Carpal Tunnel Syndrome
Your carpal tunnel is the area at the base of your wrist, where nerves and tendons pass through on their way into your hand. This tunnel is formed by non-elastic connective tissue that serves to protect the structures that run through it. Carpal Tunnel Syndrome (CTS) is a common condition where the nerve running through this passage (the median nerve) becomes compressed and inflamed.
CTS causes pain, numbness, tingling and sometimes weakness in your hand and fingers. Your thumb, index finger, middle finger and sometimes your ring finger, will be affected since these fingers are supplied by the median nerve.
Later symptoms can include pain radiating up into your arm, as well as further weakness, loss of sensation, and decreased ability to use your hand. You may notice worsening of symptoms when you try to grasp objects, and may drop objects unexpectedly.
Anything causing a narrowing of the carpal tunnel can increase the pressure on the median nerve and cause CTS. Some people have a genetic predisposition to CTS, and it can develop for no other apparent reason. Performing work or other activities that require extreme or repeated wrist movements also increases your risk of developing CTS. People who type a lot, sew, use vibrating hand tools, play racket sports or play string instruments can also develop CTS. Other things that can increase your risk of CTS include being overweight, or having disorders such as rheumatoid arthritis and diabetes. Pregnant women are also at risk, since the hormones involved in pregnancy can cause fluid to build-up in the carpal tunnel, reducing the space and compressing the nerve. For the same reason, post-menopausal women are at risk. Also, after the birth of their child, women who constantly hold and lift their newborn baby can also develop CTS due to these sudden unaccustomed movements.
Symptoms typically start gradually. You may wake up with numbness, tingling or burning in your hand. Most people feel the need to shake their hand to relieve symptoms. As the condition advances, pain and sensory symptoms can become more constant and progress to weakness, clumsiness and loss of hand function. The earlier CTS can be treated, the better your outcome will be. We are well-trained to identify conditions and will be able to provide a possible diagnosis of CTS without the need for you to undergo various extensive testing such as ultrasound or MRI. A visit to us will save you time and money.
Early physiotherapy treatment will, in most cases, be effective enough to resolve your symptoms and avoid surgery. Sometimes, your doctor may prescribe anti-inflammatory medication or give you a corticosteroid injection to manage your symptoms. Vitamin B6 supplementation can also be beneficial but you should discuss this with your doctor first. Physiotherapy is the best treatment for CTS. After having a full discussion with you about your symptoms and other relevant history, we will perform a comprehensive physical evaluation. Based on our findings, we will develop a treatment program specifically for you. The goal of our treatment will be to reduce your symptoms, help you restore the function of your hand, and help you return to your normal daily activities without the need for surgery. We will provide you with appropriate information and advice on ways to improve your condition, which may include proper wrist positions, postural adjustments, and using ice or heat. We will work through a stretching and strengthening exercise program with you, which will maintain the mobility and strength of your wrist.
Additional treatments we can do include ultrasound and electrotherapy to manage pain and inflammation, manual therapy to mobilise wrist joints, soft tissues and nerves, and taping to provide support to your wrist.
Few people will require surgery for CTS, especially if they wait too long before seeking treatment. We will refer each patient who does not get better with our treatment to the appropriate medical professional for further management. Physiotherapy after a carpal tunnel release surgery is also vital to manage scar tissue, help to restore wrist functioning and find ways to change the factors that lead to the development of CTS in the first place.
DeQuervain’s tenosynovitis (hereafter referred to DeQuervain’s syndrome) is a painful inflammatory condition involving the tendons at the base of your thumb where it joins your wrist. Tendons are tough, non-elastic bands of connective tissue that attach muscles to bones. DeQuervain’s syndrome happens when the tendons are irritated or constricted as a result of overuse over a period of time.
Repeated wrist or thumb movements and repetitive gripping or wringing actions often lead to DeQuervain’s syndrome. Activities such as typing, carpentry, playing musical instruments, playing racket sports or golf, and even gaming and texting, can overwork the tendons. People of all ages can get DeQuervain’s syndrome, though we see it more in people over the age of 40, and more in women. Classically, mothers who repeatedly lift their newborn babies using their wrists develop DeQuervain’s syndrome. For this same reason, child care providers are also at high risk.
The first sign of DeQuervain’s syndrome is pain and tenderness at the base of your thumb, which is made worse with wrist and hand movements. This area will be tender and might be swollen. If left untreated, this inflammation will cause radiating pain up into your arm, as well as reduced mobility and strength of your wrist and hand. As your body tries to heal the injured area, scar tissue will form and further restrict your wrist and hand movements, which can become permanent.
Seeking treatment early will ensure your symptoms are well managed and allow you to recover fully without any complications. Physiotherapy is the best first treatment for DeQuervain’s syndrome, since we help you manage your pain, reduce inflammation, and recover the use of your hand and wrist. We are also knowledgeable on this condition and will educate you about it, as well as teach you ways to manage your daily activities without aggravating your symptoms.
Your visit to Just Physio will start with a comprehensive interview with one of our well-experienced physiotherapists. Here, we will gather as much information from you about your condition to help us understand what you are experiencing. After the interview we will perform a physical assessment on your wrist, hand and arm. We look at the mobility, strength and functioning of your arm and perform specific tests to confirm a diagnosis.
To manage pain and swelling we may decide to use ice, ultrasound and taping (for compression and to protect your wrist). Further, we aim to reduce any tightness in the surrounding muscles and connective tissue by using heat, massage, dry needling and stretches. We also want to improve the mobility of the small joints in your wrist and may perform manual joint mobilisations to promote normal movement there. A major aspect of successful treatment is to help you find ways to manage your symptoms outside of the therapy sessions. Therefore, we advise and guide our patients on self-management strategies as much as possible.
For persistent symptoms that do not improve with conservative treatments, or for people who delay seeking treatment for too long, a corticosteroid injection or surgery might be necessary. If we see that you are not improving with our treatment, we will refer you to the appropriate medical professional. If you are one of the minority people who require surgery, physiotherapy after surgery is also vital. Post- urgery treatment will help control swelling, stabilise the healing area, regain your wrist and hand mobility and strength, as well as finding ways to safely return to your previous activities.
Joint and Ligament injuries
Our wrists and hands have very intricate anatomical structures. There are 27 bones in your wrist and hand, with many muscles, tendons, and ligaments surrounding, stabilising and controlling its movements. We use our hands for almost all our daily activities, and consequently, we can injure them easily. A wrist or hand injury will therefore cause a lot of issues with our daily functioning, and getting early treatment for an injury will allow you to recover quickly.
Joint or ligament injuries of the wrist or hand can occur with acute traumatic events such as falls, or other movements that force your wrist or hand into an awkward or overstretched position. Ligament injuries can also occur with repetitive strain over time. any of the small joints in your hand can also be affected by chronic conditions like arthritis.
At Just Physio, we can successfully treat any joint or ligament injury and help you regain the use of your wrist so that you can return to your normal daily life.
Sometimes pain that is felt in your hand is actually coming from a different area of your body. This pain is called referred pain: when the source of your pain is not the same area as where you feel pain. Your hand itself might not be injured but there may be a problem in your arm, shoulder, neck or upper back that is causing you to feel pain in your hand.
That is the beauty of our sophisticated anatomy. All parts of your body are interconnected in a specialised functional way. Fascia, which is a highly specialised type of connective tissue that runs all along our bodies, connects various parts of our body together. If there is an issue anywhere along this fascia network, pain may be felt anywhere along its path. Fascia restrictions in your back, neck, shoulder or arm can cause referred pain into your hand.
Good shoulder stability, mobility and strength is required for you to use your arm and hand properly. Many muscles control the movements of your shoulder and arm. If there is muscle spasm or trigger points in any of the shoulder muscles, it may affect your entire arm. There are specific pain referral patterns for each muscle. Pain from muscle or fascia may be aggravated with specific movements of your neck, shoulder or arm.
Damaged or compressed nerves can also cause referred pain anywhere along the route that they travel from your spine into your arm and down to your hand. Various things can irritate, compress or injure a nerve. Poor postures, muscle spasm, joint problems, overuse injuries etc. can all injure a nerve. Referred pain from a nerve will cause deep, burning or aching pain that is often accompanied by sensations of tingling, numbness, loss of feeling and even weakness in your arm or hand.
Pain is not always a direct indication of injury or damage at the painful area, especially with referred pain. The type and severity of pain and will vary greatly depending on, amongst other things, the structure causing pain. When you present to us at Just Physio with pain, we will do a thorough assessment to determine where your source of pain is. Prior to the physical assessment, we also listen to your story of your symptom history, nature and severity. Referred pain must be treated specifically to your unique situation, since it can be complex. We aim to provide the best individualised treatment for you.
Depending on the cause for your referred pain, we may include treatments such as electrotherapy, heat or ice therapy, massage and myofascial release techniques, nerve mobilisations, spinal mobilisations, dry needling and taping. To continue symptom relief outside of therapy, we can provide suggestions as to how you can modify your daily activities or work tasks, give you postural advice and corrections, and show you stretches and exercises you can do.
Referred pain often responds to treatment immediately, but it can also take longer to treat. Typically, early treatment gives the best results. Therefore, do not delay contacting us to get your symptoms sorted out before it gets worse, or book a 10 minute no obligation telephonic consultation to discuss your situation and determine whether you require further treatment. Referred pain should never be ignored.
Conditions We Treat
Jaw and TMJ Disorders
Chest Pain/ lung problems
Elbow & Arm Pain
Thoracic / upper back Pain
Lower back Pain
Wrist,hand and finger Pain
Lower leg Pain