Friday, 22 November 2013

Carpal Tunnel Syndrome

With the 94.7 Cycle Challenge having taken place recently, I thought I’d write about a common injury amongst cyclists, namely carpal tunnel syndrome. This injury is not only prevalent amongst the active population who are involved in sports requiring repetitive movements of the wrist, but also in the less active population.

What is Carpal Tunnel Syndrome?
The carpal tunnel is a sheath through which the tendons of the flexor muscles of the hand, as well as the median nerve, pass. Any irritation of this sheath will cause inflammation which puts pressure on the median nerve, causing pain and tingling.



Causes
Any repetitive compression of the carpal tunnel can lead to this condition. Carpal tunnel syndrome can be caused by a traumatic injury to the wrist, repetitive overuse of the wrist joint or structural abnormalities in the wrist itself. The following sporting activities can predispose one to carpal tunnel syndrome:
·         Cycling
·         Racquet sports
·         Throwing sports
·         Archery
·         Gymnastics
Certain infections, such as pneumonia and malaria, as well as metabolic diseases, such as diabetes, rheumatoid arthritis and gout can also cause carpal tunnel syndrome.

Signs and Symptoms
·         Pain that wakes one in the middle of the night that is often relieved by shaking the hands
·         Pain, numbness, tingling or a burning sensation into the palm of the hand and fingertips
·         The ability to grip and pinch is often diminished
·         Generally, only one hand is affected – usually the dominant hand
·         Fine motor skills, such as fastening buttons, is often difficult
·         Symptoms recur when direct pressure is placed on the median nerve in the carpal tunnel for approximately 30 seconds


Treatment
Individuals with carpal tunnel syndrome should see a physician for treatment. Initially, the wrist should be immobilized using a splint. Rest, ice and anti-inflammatories are also used to reduce the initial pain and inflammation. However, compression bandages should be avoided, as they place additional strain on the already compressed median nerve in the carpal tunnel. Most people respond well to this conservative treatment; however, if symptoms continue, a cortisone injection into the site may be required. The final resort is surgical treatment which may be required in severe cases.

Exercise
Any sporting activities that contribute to this condition should be stopped immediately to allow the inflammation and pain to subside. Certain exercises can be performed to maintain mobility of the wrist in mild cases; however, these exercises should not be performed in severe cases, as they may exacerbate symptoms. Exercise therapy alone is not likely to relieve symptoms, but may be useful when used with other treatment.

References
Foundations of Athletic Training: Prevention, Assessment and Management

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