What is wrong with my hand?

Post by Sam Donaldson (M.PhtySt, BAppSci(HMS), Physiotherapist APAM SMAM)

Do you get some odd tingling in your hand, or have you had some clumsiness with fine motor skills like holding a pen or opening a door? Do you have a reason why?

These symptoms suggest that there might be an issue relating to a nerve that supplies your hand. Chances are there was no particular injury that caused this. If the symptoms seemed to randomly start, one possible diagnosis is Carpal Tunnel Syndrome. Importantly, check with your physio first before claiming that this is what ails you!

About Carpal Tunnel Syndrome

Carpal tunnel syndrome affects approximately 3-5% of the population, so chances are you know someone who has suffered with it. It is a compression injury to the Median Nerve as it passes through a small space in the wrist, called the Carpal Tunnel.

It is characterised by sensation loss (tingling or numbness) in 3 ½ fingers: the thumb, index, middle fingers and the thumb side of the ring finger. More severe Carpal Tunnel Syndrome might affect the motor control of those fingers as well, so using a pen, handling paper or gripping might have become difficult. Pain might also be a feature and often these symptoms are relieved with a flicking of the wrist.
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It is not common for the palm of the hand, the little fingers and anywhere in the forearm to be affected with similar symptoms. However, if the symptoms are left for a long time and have continually been getting worse, it is not unreasonable for symptoms to progress into the forearm, although this is much less common and may indicate that the problem stems from further up the arm, shoulder or neck.

Rehab!

Carpal Tunnel Syndrome is usually made worse by overuse of the wrist and hand. The compression injury of the nerve results in some damage to the nerve tissue and the subsequent symptoms. So in rehabilitation of Carpal Tunnel Syndrome, the aim is to initially reduce the compression before targeting the nerve health. There may also be other medical conditions that can affect this Carpal Tunnel space, so be sure to discuss it all with the Physiotherapist.

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Conservative management usually involves the use of a splint, particularly at night time. Your physiotherapist can also help with other management options such as massage and acupuncture to relieve some pain. Occasionally pain relief in the form of a corticosteroid injection or oral tablets may be prescribed by your doctor.

If tolerated, some interesting dance-like movements involving the wrist and whole upper limb can help move the nerve through its space. These are often very specific to each person. Mobilising the nerve tissue has been shown to improve normal healing of the nerve and even improve electrical conduction of the damaged nerve.

Prognosis

Carpal Tunnel Syndrome that is severe, constant and chronic (over 3 months), may not resolve with conservative management and may require a surgical release. In severe cases symptoms may never fully resolve, but appropriate management can result in a return to normal daily function. However, if caught early, many people will return to normal function over approximately three – six months.

If you, or someone you know is suffering something similar, it is recommended that they seek some assistance in getting an accurate diagnosis and managing the condition appropriately.