in the wrist made of a few small bones and a strong ligament.  The median nerve passes through it and can become compressed, causing the hand to become numb / tingly or weak. Manual therapy aims to stretch the ligament, mobilise the bones, and free up the nerve’s pathway.

Risk factors for CTS include diabetes, pregnancy, repetitive manual tasks and vibrational manual tasks.  In some cases, no amount of manual therapy will help the problem – it is just too compressed.  So in these cases, the thumb especially becomes very weak and grip strength is severely affected.  Surgery becomes the only option, and the ligament is released / remodelled, which is usually very effective.

The less severe cases are best managed non-operatively and this involves manual / manipulative therapies aimed at releasing the bones and ligament.  Neural ‘flossing’ is used to slide the nerve back and forth to minimise any adhesions and to promote blood flow to the nerve.  Night splinting is also an option, as the problem often becomes more noticeable when trying to sleep.  The splint simply holds the wrist in its most ‘open’ position, preventing clenching and curling of the hand and wrist when sleeping.  We order these in when needed and they cost about $40 each.

Mild CTS tends to be a medium term problem, lasting 1-6 months.  Treatment usually involves once a week 40 minute sessions working on the entire pathway of the median nerve, from the neck to the hand, and we’ll generally do about 4 of these in a row before diminishing the treatment frequency as the problem improves.