surgery – ROCKSHOULDERS

The fastest way to heal carpal tunnel syndrome is by early responding to your symptoms. Don’t wait for them to worsen but seek medical advice to figure out if it is carpal tunnel syndrome that’s bothering you. Then, if there’s entrapment of the median nerve in your carpal tunnel, if your symptoms allow, go for conservative treatment first. And if that doesn’t work consider surgery. To help you decide on the fastest way to heal carpal tunnel syndrome I’m going to explain what carpal tunnel syndrome is, which treatment options you have, and what you can do yourself to increase the efficacy of your treatment. Are you ready to dive in? Let’s do this. 1. What is Carpal Tunnel Syndrome? Carpal Tunnel Syndrome (CTS) is the entrapment of the median nerve in de carpal tunnel. This is a space on the palmar side of your wrist. This space is made up of several tendons, ligaments, and the median nerve. All are held in place by the transverse carpal ligament. The possible symptoms of carpal tunnel syndrome are: Pain in the wrist, usually radiating into the thumb, index, and middle finger (and sometimes also into the elbowLoss of strength in the handLoss of sensation in the handIn severe cases atrophy of the hand muscles 2. How is Carpal Tunnel Syndrome Diagnosed? Carpal Tunnel Syndrome can be diagnosed by a neurologist who performs a nerve transduction test. With a tool, the neurologist measures the capacity of your median nerve to transmit signals. If there’s a lack of transduction this indicates damage to the nerve in the tested area. Another way to diagnose CTS is by performing a Musculoskeletal Echography (MSE) of the carpal tunnel. This is done by using ultrasound like is done during pregnancy to see the development of the baby. A certain reduction of the carpal tunnel size would indicate CTS. Clinically, two tests can be performed to get an idea if someone has CTS. This is done by performing the “Tinel Sign” and the “Phalen Test". Phalen Test: Hold for 30 Seconds Tinel Sign Tap thouroughly for 10 seconds When both are positive (they provoke your symptoms) and your history indicates CTS you can be pretty sure it’s that. This can be sufficient to initiate conservative treatment. However, if there’s no change in your symptoms after several months of treatment you should see a neurologist to confirm. 3. What are the Treatment Options for Carpal Tunnel Syndrome? There 3 well-defined ways to treat carpal tunnel syndrome: Pain and anti-inflammatory medicationPhysiotherapySurgery You should always try conservative treatment (options 1 & 2) before considering surgery. How and when exactly you should try conservative treatment or surgery depends on your situation. I’ll start with explaining when conservative treatment is indicated. 4. When Should You Try Conservative Treatment? Conservative treatment is indicated in the following situations: If you have pain in your hands but no loss of strength or sensationIf you do experience strength and sensory deficits, they should be small and they shouldn’t exist longer than 6 weeksThere shouldn’t be any atrophy of the muscles in your hand palm What your conservative treatment for carpal tunnel syndrome will look like, depends on your situation. Still, there are several treatments I would consider anyway if you came to our clinic. 5. How is Conservative Treatment for Carpal Tunnel Syndrome in Rock Climbers? Conservative treatment for CTS in rock climbers with a physiotherapist consists of: Increasing median nerve mobilityIncreasing neck, upper back, shoulder girdle, elbow, and hand mobilityLoad managementReducing tension in the muscles and or connective tissue of the arm Below I will discuss the why’s and how’s for each of the therapeutic goals. 5.1 Increasing Nerve Mobility One of the consequences of CTS is reduced mobility of the median nerve through the carpal tunnel. This can both be due to the rigidity of the structures of the wrist as a result of overload, as well as a result of the inflammation itself. The entrapment of the nerve hurts and provokes your symptoms. By moving the nerve past this blockade, you allow it to recover. The easiest way to move your nerve is by doing sliders. These are a series of movements in all the joints from your neck to your fingers to get the nerve “sliding”. Watch the video below to see how you slide your median nerve for optimal nerve mobility. https://youtu.be/ZvbZ8S4I-Qc You’re allowed to feel light symptoms while you do this exercise. Usually, when you repeat the movement often, you’ll notice a reduction in your symptoms. 5.2 Increasing Neck, Upper Back, Shoulder Girdle, Elbow, and Hand Mobility On some occasions, CTS can be provoked by a lack of facet joint mobility in the neck. These are the joints between each of the vertebrae. Since the median nerve is connected to your central nervous system via the brachial plexus and the nerve roots exiting the spinal canal at levels C5-C8 and T1, a problem there could influence the nerve signal transmission and/or influence movement down the kinetic chain. What is the kinetic chain? The kinetic chain between your neck and hand is the chain of all the joints together. Even though CTS is a problem in the hand, the hand responds to how your elbow moves, which in turn responds to how the shoulder moves, which again, responds to how the scapula and upper back move. This concept of the kinetic chain is true everywhere in your body and might be what is responsible for your CTS symptoms. Thus, a thorough look at the mobility and movement quality of all the joints from your neck, and your upper back might reduce your symptoms. 5.3 Load Management Load management is essential in CTS. Definitely, if you just started experiencing symptoms. You might not need to stop climbing to heal if you just reduce your climbing frequency and intensity. What this looks like in your situation depends on: What provokes your CTS symptoms?how long do your symptoms exist?Other factors influencing your symptoms (kinetic chain mobility, muscle tension) In more severe cases load management can be done by using a brace to immobilize the wrist. This might help to reduce strain on the carpal tunnel and the median nerve giving it time to recover. 5.4 Reducing Tension in the Muscles and or Connective Tissue of the Arm The median nerve passes through your upper arm on the inside between the biceps and triceps, passing the medial part of the elbow through the lower arm, and wrist into your hand. Tension in muscles and/or connective tissue along this path can influence the health of your median nerve. Things you can do at home to reduce the tension in your arms are: Rest (!)StretchingCuppingManual Friction Massage (find tender spots in your muscles called trigger points and get your elbow in there) Another part of conservative treatment, which I don’t get into here, is pain- and anti-inflammatory medication. Talk to your general practitioner if this is something that could help with your CTS. 6. When Should You Have Carpal Tunnel Surgery? You should have carpal tunnel surgery in the following situations: If conservative treatment has failedIf your hand muscles are degenerating (this means your median has been compressed to an extent it doesn’t activate your muscles enough)If you have a loss of sensation Another reason for carpal tunnel surgery would be if you have been experiencing pain for a period longer than 6 months. However, pain means that the median nerve is being irritated, not necessarily that it’s damaged. Loss of sensation, strength, and muscle atrophy dó indicate damage. If you experience these symptoms, you should consider the most effective treatment in the short term so you don’t lose nerve function forever. 7. How to Prepare for Carpal Tunnel Surgery? The “better in better out” principle applies to all surgeries, carpal tunnel surgery included. It means that the fitter, healthier you go into surgery, the fitter and healthier you come out. So, if you can, do the following things: Keep moving your hand and fingers as much as possibleIf you can climb without worsening your symptoms do thisStretch the muscles around your hand to keep the tissues flexibleDo strengthening exercises as long as they don’t worsen your symptomsStop/reduce smoking if you do because smoking can decrease healing capacity 8. What Happens During Carpal Tunnel Surgery? There are two ways to do carpal tunnel release: Open method: a cut is made on the palmar side of your wrist and through this opening, the transverse carpal ligament is divided.Endoscopic method: two small cuts in your wrist are made. Through one the surgeon puts a camera and through the other 2 small instruments which she uses to cut the transverse carpal ligament. Once the ligament is divided the wound in your wrist will be stitched up and your wrist will be braced in a splint or covered in a thick bandage. This helps to immobilize the wrist to ensure proper healing in the first 1-2 weeks after surgery. After surgery, it’s normal to experience symptoms of inflammation. As things go, this is the initial wound healing phase that kickstarts the recovery. The inflammatory symptoms are pain, swelling, redness, heat, and lack of function (strength and mobility). Both of the latter are inhibited by the brace anyway. 9. How to Quickly Recover from Carpal Tunnel Surgery as a Rock Climber? The best way to quickly recover from carpal tunnel release is by entering the surgery as healthy and fit as possible (see the chapter above about how to prepare for carpal tunnel surgery). After surgery, it’s key that you rest intensely for the first 2 weeks. During this time your body starts recovery and is aided by partial or entire immobilization of the wrist. As soon as your doctor takes your brace away though, it’s important to start moving your wrist. First, small movements, then larger movements bringing you past your limit. This includes stretching, strengthening, and climbing-specific exercises like (sub-maximal) dead hang pull-up variations, and fingerboard exercises. Each step in your rehab process should be taken once your tissue is ready for it. Carpal Tunnel Release is a small surgery and recovery can be quick, still, if you force it in the beginning you might pay the price after. The best way to benchmark your progress is by using the amount of pain your feel during and after exercising, as well as your perceived force and stability in the wrist. And most importantly, carpal tunnel syndrome-like symptoms would be a clear sign of overload. 10. What Heals Carpal Tunnel Syndrome Faster in Rock Climbers? The fastest way to heal carpal tunnel syndrome is by identifying it early on. Once you know, you can reduce exposure to situations that increase your symptoms. Combine this with a proactive conservative treatment for the highest chance of success. If you respond (too) late to your carpal tunnel syndrome surgery might be the quickest way to reduce your symptoms. Still, give conservative treatment a try for at least 4-6 weeks. If there’s no effect, you know that the risks of surgery are worth it.