The carpal tunnel is a narrow, tunnel-like structure in the wrist, which is a key area in the anatomy of the hand. Understanding its structure involves several components:
Location and Structure: The carpal tunnel is located on the palmar side of the wrist. It is a narrow passageway bounded by the bones of the wrist (carpals) on three sides and a strong band of connective tissue called the transverse carpal ligament on the fourth side.
Bones: The floor and sides of the carpal tunnel are formed by the carpal bones - a group of eight small bones that make up the wrist. These bones are arranged in two rows, each containing four bones.
Transverse Carpal Ligament: This is a broad band of fibrous tissue that forms the roof of the carpal tunnel. It stretches across the wrist, attaching to the carpal bones and forming the superior boundary of the carpal tunnel.
Contents of the Carpal Tunnel:
Median Nerve: One of the major nerves of the hand, it provides sensation to the thumb, index, middle, and part of the ring fingers. It also controls some muscles at the base of the thumb.
Tendons: The carpal tunnel also contains the flexor tendons, which are long strands that attach the forearm muscles to the bones of the fingers and thumb. These tendons are enclosed in a synovial sheath, which allows smooth movement of the tendons.
Vascular Supply: Although primarily a passageway for tendons and the median nerve, the carpal tunnel also contains important blood vessels that supply blood to parts of the hand.
Function and Movement: The carpal tunnel serves as a conduit through which the flexor tendons and the median nerve pass into the hand. This arrangement allows for the efficient and smooth flexion of the fingers and thumb.
Carpal Tunnel Syndrome:
Carpal tunnel syndrome (CTS) is a common condition characterized by compression of the median nerve as it passes through the carpal tunnel in the wrist. Understanding the epidemiology of carpal tunnel syndrome involves examining its prevalence, risk factors, and demographic characteristics. Here are key points regarding the epidemiology of carpal tunnel syndrome:
Prevalence:
Carpal tunnel syndrome is one of the most prevalent nerve entrapment disorders, affecting a significant number of individuals worldwide.
The prevalence of carpal tunnel syndrome is estimated to be around 3-6% in the general population.
Age and Gender:
Carpal tunnel syndrome is more common in middle-aged and older individuals, particularly those over the age of 40.
Women are more likely to develop carpal tunnel syndrome, with the prevalence being 2 to 3 times higher in women compared to men.
Hormonal factors, such as those related to pregnancy and menopause, may contribute to the higher prevalence in women.
Occupational Factors:
Certain occupations that involve repetitive hand and wrist movements, forceful gripping, or exposure to vibration (e.g., manufacturing, assembly line work, typing) are associated with a higher risk of developing carpal tunnel syndrome.
Workers in jobs with repetitive motions and use of hand tools are at an increased risk.
Underlying Medical Conditions:
Conditions like obesity, diabetes, rheumatoid arthritis, hypothyroidism, and metabolic syndrome are associated with an increased risk of developing carpal tunnel syndrome.
Chronic medical conditions that cause fluid retention or inflammation can contribute to nerve compression within the carpal tunnel.
Pregnancy:
Carpal tunnel syndrome is relatively common during pregnancy, likely due to fluid retention and hormonal changes that can increase pressure on the median nerve.
Genetic Factors:
Some evidence suggests a genetic predisposition to carpal tunnel syndrome, with a higher risk observed in individuals with a family history of the condition.
Repetitive Stress:
Repetitive or sustained stress on the wrist and hand, especially with poor ergonomics and prolonged use of handheld devices, can contribute to the development of carpal tunnel syndrome.
Treatment of carpal tunnel syndrome non-surgically involves a process of reducing the pressure around the median nerve in the tunnel. This can include the use of splints to reduce the repetitive strain on the wrist or modifying the way repetitive tasks are performed. It is common on examination to find tendons around the nerve in the tunnel to be thickened by chronic inflammation due to repetitive strain. The thickened tendons reduce the space available in the tunnel causing compression on the median nerve. Often, examination reveals that trigger points in the muscles associated with the tendons have resulted in the thickening and chronic inflammation due to the constant tension in the muscles containing the trigger points. In these cases, physical therapy interventions directed at eliminating the trigger points can be very effective, including trigger point dry needling techniques. Trigger Point Dry needling to address the muscular portion of the problem in addition to ASTYM treatment to correct the tendon thickening can result in a nearly 100% non-surgical correction of carpal tunnel syndrome if addressed before permanent nerve damage occurs.
Dry Needling Technique for Carpal Tunnel Syndrome
If you are experiencing pain, numbness and tingling in her hand and would like to explore non-surgical options, please schedule a consult with one of our licensed professionals at Lanier Therapy In Motion.
