Avin Patel

Carpal Tunnel Syndrome

The carpal tunnel is a narrow space in the wrist. Nerves and tendons pass through here on their way to or from the hand.

The carpal tunnel

The median nerve runs through the tunnel, and it can be irritated in this small space. This nerve supplies some of the palm with sensation and movement.

When the nerve is irritated, it can cause pain, weakness, numbness, and pins and needles in the area it supplies. These are symptoms of Carpal Tunnel Syndrome (CTS). These symptoms are often worse at night, potentially due to compression of the wrist while sleeping. Bending the wrist is an aggravating factor in itself.

How Carpal Tunnel Syndrome Occurs

The nerve can be irritated in two ways: from pressure from within the tunnel, or from outside.

Internal Pressure

Overuse of the muscles whose tendons run through the tunnel can cause CTS. This is generally agreed to be the most common cause of CTS. Previously known as “repetitive strain injury” or RSI, this can be associated with excessive computer work. The effect on the carpal tunnel is more apparent with poor ergonomics- resting the wrists on a hard desk while typing adds more pressure to the nerve.

Anything that reduces space within the tunnel can predispose CTS. One common factor is fluid retention, as may occur with:

  • pregnancy
  • kidney disease
  • heart failure
  • some medications

As cells become more full of fluid, they take up more space and can lead to compression.

External Pressure

Positional problems can cause unnecessary pressure on the nerve from outside the tunnel. One reason that symptoms may be worse overnight is that we commonly sleep with a flexed wrist. This causes compression through the tunnel, and can encourage symptoms to develop overnight.

As discussed previously, direct pressure to the wrist at work will also apply external pressure.

Persistent Symptoms of Carpal Tunnel Syndrome

Occasionally we see patients who still have symptoms after CT release surgery. This is a procedure to make space in the tunnel by cutting the band of tissue near the surface. Persistent symptoms tell us that either there is something in the wrist that continues to cause irritation, or it’s not the wrist at all.

The median nerve can also be irritated further up the arm, causing similar symptoms but having nothing to do with the wrist. One of the muscles that turns the hand over is another point at which the nerve can be compressed. Alternatively, other nerves could be irritated as far up as the neck, causing discomfort, weakness, or numbness into the hand. However, this latter alternative is unlikely to mimic CTS so closely.

Persistent symptoms without surgery do not necessarily mean that surgery is the answer. As overuse of the wrist muscles is considered the most likely cause on average, it makes sense that symptoms may remain as long as the wrist is overused. Your osteopath may be able to help here.

Treatment

Osteopathy is built on the principle that the body can heal itself. As mentioned above, this may be as simple as changing a movement to remove an aggravating factor. Whether this means strengthening one muscle group to take the load off another, or advising the use of a splint overnight,

In the case of wearing a splint, it may be possible to work on other factors at play in order to avoid reliance. Advice such as using ice, or self massage to reduce the impact of overstrained muscles can help here. Techniques from the treatment room that may be adapted for exercise at home could include gentle “flushing” techniques. These aim to reduce any inflammation or fluid build up in the wrist.

For help managing symptoms of carpal tunnel syndrome, book now.

Sciatica

The sciatic nerve runs from the lower back down the back of the thigh and outside of the calf. Sciatica is a symptom of irritation of this nerve.

Scatica and its causes

Symptoms

When the nerve is irritated, symptoms can develop anywhere along the length of it. For some people this means pain from the back to the foot, and for others it can be a lot more focal. A sharp, shooting pain in a defined line is a typical symptom of sciatica. This is rarely constant but might be somewhat unpredictable. Pins and needles in the same area, or numbness or weakness are also common.

If the cause is a disc bulge, movements that stress the disc can aggravate symptoms. Examples of this are heavy lifting, twisting, and straining on the toilet. It is important to note that symptoms are not indicators of damage. Nor does intensity of symptoms predict how long an episode will last. Sometimes people with the most debilitating pain are the quickest to recover.

Causes of sciatica

The basic cause of sciatica is irritation of the nerve in the back or upper leg. There are a number of ways this can happen, and sometimes there are multiple causes. Two of the most common are:

  • Nerve compression in the back due to a bulging disc (diagram C)
  • Nerve compression in the buttock due to a tight gluteal muscle (piriformis syndrome)

When is Sciatica not Sciatica?

Not all pains in the back of the leg are down to the sciatic nerve.

Hamstrings

The sciatic nerve runs through the same area as the hamstrings, so pain can be mistaken for sciatica when it’s not a nerve at all. A simple pulled muscle can imitate the symptoms without any sciatic involvement.

Referred pain

Sometimes the brain misinterprets pain signals and detects pain where it shouldn’t be. You may have heard of people having heart attacks but experiencing jaw pain: this is the same mechanism. Nerves cover a broad area, so when a nerve brings a pain signal to the brain, the brain has to work out where exactly the pain is coming from. Heart pain isn’t a usual sensation, so the brain thinks the pain must be coming from somewhere else in that nerve’s area. One nerve that supplies the heart also supplies the jaw, so the brain makes an educated guess.

The same can happen in the back and leg. Irritated joints in the lower back and pelvis can cause pain in the back of the thigh. This doesn’t necessarily mean that anything is wrong with your leg! Your osteopath can work out what’s happening and what needs to be done.

Plantar fasciitis

Pain and pins and needles in the foot can be symptoms of sciatica, but when they’re isolated to the sole of the foot alone they could be something else. Plantar fasciitis is inflammation of the soft tissues on the sole, unrelated to the sciatic nerve.

Book an appointment today to get on top of your sciatica