Carpal tunnel syndrome

canal-carpien0002m-s The carpal tunnel is the osteofibrous tunnel at the wrist by:
- the bones of the carpus on the back and the side
- a fibrous band called flexor retinaculum which arches over the carpus

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Jocelyn-William LOUBRIAT
 

Definition

The carpal tunnel is the osteofibrous tunnel at the wrist by:
- the bones of the carpus on the back and the side
- a fibrous band called flexor retinaculum which arches over the carpus (fig 1).

The Carpal Tunnel Syndrome (CTS) is a condition the symptoms of which are tingling, numbing or swelling sensations, felt in the first 3 fingers of the hand (thumb, forefinger and middle finger). These neurological incidents are caused by the compression of one nerve – the median nerve – in this tunnel.

This is not a specific pathology of climbers, but a condition that occurs frequently in the general population.

It develops mostly progressively with some short lived symptoms that can worsen until they become so strong that they prevent you from sleeping at night. The pain can become diurnal and make it progressively impossible for you to hold heavy things.
At worst, some small muscles of the hand (intrinsic muscles) can become paralysed.


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Fig 1: Transverse cut of the carpus,
by M.Dufour, Anatomy of the locomotive apparatus

Mechanism of the lesion

The carpal tunnel is a narrow tunnel with many tendons running: the finger flexor tendon in there synovial sheath, such as the median nerve.

When climbing, the strain of the flexor tendons is very high and the constraints inside the tunnel can increase. The increased volume of the synovial sheath (tenosynovitis) can have a compressive effect inside the tunnel. Furthermore, a restriction of blood supply, ischemia, could be the cause of an oedema that obstructs the tunnel.

The nerve is compressed and the neurological signs appear.


Prevention

For prevention, make sure you have good physical preparation, favour a good recovery and avoid ischemic phenomenon linked to a restriction of blood supply in the forearms.

Regular stretching exercises of the flexors of the fingers (fig 2) enable you to keep good mobility of the tissues at wrist level, in particular those of the flexor retinaculums.

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Fig 2: Stretch the flexors of the fingers

Long postures (about 30 sec to 1 min) of the fascias of the superior limbs (fig 3 and 4) will enable a good regulation of the muscle-aponevrotic tensions, which is the essential factor of the prevention of the CTS.

postureextm postureflexm
Fig 3: Posture of the fascias
of the extensors
Fig 4: Posture of the fascias
of the flexors

Treatment

It is essential to treat the CTS as soon as the first symptoms appear.
Appropriate physical therapy will in most cases prevent a worsening of the condition.
This treatment should give you back the mobility at the wrist tissues and also release all the tension in the upper limb. Using a wholistic treatment like the Mézières method, the Fascias method, is essential to release all the tension in the body and to treat the causes and not only the symptoms.
The techniques of the neuromeningeal tissue therapy, which aim at a good vascularisation of the nerve and its free movement, are useful tools.
Electrotherapy should be used mainly for the analgesic effect (TENS).
To be able to continue to practice climbing, try everything to avoid surgery, which resolves the problem with a bistoury cut in the flexor retinaculum. This reduces the muscle performance of the flexor of the fingers considerably, resulting in a loss of strength and sensation.

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