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Pursuit Physiotherapy- Managing and Preventing Carpal Tunnel Syndrome

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Carpal tunnel syndrome is one of the most commonly diagnosed repetitive strain injuries. It occurs when the median nerve, which is the main nerve that travels down the inside of your forearm to your hand, becomes compressed or irritated as it passes through the carpal tunnel at the wrist. The carpal tunnel is an opening formed by ligaments and bones on the inside of the wrist which allow tendons and nerves to pass through it.

The problem is that this passageway is narrow and can be easily obstructed by local swelling and inflammation, usually from overuse or direct trauma. For example, repetitive work or leisure activities that involve a lot of gripping or use of the flexors (inner forearm muscles) can cause inflammation of the tendons. Similarly, long hours of computer work with improper ergonomics can cause excessive pressure on the inside of the wrist.

The common symptoms of carpal tunnel syndrome are numbness, tingling, or burning sensations in the palm of the hand and fingers, often accompanied by skin sensitivity and grip weakness. As the symptoms worsen people often experience sharp, shooting pain from the inner wrist up the forearm and decreased ability to use the affected hand.

Our treatment strategy is geared towards reducing the pressure on the carpal tunnel area and allowing the median nerve to function properly again. We are able to use a number of different treatment strategies such as:

  • Joint mobilization – stiff joints around the carpal tunnel can cause narrowing of the passageway and compression of the median nerve and flexor tendons. Using manual techniques we will loosen stiff joints and work to restore normal mobility and range of motion in the wrist and hand bones, taking pressure off the nervous tissue.

  • Soft tissue release – it is important to release tight muscles in the forearm and hand that may be compressing the median nerve and contributing to nerve pain and tightness. We can use a number of techniques to achieve this such as massage, cupping, acupuncture, and IMS.

  • Ergonomic correction – we will work with you to determine how to optimize your ergonomic set-up for work or home to minimize strain on your body. A brace may also be recommended to manage symptoms at work or at night. A brace will keep your wrist in a neutral position and prevent the wrist from flexing and compressing the carpal tunnel.

There are also a number of prevention strategies that you can use to reduce your risk of developing carpal tunnel syndrome:

  • Optimize your ergonomic set-up – position your keyboard and mouse so that your wrists are neutral and not hyperextended or flexed. Also be aware of your posture and try to keep your neck, shoulders, and back in a straight and relaxed position. Ergonomic equipment may also be useful especially for people who spend long hours at the computer. For more detail see the full blog on correct ergonomics.

  • Take regular breaks from repetitive activities – prevent tension and strain from building up in your tissues by planning regular breaks for stretching and changing position.

    Seek help from a physiotherapist at the first signs of pain; don’t wait for it to get worse.

Carpal tunnel release surgery is also an option for chronic cases that do not completely resolve with physiotherapy; however it should be seen as a last resort. A course of physiotherapy treatment is always recommended before having an invasive procedure.

**It should be noted that NOT ALL WRIST AND HAND TINGLING IS DIAGNOSED AS CARPAL TUNNEL SYNDROME. Your nervous system is a continuous network of tissue, therefore nerve compression or irritation in other areas of the body such as the neck, back, shoulder, or elbow can contribute to or cause your hand symptoms. Especially if your condition is bilateral (symptoms on both sides), it is likely that body parts other than your wrist and hand require treatment.

As physiotherapists we are trained to comprehensively assess and diagnose your body as a whole and treat all the factors contributing to your pain. We can help ensure you get thorough treatment to eliminate your symptoms as quickly as possible and prevent it from becoming a chronic condition. Don’t try to treat it yourself off the internet! Leave it in the hands of the trained experts.

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RCMP seeks names of potential victims of coerced sterilization, Lucki says

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OTTAWA — The RCMP is seeking the names of potential victims of coerced sterilization procedures and wants lawyers to help in the process, RCMP Commissioner Brenda Lucki said Tuesday.

In testimony before the House of Commons health committee, Lucki said the RCMP is willing to meet with victims, adding it would be helpful if lawyers could talk to complainants about coming forward.

“The lawyers … if they were to speak with those victims and provide them the options of coming to the police, we would absolutely sit down with each and every victim that they had to look at it from a criminal point of view,” she said.

“Obviously they are not going to release their names without their consent as well. But … if we were to have those conversations, and possibly we could convince victims to come forward through the lawyers, that would be one avenue that we could explore.”

MPs asked Lucki to testify as part of a study about ongoing concerns from predominantly Indigenous women who allege they were coerced or forced into tubal ligation procedures during childbirth.

Her testimony also followed a letter sent this spring by NDP health critic Don Davies who asked the RCMP to conduct an investigation of serious and credible allegations that have been brought forward.

Lucki told Davies in a March letter that the force would work with commanding officers in each province and territory as well as other police agencies to see if any complaints have been reported.

“To date, we have no allegations that are on file for forced or coerced sterilization that were found to be reported to the RCMP directly,” Lucki said Tuesday. She said the RCMP takes all criminal allegations very seriously and that the force has reached out to the Canadian Association of Chiefs of Police to raise awareness.

The issue has been the subject of much public scrutiny, particularly in the past two years.

In 2017, the Saskatchewan Health Region issued a public apology after complaints from Indigenous women, and a proposed class-action lawsuit was launched naming as defendants the Saskatoon Health Authority, the provincial and federal governments, and a handful of medical professionals.

Dr. Judith Bartlett, a Metis physician who co-authored the external review, told the committee on Tuesday that Indigenous women interviewed for the report often felt invisible, profiled and powerless.

She also said she does not believe women will come forward to the RCMP because there is “no safety there for them.” Those interviewed for the report were granted anonymity, she said, noting they often felt much better having been able to express the harm done to them.

Much more research is needed to understand the scope of the problem because any time an individual is asked to make a decision when they’re not in the state of mind to weigh pros and cons constitutes coercion, Bartlett said.

Dr. Jennifer Blake, chief executive of the Society of Obstetricians and Gynaecologists of Canada, told MPs that obtaining consent for tubal ligations at the time of delivery should be avoided at all costs. She also noted that when she first learned of allegations a forced sterilizations, she thought it was in reference to a historical issue.

Last Tuesday, lawyer Alisa Lombard, a partner with the firm Semaganis Worme Lombard, told the health committee she represents a client, referred to as D.D.S., was sterilized without proper and informed consent in December 2018 at a Moose Jaw, Sask., hospital

That same month, the United Nations Committee Against Torture urged Canada to act to address the issue of coerced sterilization, setting a one-year deadline to report back on progress.

In response, Health Minister Ginette Petitpas Taylor and Jane Philpott, then Indigenous services minister, sent a letter to provinces and territories proposing a working group of officials to discuss the concerns.

Health Canada said Tuesday the group has had “productive discussions” about the scope and purpose of the federal-provincial-territorial plan to “advance cultural safety and humility in the health system.” As a first step, officials decided Health Canada would take the lead on “an environmental scan of cultural safety initiatives and practices across Canada,” the agency said in a statement.

—Follow @kkirkup on Twitter

Kristy Kirkup, The Canadian Press

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Blair says more gun-control action needed, signals no new steps before election

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OTTAWA — Crime Reduction Minister Bill Blair says more must be done to address gun violence, but he’s also signalling that no new measures will be taken before the fall election.

Steps could — and should — be taken to prevent the theft, illegal diversion and cross-border smuggling of handguns, Blair said Tuesday. 

As he entered a cabinet meeting, Blair emphasized the importance of secure storage of firearms to prevent them from being stolen and ending up in the wrong hands.

The government is also open to working with municipalities to allow them to decide exactly where, or even if, firearms can be stored within their boundaries, he said.

However, the parliamentary sitting is expected to conclude shortly and the government is scrambling to tie up loose ends before the summer recess and an election campaign likely to begin in September.  

“Some of this would require regulatory and legislative change,” Blair said. “And I think it’s important not only to do the right thing, but to take the time to do it right.”

Prime Minister Justin Trudeau asked Blair last August to study the possibility of a ban on handguns and assault-style rifles after a shooting spree in Toronto.

A recently released summary of a federal consultation said Canadians were divided on the idea.

Still, Blair’s office said late last month that no options had been ruled out to clamp down on guns “designed to hunt people” as it weighed new options. Rumours of a federal ban on the popular AR-15 semi-automatic rifle began to circulate.

While Blair reiterated Tuesday there are firearms the government considers “so dangerous that there really is no place in a safe and civil society for them,” he made no firm commitment to ban or buy back such guns from owners.

Blair stressed a need to ensure secure storage, prevent people from buying firearms on behalf of criminals and deter smuggling of weapons into Canada from the United States, which he called “the largest handgun arsenal in the world.”

“There are a number of very effective measures that I believe that we can and must take to create a safer environment.”

Allowing municipalities to enact additional restrictions on handguns would not only be “wholly inadequate,” it would also be inefficient, said Heidi Rathjen, co-ordinator of PolySeSouvient, which wants an overhaul of the gun classification system with the ultimate aim of banning weapons specifically designed to kill people.

“All one has to do is consider the glaring disaster resulting from a patchwork of state and local gun laws south of the border,” she said Tuesday.

“And one has to ask: why would stricter controls on handguns be justified in cities and not in rural areas? It seems more like the Liberals chose not to deal with the highly politicized issue of banning handguns and instead decided to pass the buck to municipalities.”

The law already requires safe storage of firearms, but there has been a “significant increase” in the theft of large numbers of handguns from homes and retailers, with the guns ending up on the street in the wrong hands, Blair said.

He acknowledged there are responsible handgun owners who obey all the rules. “We may ask them to undertake additional measures to secure their weapons to make sure that they’re not vulnerable to being stolen.”

Public Safety Canada says 24 firearms were stolen from a shop in Prince Albert, Sask., by snipping one cable, raising concerns that the after-hours commercial storage regulations could be insufficient.

Some businesses “may not be fully compliant” with existing regulations, say department notes released through the Access to Information Act. However, chief firearms officers “indicate this is infrequent and businesses come into compliance quickly when non-compliance is identified.”

The RCMP says some businesses go beyond minimum requirements through measures including shatterproof glass in display cases, video-monitoring systems and alarms, safes bolted to the floor, deadbolt locks and solid doors instead of hollow ones for storage rooms.

— Follow @JimBronskill on Twitter

Jim Bronskill , The Canadian Press


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