Carpal Tunnel Syndrome

Most of us have heard about or know someone who has suffered from carpal tunnel syndrome (CTS), but what is it?  What causes it? And what can you do about it?

The Anatomy of the Carpal Tunnel

The carpal tunnel is an important structure found at the front of the wrist, just below your palm.  It is formed by the bones of the wrist (carpal bones) and a thick band of connective tissue known as the flexor retinaculum.

The tunnel houses the tendons of the muscles that allow you to flex your wrist and fingers.  The median Nerve, which supplies some of the muscles in the forearm and hand, also runs through the tunnel.  Compression of this nerve in the carpal tunnel leads to a collection of signs and symptoms that are known as carpal tunnel syndrome.

What causes CTS?

Often CTS develops idiopathically, meaning it occurs spontaneously without a known cause.  It can also be caused by the thickening of ligaments and tendons, bony spurring of the carpal bones and inflammation within or near the carpal tunnel.

There are a few things that can increase your risk of developing carpal tunnel syndrome, such as:

  • Conditions that affect the nervous system (e.g. diabetes)
  • Rheumatoid arthritis
  • Obesity
  • Occupations that require repetitive wrist movements, especially wrist flexion

Your osteopath will work with you to identify any underlying risk factors that you may have and manage them accordingly.

What are the signs and symptoms?

The main symptoms are pain, numbness and tingling in the thumb and first three fingers.  This pain can radiate further up the forearm and can often wake you up at night. If left untreated, CTS may cause weakness and atrophy (muscle wasting) of the muscles of the thumb.  This may cause you to drop things and struggle to button up shirts or jackets.

What can I do about it?  And what can an osteopath do for me?

Your osteopath here at Pakenham Osteopathy will take a detailed history and conduct a thorough examination to formulate a diagnosis.  We will tailor a management plan to your specific goals and needs, so that you have a clear understanding of exactly what is needed to get you out of pain and back to full health. 

Inside the treatment room, your osteopath may use techniques such as soft tissue massage and stretching, articulation, mobilisation, manipulation and dry needling, as well as provide you with some advice about your posture at work.  A home based exercise program may also be prescribed to target areas that may be contributing to your CTS.

What about bracing?

In some instances, braces can provide some relief of overnight discomfort.  There are plenty of options out there and it can be hard to know which one is right for you, so your osteopath at Pakenham Osteopathy will discuss this with you.

I want to know more!

If you have any further questions, don’t hesitate to get in touch via email at darren@pakenhamosteopathy.com.au or call the clinic on 5941 4157.

LET US DISCUSS, THE MEN-IS-CUS

Before I get stuck into the nitty gritty of one of the most common knee injuries, I want to talk about where my fascination with a little piece of cartilage began. 

Growing up as a Miami Heat fan I loved Dwyane Wade and the way he approached basketball on and off the court.  For those of you who don’t know, Wade’s career was arguably cut short by ongoing knee issues stemming from an injury he suffered in his college career – a meniscus tear.  The decision was made to remove the meniscus in his left knee completely.  By his own admission, that’s likely where his ongoing troubles began (1).  These days, complete removal of the meniscus (meniscectomy) is uncommon – but more on that later….

 

WHAT is a meniscus?

A meniscus is a C-shaped piece of cartilage that sits in both of your knees on top of your tibia.  You have two in each knee and they act as shock absorbers, providing cushioning and stability when you run, walk and jump. 

As you can see in the image below, the outer part of the menisci (the ‘red zone’) receive a reasonably good blood supply but the further we go inside the knee (the ‘white zone’), the poorer this supply gets. This can play a significant role in the management of meniscus injuries, as we’ll discuss later.

HOW does a meniscus tear happen?

In the younger population, meniscus injuries typically occur during sports that require sharp directional changes and twisting movements such as basketball, netball, cricket and football. 

This can be the same for the older population, however degenerative injuries are more common in this demographic due to gradual fraying of the meniscus as we get older.

 

WHAT are the signs and symptoms of a meniscus tear?

There can be great variation in how a meniscus tear presents and they can often be completely symptom free. In fact, a systematic review on 5,397 asymptomatic knees conducted in 2018 (2) found that 19% of people aged over 40 had a meniscus tear upon imaging (4% in individuals under 40).

The most common signs and symptoms of meniscus injuries are:

  • Pain in the knee, especially when twisting or changing direction
  • Swelling (usually minor due to the poor blood supply)
  • A sense of instability
  • ‘Locking’ of the knee
  • Inability to fully extend the knee
  • Clicking/grinding in the knee

 

HOW long will I be out of action for?

There is great variation in the healing time frames for meniscus injuries. 

Tears in the ‘red zone’ tend to heal more rapidly as they have a reasonable supply of blood and nutrients, where as tears in the ‘white zone’ can be more difficult to manage and can take longer to fully recover. 

Healing times are also heavily dependant on what type of injury or tear is present, how significant it is, how impaired your activities of daily living have become and whether or not surgery is warranted. Typically, recovery can take anywhere between 4-12 weeks.

 

WHAT can I do about it?

If you suspect you might have a meniscus injury, basic first aid principles (such as rest, ice, compression and elevation) may help with the pain and swelling in the short term.  Conservative management (i.e. manual therapy, activity modification and exercise rehabilitation) is usually trialled first. If this is unsuccessful, other options can be explored such as surgical repair of the meniscus.

The osteopaths at Pakenham Osteopathy have a thorough understanding of the knee and will be able to assess you and develop a management plan based on your specific needs.

 

BUT I still ‘kneed’ to ask more questions?!

Don’t hesitate to get fire through some questions via email at darren@pakenhamosteopathy.com.au or call the clinic on 5941 4157.

References:

1. https://www.espn.com.au/nba/truehoop/miamiheat/story/_/id/9760169/dwyane-wade-miami-heat-regrets-having-meniscus-removed-college

2. Culvenor, A. G., Øiestad, B. E., Hart, H. F., Stefanik, J. J., Guermazi, A., & Crossley, K. M. (2018). Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. Br J Sports Med, bjsports-2018.

Stress!!! And How to Deal With it Better…

It’s something all of us have or will experience in our lifetime.  Don’t get me wrong, we need a degree of stress in our lives; it protects us.  Think of coming face-to-face with a lion or a tiger. What would happen if we didn’t have a stress or ‘fight or flight’ response?  The trouble is, it’s not often that we find ourselves in a 1 on 1 with a lion during our regular 9-5. Often we find ourselves stressing about minor, insignificant events.  Whether it be the weather, traffic, work or even our favourite sports team underperforming (I’m looking at you, Melbourne). All of this mounts up.

So why is an osteopath rambling about stress?  Well we know that stress affects more than just our minds.  It affects our body in many ways and the hormones involved may be associated with chronic pain (1).  So it makes sense that if we can minimise our stress levels, we can live healthier and happier lives.

 

So how do I do this?

There are plenty of ways to tackle stress and below are just a few that we can all easily implement into our daily routine.  It’s important to remember that, as with any injury or gym program, change takes time and it can occur at different rates for everyone.  The same applies with reducing your stress levels.

 

Drink water & enjoy a balanced diet

This one speaks for itself.  It’s important to eat a healthy diet, but it’s also important to enjoy the food you’re eating.  Restricting yourself too much can lead to undue stress and binge eating later down the track.

 

As for drinking water, the average adult water consumption is estimated to be around 1-1.5L per day which may sound like a reasonable amount, but not when you consider that the average adult loses at least 2.5-3L throughout a regular day. 

 

There’s no hard and fast recommendation for water intake but the BetterHealth Channel website suggests that males should be consuming 2.6L and females 2.1L. Our team at Pakenham Osteopathy recently completed a health challenge where we were asked to drink at least 1 glass of water for every hour we spent at work and the effects were surprising!  Give it a go yourself!

 

Exercise

Whether it’s going for a walk, jog, hitting the gym or throwing a few haymakers at a punching bag, exercise can have a dramatic effect on our overall physical and mental wellbeing. 

 

The Australian guidelines recommend at least 60 minutes of moderate-vigorous intensity physical activity everyday for individuals aged 5-17 years. For adults aged 18-64, the guidelines suggest accumulating 150-300 minutes of moderate intensity physical activity or 75-150 minutes of vigorous intensity activity each week.  More information about these guidelines can be found at: https://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines.

 

Mindfulness or meditation

I know what you might be thinking – I’m not asking you to sit cross legged on the top of a mountain and hum (although if you’re interested in that type of thing, go for it!).  Meditation isn’t for everyone, but it can be a great option to lower your stress levels or at the very least, enjoy some time to yourself.

 

There are some great applications out there that can help you get started including the Smiling Mind app which is completely free and can be tailored to your specific needs – whether it be general wellbeing, eating better, sleeping better or even exercising more.

 

Address the big things before the little things

Prioritise the things in your life that mean the most to you and the tasks that are the most time-sensitive.  If you have a big project for work coming up, avoid procrastinating and get it done! The Asana task manager application offers a simple way to keep track of all your tasks if you find the old pen and paper isn’t cutting it anymore.

 

Sleep

This one is a big one – so big in fact that it deserves its own blog piece, which your friendly neighbourhood osteopath Tom Gubbins kindly took care of last week!

 

If you have any questions or require any further information, please don’t hesitate to get in touch via email at darren@pakenhamosteopathy.com.au or call the clinic on 5941 4157.

References

  1. Hannibal, K. E., & Bishop, M. D. (2014). Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitation. Physical therapy, 94(12), 1816-1825. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263906/ 

Shoulder Pain

We rely on having a huge range of movement out of our shoulders.  We reach up to hang washing out, we reach into the backseat of our cars, and some of us wrestle into bras every morning! If your shoulder is giving you pain, it can be really frustrating and can have a big impact on your life.

One of the common causes of shoulder pain can be what us health professionals call “Subacromial impingement”.

 

What is it?

No one likes technical terms!  So let’s break it down. “Subacromial” is essentially a term that refers to a space under the very top of your shoulder blade (the acromion).  It houses the tendons of a group of muscles that help to stabilise your shoulder (the rotator cuff).  Located within this space is what we call a bursa.  It is a tiny fluid-filled sac that plays an important role in shock absorption and reducing friction between bones.

Subacromial impingement occurs when these tendons or bursa are squeezed or ‘impinged’.

 

Okay, so why does it happen?

If we think of your shoulder as a ‘ball and socket’, when you lift your arm, the ball should glide downwards in the socket to prevent compression of the bursa.  Occasionally, when your shoulder isn’t moving optimally, the ball doesn’t glide down which squeezes the bursa and tendons in the subacromial space, resulting in pain and inflammation.

There are a number of reasons that your shoulder might not be functioning well – injury to the tendons that occupy the space in your shoulder, muscular imbalance and tears, poor postural control and awareness and repetitive overhead movements.  The good news? These are all factors that your osteopath can assist you with.

 

What can I do about it?

Your osteopath will work closely with you to tailor a management plan that addresses the key factors contributing to your subacromial impingement.  Generally, this will include hands on treatment and exercises (like the ones demonstrated below) to decrease your pain, restore your shoulder mobility and strengthen the surrounding muscles.  You may also find that your osteopath recommends exercises to address other areas such as your neck and upper back as these can also contribute.

 

How long will this take to heal?

Healing times for any injury can vary greatly, but complete resolution and healing can take up to 6 months.  If you have any questions or just want some more information, please don’t hesitate to email me at darren@pakenhamosteopathy.com.