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carpal tunnel

Carpal Tunnel Causes, Relief, and Treatment

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What is carpal tunnel and why does it hurt so much?

The carpal tunnel is a small space at the wrist in which the median nerve and nine tendons pass through. The median nerve travels on top of the tendons through the tunnel. The tunnel itself is made up of your wrist bones and along the top of the tunnel is a thick fibrous ligament called the transverse carpal ligament. If the tendons become swollen (tenosynovitis) or if the tunnel size itself decreases because of injury, compression to the median nerve can occur. Symptoms may include: pain during pinching and gripping, a feeling of clumsiness – the inability to hold things, numbness in the fingers at night, or a radiating pain up the arm.

Risk factors at home and at work

There are many factors that can contribute to pain in the carpal tunnel, but these are some of the most common causes.

  • Repetition – Overuse can occur with light forces. Irritation of the tendon can be caused by rapid, repetitive activity without a break. Decreased blood flow to the nerves and tendons may be caused by holding or gripping an object without relaxation.
  • Force – The muscles of the hand and fingers are contracted when gripping or pinching. These contractions place stress on the tendons that go through the carpal tunnel. Higher forces are more likely to expose you to greater risks.
  • Bending – The tendons in the carpal tunnel can be irritated by bending your hand. Bending your hand up, down, or sideways may inflame the tendons in the carpal tunnel.
  • Vibration – Nerves are especially susceptible to vibration. Common causes of vibration of the nerves in the carpal tunnel are power tools, steering wheels, or other mechanized equipment.
  • Impact – Your hand is not a tool. Hitting, moving, or jerking objects may damage the structures of the wrist. Even using a hammer transmits sudden force to these delicate structures.

Practicing prevention

The first line of defense against Carpal Tunnel Syndrome is reducing the risk factors that may lead to CTS. Look carefully at your equipment and tools and try to eliminate the forces that are risk factors. This can include bending, vibration, impact, and repetition.

  • Tool Handles – A handle should have an optimum grip span of about 2 ¼ inches.
  • Gripping Surface – Use rubberized coating or tubing on your gripping surface. This will lower the grip strength required to hold onto the tool.
  • Reduction in vibration – Place a rubber or gel material on the handles or utilize gloves with rubber inserts to reduce vibration.

Home treatment

  • Ice – Use an ice pack on the palm and wrist area for 10 minutes after intensive hand activities. This can be followed by the wrist stretches.
  • Rest – Rest your hands after frequent, forceful, or repetitive activities that last 30 – 60 minutes. Try doing a different activity which is not as stressful to your wrist and hand.

carpal tunnel

If your pain does not subside, call your physical therapist to schedule an appointment. Physical therapy may be able to reduce pain and remove the need for surgery.

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What is Trigger Point Dry Needling?

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TRIGGER POINT DRY NEEDLING uses small, thin needles to stimulate underlying myofascial trigger points, muscular and connective tissues for the management of many orthopedic conditions, both acute and chronic. Physical therapists use dry needling as a safe, effective, and efficient treatment technique to release painful hyper-irritable spots within a band of skeletal muscle. By inserting a needle into the dysfunctional tissue, it often leads to a contraction of the muscle which then stimulates a release. This leads to a reduction of pain, improvements in flexibility and a restoration of normalized movement when combined with corrective exercises.

WHAT IS A MYOFASCIAL TRIGGER POINT?
A myofascial trigger point is a hyperirritable spot within a taut band of skeletal muscle that produces local or referred pain. The trigger point can lead to increased pain, decreased flexibility and decreased muscle function if not treated. Trigger point dry needling is a safe, effective and efficient treatment technique to release these painful spots.

WHAT TYPE OF PROBLEMS CAN BE TREATED?

Muscle dysfunction can be the primary or secondary contributing factor to many neuromusculoskeletal conditions, which can include:

•  Repetitive Stress Injuries
•  Tendonitis or Tendinopathy
•  Muscle Strains
•  IT Band Syndrome
•  Patellofemoral Dysfunction
•  Plantar Fasciitis
•  Neck Pain or Headaches
•  Rotator Cuff Impingement
•  Carpal Tunnel Syndrome
•  SI Joint Dysfunction
•  Sciatica

Dry needling

This treatment is NOT acupuncture. Modern dry needling is based on Western neuroanatomy and modern scientifi c study of the muscles and nervous system. This modality can only be done by trained clinicians.

If you are interested in Trigger Point Dry Needling, find a physical therapist near you and ask for more information.

causes of carpal tunnel

Common Causes of Carpal Tunnel Syndrome

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Carpal Tunnel happens when the tendons become swollen (tenosynovitis) or if the tunnel size itself decreases because of injury – causing compression to the median nerve.  When compression occurs, a person can experience numbness, tingling, or a dull sensation of the thumb, index, middle and ring fingers. Symptoms may include pain during pinching and gripping, or a feeling of clumsiness and the inability to hold things. The best way to avoid carpal wrist pain, is to understand the main causes of carpal tunnel and use that information at work and at home.

WHAT IS THE CARPAL TUNNEL?
The carpal tunnel is a small space at the wrist in which the median nerve and nine tendons pass through. The median nerve travels on top of the tendons through the tunnel. The tunnel itself is made up of your wrist bones and along the top of the tunnel is a thick fibrous ligament called the transverse carpal ligament.

COMMON CAUSES OF CARPAL TUNNEL
Carpal Tunnel is typically not related to a specific injury. Some common causes of carpal tunnel syndrome include:

Genetic Preposition – Many cases can be a result of physical characteristics of carpal tunnel or medical conditions associated with CTS, which also run in the family.

Repetitive Movements – Certain types of work, leisure and sports activities require use of the hand and wrist repetitively. Occupations such as manufacturing/assembly line workers, grocery checkers, musicians, carpenters and many others require the same movements. Common hobbies such as golfing, knitting and gardening also require repeated movements that cause carpal tunnel syndrome.

Injury or Trauma – Sprain or fracture of the wrist can cause swelling and pressure to the median nerve.

Pregnancy & Menopause – Hormonal fluctuation in women play a role in CTS. Such fluctuation may cause fluid retention and other changes that cause swelling in the body. Fluid retention frequently occurs during the last trimester of a pregnancy and is the reason for CTS.

Medical Conditions – Diabetes, hypothyroidism, lupus, obesity, and rheumatoid arthritis.

ACTIVITIES TO AVOID TO MINIMIZE SYMPTOMS

  • Avoid keeping your wrists bent in either direction. The best position for the wrist is neutral (straight)
  • Avoid rapid repetitive forceful or prolonged hand or arm use such as seen with factory work or data entry.
  • Avoid tight gripping and pinching
  • Avoid pressure to the palm or wrist
  • Avoid extreme cold or vibration.
avoiding workplace hazards for feet and hands

Avoiding Workplace Hazards for Feet and Hands

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OSHA Estimates totals for foot and hand types of injuries annually at 320,000 hand and finger injuries, 70,000 eye injuries, 70,000 head and face injuries, and 110,000 foot and toe injuries in 1987. Close to 30% of the total injury base. Sharp or heavy falling objects are the primary sources of foot injuries. So how does one go about avoiding workplace hazards for feet and hands?

To help you get started we have listed out some of the common injuries and actions that lead to workplace injuries of the hand and foot. This is by no means complete as there certainly could be burns or lacerations or multiple levels of sprains/strains in either body area in addition to those noted.

Foot Injuries

One’s feet provide support and movement. Yet, the 26 bones in the human foot can be easily damaged. According to the BLS, 40 laborers suffer disabling injuries to their feet and toes every day. These injuries account for 8.5 percent of all lost-time injuries in the construction industry.

  • Compression – when foot or toe is squeezed between two objects
  • Puncture – when a sharp object like a nail, penetrates the shoe
  • Slipping – loss of traction due to oil, water or chemicals
  • Chemicals/Solvents – may penetrate ordinary safety shoes and can harm feet
  • Temperature Extremes – insulated boots may be necessary, depending on climate
  • Wetness – extended exposure to water may result in discomfort and possible infection
  • Electricity – a danger when using power tools or electric equipment

Some of the most common foot and leg injuries include:

  • Fractures – A fracture of the bones in the leg, foot, or knee may be caused by falling objects or an accidental fall from a height. Some fractures can be treated by using a lightweight cast and crutches, while more serious fractures may require surgery and extensive physical therapy.
  • Knee Tendonitis – Knee Tendonitis is a swelling of the tendons surrounding the knee. Individuals who spend a lot of time walking, standing, or lifting objects while at work are at risk of developing this painful condition. Older individuals are, particularly at risk.
  • Knee Bursitis – Knee Bursitis is a swelling of a fluid sac that provides cushioning for your knee joint. Like tendonitis, bursitis can cause severe pain, inflammation, and loss of mobility.
  • Loss of Limb – The most serious workplace accidents may require amputation. These life-altering accidents can have devastating effects on an individual’s quality of life and ability to work. Amputation cases are especially complicated because they involve issues of retraining, prosthetic replacement, wound care, and home modification. Leg and foot injuries can be among the most devastating for an individual to sustain as well as the most difficult to overcome. Using crutches or a wheelchair can severely limit a person’s mobility, and make it difficult to complete, let alone enjoy, everyday activities at work, at home, and in the community.
    Leg and foot injuries can also make it very difficult, if not impossible, to return to one’s pre-injury employment. Individuals who perform manual labor rely on the use of their legs and feet to perform nearly every aspect of their jobs. Furthermore, many workplaces are also not properly equipped for individuals with limited mobility.

hand injury


Hand Injuries

The hands are an extremely important part of the body and can be damaged in a matter of seconds, leaving a Laborer permanently disabled. According to the Bureau of Labor Statistics (BLS), Laborers suffer over 8,600 disabling hand injuries each year, accounting for roughly 18 percent of all disabling injuries.

The most common dangers include:

  • Pinch or crush points
  • Hot surfaces
  • Rotating devices
  • Chemicals
  • Machinery not properly locked out

Some common hand, wrist, and arm injuries that can occur in the workplace include:

  • Fractures – A hand, wrist, or arm fracture can occur due to falling objects or other accidents. Some fractures can be severe and may require extensive reconstructive surgery.
  • Nerve damage – An accident may damage the nerves in the hand and arm, which may cause numbness and pain.
  • Loss of limb – A serious accident may require the amputation of an arm or hand. This serious injury can dramatically affect all aspects of your life. Individuals must relearn how to conduct even simple functions, and while prosthetic limbs can help, they are expensive. Furthermore, approximately 60-80% of amputees experience phantom limb syndrome, causing them to feel sensations such as aching, itching, and burning to emanate from the body part that is no longer there.

In addition to hand and arm injuries that are caused by an accident, many common injuries are caused or worsened by repetitive stress.
These ailments include:

  • Carpal tunnel syndrome – People with carpal tunnel syndrome experience pain and tingling sensations in their thumbs and fingers. Although the exact cause of carpal tunnel syndrome is unknown, many researchers believe that performing repetitive manual tasks, such as typing on a keyboard, may cause or worsen the condition. Carpal tunnel syndrome may require wrist surgery, steroid injections, or the use of a brace.
  • Repetitive strain injuries – Repetitive strain injuries are characterized by painful sensations while performing a repetitive task, such as lifting heavy objects. These injuries can worsen the more an activity is performed. Injuries to the arm and hand, whether suffered by an accident or through repetitive strain, can permanently impact a person’s life. Even the completion of simple, everyday tasks may become difficult and exhausting, diminishing one’s overall quality of life.

Understanding what the injuries are is the first step in prevention. If you are looking to put protocols in place to help team members avoid workplace hazards for feet and hands, please reach out to a physical therapy clinic that specializes in industrial rehabilitation. They can work with you to improve the safety of the workplace and the employees.

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