Health
Pursuit Physiotherapy- Managing and Preventing Carpal Tunnel Syndrome
Management & Prevention of Carpal Tunnel Syndrome
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:
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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.
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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.
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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:
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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.
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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.
Alberta
Early Success: 33 Nurse Practitioners already working independently across Alberta
Nurse practitioners expand primary care access |
The Alberta government’s Nurse Practitioner Primary Care program is showing early signs of success, with 33 nurse practitioners already practising independently in communities across the province.
Alberta’s government is committed to strengthening Alberta’s primary health care system, recognizing that innovative approaches are essential to improving access. To further this commitment, the Nurse Practitioner Primary Care Program was launched in April, allowing nurse practitioners to practise comprehensive patient care autonomously, either by operating their own practices or working independently within existing primary care settings.
Since being announced, the program has garnered a promising response. A total of 67 applications have been submitted, with 56 approved. Of those, 33 nurse practitioners are now practising autonomously in communities throughout Alberta, including in rural locations such as Beaverlodge, Coaldale, Cold Lake, Consort, Morley, Picture Butte, Three Hills, Two Hills, Vegreville and Vermilion.
“I am thrilled about the interest in this program, as nurse practitioners are a key part of the solution to provide Albertans with greater access to the primary health care services they need.”
To participate in the program, nurse practitioners are required to commit to providing a set number of hours of medically necessary primary care services, maintain a panel size of at least 900 patients, offer after-hours access on weekends, evenings or holidays, and accept walk-in appointments until a panel size reaches 900 patients.
With 33 nurse practitioners practising independently, about 30,000 more Albertans will have access to the primary health care they need. Once the remaining 23 approved applicants begin practising, primary health care access will expand to almost 21,000 more Albertans.
“Enabling nurse practitioners to practise independently is great news for rural Alberta. This is one more way our government is ensuring communities will have access to the care they need, closer to home.”
“Nurse practitioners are highly skilled health care professionals and an invaluable part of our health care system. The Nurse Practitioner Primary Care Program is the right step to ensuring all Albertans can receive care where and when they need it.”
“The NPAA wishes to thank the Alberta government for recognizing the vital role NPs play in the health care system. Nurse practitioners have long advocated to operate their own practices and are ready to meet the growing health care needs of Albertans. This initiative will ensure that more people receive the timely and comprehensive care they deserve.”
The Nurse Practitioner Primary Care program not only expands access to primary care services across the province but also enables nurse practitioners to practise to their full scope, providing another vital access point for Albertans to receive timely, high-quality care when and where they need it most.
Quick facts
- Through the Nurse Practitioner Primary Care Program, nurse practitioners receive about 80 per cent of the compensation that fee-for-service family physicians earn for providing comprehensive primary care.
- Compensation for nurse practitioners is determined based on panel size (the number of patients under their care) and the number of patient care hours provided.
- Nurse practitioners have completed graduate studies and are regulated by the College of Registered Nurses of Alberta.
- For the second consecutive year, a record number of registrants renewed their permits with the College of Registered Nurses of Alberta (CRNA) to continue practising nursing in Alberta.
- There were more than 44,798 registrants and a 15 per cent increase in nurse practitioners.
- Data from the Nurse Practitioner Primary Care Program show:
- Nine applicants plan to work on First Nations reserves or Metis Settlements.
- Parts of the province where nurse practitioners are practising: Calgary (12), Edmonton (five), central (six), north (three) and south (seven).
- Participating nurse practitioners who practise in eligible communities for the Rural, Remote and Northern Program will be provided funding as an incentive to practise in rural or remote areas.
- Participating nurse practitioners are also eligible for the Panel Management Support Program, which helps offset costs for physicians and nurse practitioners to provide comprehensive care as their patient panels grow.
Related information
Addictions
BC Addictions Expert Questions Ties Between Safer Supply Advocates and For-Profit Companies
By Liam Hunt
Canada’s safer supply programs are “selling people down the river,” says a leading medical expert in British Columbia. Dr. Julian Somers, director of the Centre for Applied Research in Mental Health and Addiction at Simon Fraser University, says that despite the thin evidence in support of these experimental programs, the BC government has aggressively expanded them—and retaliated against dissenting researchers.
Somers also, controversially, raises questions about doctors and former health officials who appear to have gravitated toward businesses involved in these programs. He notes that these connections warrant closer scrutiny to ensure public policies remain free from undue industry influence.
Safer supply programs claim to reduce overdoses and deaths by distributing free addictive drugs—typically 8-milligram tablets of hydromorphone, an opioid as potent as heroin—to dissuade addicts from accessing riskier street substances. Yet, a growing number of doctors say these programs are deeply misguided—and widely defrauded.
Ultimately, Somers argues, safer supply is exacerbating the country’s addiction crisis.
Somers opposed safer supply at its inception and openly criticized its nationwide expansion in 2020. He believes these programs perpetuate drug use and societal disconnection and fail to encourage users to make the mental and social changes needed to beat addiction. Worse yet, the safer supply movement seems rife with double standards that devalue the lives of poorer drug users. While working professionals are provided generous supports that prioritize recovery, disadvantaged Canadians are given “ineffective yet profitable” interventions, such as safer supply, that “convey no expectation that stopping substance use or overcoming addiction is a desirable or important goal.”
To better understand addiction, Somers created the Inter-Ministry Evaluation Database (IMED) in 2004, which, for the first time in BC’s history, connected disparate information—i.e. hospitalizations, incarceration rates—about vulnerable populations.
Throughout its existence, health experts used IMED’s data to create dozens of research projects and papers. It allowed Somers to conduct a multi-million-dollar randomized control trial (the “Vancouver at Home” study) that showed that scattering vulnerable people into regular apartments throughout the city, rather than warehousing them in a few buildings, leads to better outcomes at no additional cost.
In early 2021, Somers presented recommendations drawn from his analysis of the IMED to several leading officials in the B.C. government. He says that these officials gave a frosty reception to his ideas, which prioritized employment, rehabilitation, and social integration over easy access to drugs. Shortly afterwards, the government ordered him to immediately and permanently delete the IMED’s ministerial data.
Somers describes the order as a “devastating act of retaliation” and says that losing access to the IMED effectively ended his career as a researcher. “My lab can no longer do the research we were doing,” he noted, adding that public funding now goes exclusively toward projects sympathetic to safer supply. The B.C. government has since denied that its order was politically motivated.
In early 2022, the government of Alberta commissioned a team of researchers, led by Somers, to investigate the evidence base behind safer supply. They found that there was no empirical proof that the experiment works, and that harm reduction researchers often advocated for safer supply within their studies even if their data did not support such recommendations.
Somers says that, after these findings were published, his team was subjected to a smear campaign that was partially organized by the British Columbia Centre on Substance Use (BCCSU), a powerful pro-safer supply research organization with close ties to the B.C. government. The BCCSU has been instrumental in the expansion of safer supply and has produced studies and protocols in support of it, sometimes at the behest of the provincial government.
Somers is also concerned about the connections between some of safer supply’s key proponents and for-profit drug companies.
He notes that the BCCSU’s founding executive director, Dr. Evan Wood, became Chief Medical Officer at Numinus Wellness, a publicly traded psychedelic company, in 2020. Similarly, Dr. Perry Kendall, who also served as a BCCSU executive director, went on to found Fair Price Pharma, a now-defunct for-profit company that specializes in providing pharmaceutical heroin to high-risk drug users, the following year.
While these connections are not necessarily unethical, they do raise important questions about whether there is enough industry regulation to minimize potential conflicts of interest, whether they be real or perceived.
The BCCSU was also recently criticized in an editorial by Canadian Affairs, which noted that the organization had received funding from companies such as Shoppers Drug Mart and Tilray (a cannabis company). The editorial argued that influential addiction research organizations should not receive drug industry funding and reported that Alberta founded its own counterpart to the BCCSU in August, known as the Canadian Centre of Recovery Excellence, which is legally prohibited from accepting such sponsorships.
Already, private interests are betting on the likely expansion of safer supply programs. For instance, Safe Supply Streaming Co., a publicly traded venture capital firm, has advertised to potential investors that B.C.’s safer supply system could create a multi-billion-dollar annual market.
Somers believes that Canada needs more transparency regarding how for-profit companies may be directly or indirectly influencing policy makers: “We need to know exactly, to the dollar, how much of [harm reduction researchers’] operating budget is flowing from industry sources.”
Editor’s note: This story is published in syndication with Break The Needle and Western Standard.
The Bureau is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.
Dr. Julian M. Somers is director of the Centre for Applied Research in Mental Health and Addiction at Simon Fraser University. He was Director of the UBC Psychology Clinic, and past president of the BC Psychological Association. Liam Hunt is a contributing author to the Centre For Responsible Drug Policy in partnership with the Macdonald-Laurier Institute.
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