Mesotherapy FAQ's

What is Mesotherapy?
Mesotherapy is a painless technique of injecting a small amount of a customized mixture of conventional pharmaceutical or homeopathic medications, vitamins, minerals, amino acids and enzymes into the mesoderm – or middle layer of skin. These very small doses of the substances are administered using very tiny needles in specific areas depending on the condition being treated. Mesotherapy is used to treat a broad range of illnesses and pain conditions. This minimally invasive approach has shown successful results in many areas: sports injuries, hair regrowth, alopecia, and cosmetic treatments. Back to Top
On what areas of the body can Mesotherapy be used?
Mesotherapy may be used for cellulite, body fat reduction, body sculpturing and weight loss, facial rejuvenation (mesolift), and eye fat pads. Back to Top




How does mesotherapy reduce cellulite?
This skin condition affects over 90% of females regardless of their weight or age. The lumpy and dimpled appearance of the skin that usually appears on the hips, buttocks, legs, and midsection is the result of connective tissue bands (septae) that hold down areas of the skin and trapping the fat, while other areas bulge outward, thereby resulting in the undesirable "orange peel" appearance. The mesotherapy formula is based on the grade of cellulite found. There are four stages of cellulite, each of which may require a different treatment:
Stage 0: No visible cellulite, even when skin is pinched.
Stage 1: No visible cellulite when standing or lying down; however, cellulite can be seen when skin is pinched.
Stage 2: Visible cellulite when standing, but not when lying down.
Stage 3: Visible cellulite when standing or lying down.
The injected customized blend of medications interacts with the fat cell, encouraging the cell to release the fat within and allowing it to be burned as fuel. It also improves blood flow and lymphatic drainage of the target area, removes the fibrotic, connective tissue bands, and melts the excess of fat deposits. This results in a significant reduction of the "orange peel" skin appearance and in the loss of inches from the treated areas. Because cellulite is a chronic condition, the mesotherapy process of correcting it may require ten to fifteen (10 – 15) sessions. Back to Top



Can it achieve the same results as liposuction?
For females and males who have an accumulation of fat in unwanted areas, mesotherapy is a non-invasive alternative to liposuction. However, the technique is not a complete replacement for liposuction. Mesotherapy is a suitable alternative for small area sculpturing or as an option for patients who may be not good surgical candidates for liposuction. The fat-burning mesotherapy injections can successfully reduce fat deposits from hips, thighs, waist, love handles, back, abdomen, arms, and double chins (or any other area where your body has unwanted pockets of fat).
Both males and females who are simultaneously engaged in a comprehensive system of diet, exercise, nutritional supplementation and hormone balancing will achieve the greatest benefit. Back to Top
What is meant by body sculpting?
Cosmetic contouring of the abdomen, face, neck, back, bra-lines, legs, thighs, and hands can be achieved with mesotherapy injections. Vitamins and amino acids are injected to tighten sagging skin while additional mesotherapy medications are used to remove areas of fat, thereby restoring a more youthful and athletic appearance of the body without downtime from work. Based on individual requirements, the physician will select a formula that is injected under the skin where it will slowly diffuse into the fat and produce fat breakdown. Where successful, visible results measured in inches are usually achieved within 4 weeks and the treatments are long lasting when combined with exercise and a healthy lifestyle. The number of required treatments will vary. Back to Top


Can mesotherapy be used for facial rejuvenation?
The mesolift is a mesotherapy approach to treat aging, sagging, and wrinkling of the skin involving the face and neck. It is also used to retard the progression of wrinkling and to rejuvenate ashen complexions. Mesotherapy helps to shrink fat from under the neck, remove free radical damage, and tighten loose skin. The effects rejuvenate the face, eyelids, and neck without the unnatural appearance and painful recovery of surgical alternatives. Back to Top


Can mesotherapy be used to remove eye fat pads?
Mesotherapy has proven successful for reduction of the fat or puffy areas found under the eyes (the “tired” look). It can usually delay, or avoid, the need for future surgical removal of fat pads (lower eyelid blepharoplasty) and the possible complications associated with the surgery. Back to Top
The Mesotherapy Technique
Mesotherapy must be performed by a licensed physician who has received proper training in performing mesotherapy procedures. Using a very fine needle (similar to the type used for Botox injections), the physician painlessly injects into the mesoderm (middle layer of skin) the specific formula to treat your condition. The needles penetrate the body at only a very small depth. The needle sticks are not felt by the patient because the skin is pinched by the physician prior to and during the injections. The number of injections and strength of each medication treatment is determined on an individual basis. Generally, patients require one treatment every ten to fourteen (10 – 14) days depending on the location and size of the area being treated. The injections are made at small distances (one inch intervals along the affected area) and in small doses per treatment.
The time frame between treatments, combined with small doses per session, provide the opportunity to observe and monitor its effects. Although mesotherapy microinjections are painless, for apprehensive patients and for those with low thresholds to pain, topical anesthetic skin creams are applied prior to the injections.
In some patients a technique of “multi-pricking” is used where a number of quick, very superficial injections are made at a specific site. “Multi-pricking” is performed by hand or by using a specially designed gun delivery system. Following the injections, the fat is emulsified (broken down) into fatty acids and burned off as energy and otherwise metabolized. Back to Top
Are there any side effects?
The majority of patients experience minimal discomfort with mesotherapy. Some patients may develop minimal local pain, a minor burning sensation for a few hours, and temporary bruising. Itching and soreness may be experienced for a few days. Like any other injectable product, an allergic reaction may occur in some people. The procedure is performed in the office and takes minutes to complete. Back to Top
How many treatments are required before I see results?
It depends on the patient’s body and the extent of the fat/cellulite/skin to be treated. Some patients see results after one treatment session while most patients require three to five (3 – 5) treatments to notice results. Often the patient’s clothing will become looser and the patient will appear thinner. Mesotherapy is more about losing inches than losing large amounts of weight. Some patients may require five to fifteen (5 – 15) treatments, and sometimes more.
Proper dietary lifestyle and nutritional supplementation are essential to achieve the best long-term results. Because aging is a dynamic process that cannot be stopped, mesotherapy injections are useful in preventing against the ravages of aging. Maintenance treatments of the face, neck, arms, and hands may be needed two to four (2 – 4) times a year. Back to Top
Can I go back to work after treatment?
Yes. This office procedure takes less than 30 minutes per session and requires little preparation or recovery time. No heavy bandage or compression girdles are required. Back to Top
How often can treatments be done?
In general, once every ten to fourteen days. Back to Top
Are there any restrictions?
General restrictions vary depending upon the area(s) and the condition that was treated.
Avoid vigorous exercise for forty-eight (48) hours.
Avoid hot showers for six to eight (6 – 8) hours.
Avoid application of makeup four (4) hours.
Use loose clothing around the area treated immediately following the injections.
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Will the fat that was removed from the treated areas return?
Mesotherapy removes the fat from the fat cell without destroying it. This helps your skin regain its natural appearance. If you gain weight after having mesotherapy, the fat will simply return to the treated area. The failure rate of mesotherapy has shown to be low (8 %). Exercise and diet in addition to mesotherapy have shown the best long-term results. Back to Top
Who is a candidate for mesotherapy?
Healthy males and females are candidates for mesotherapy. Pregnant women, those with insulin dependent diabetes, severe heart disease, history of stroke or ischemic attack, recent cancer, cutaneous lesions, allergies to mesotherapy components, or those who are taking blood thinning medications, are not candidates for mesotherapy. Back to Top
How much does mesotherapy cost?
Mesotherapy treatments typically cost from $300 – $450 per area per session, depending upon the size, location and difficulty of the area(s) being treated. If more than one area is to be treated per session, pricing may be determined on an individual basis. Back to Top
Is mesotherapy different from liposuction?
Yes. Mesotherapy is a non-surgical medical treatment. Mesotherapy removes the fat from the fat cell, where liposuction removes the entire fat cell. Liposuction is a surgical procedure that requires anesthesia (local, regional, or general). Mesotherapy does not require anesthesia nor recovery time.
However, mesotherapy is not a replacement for liposuction. Mesotherapy is applicable for the reduction of small areas of unwanted fat spots, cellulite and skin rejuvenation. Mesotherapy is best suited for men and women who are not excessively overweight but, instead, have certain problem areas with stubborn fat that can no longer be reduced by diet and exercise. These patients want liposuction but are hesitant to undergo a surgical procedure. The downside with mesotherapy is mainly that the results are gradual when compared with the immediate results that liposuction offers.
Mesotherapy has shown excellent results to smoothen and reduce uneven fat spots that may persist after liposuction, thereby avoiding the need for additional touch-up liposuction procedures. Mesotherapy and liposuction are not competitive procedures but, rather, they complement each other. In our experience, mesotherapy injections have shown great results when combined with liposuction. Mesotherapy is an excellent initial alternative to liposuction for minor to medium body sculpting of specific areas of the body such as the stomach, upper arms, thighs, chin, hips, and so forth. Back to Top

Arthritis of the Spine

Arthritis of the spine can be sub classified into 2 broad categories. Spinal Spondylosis and Spinal Stenosis. Continue reading to find out more.
Spondylosis
The spine is made up of many moving parts. Each joint in the spine hinges on the vertebrae above and below it allowing us to move in all directions. Excessive movement of the joints will lead to wear and tear in the joints. This is known as degeneration.
We all will have some degree of degenerative changes as we get older, however in some people this is more significant than others. All areas of the spine are subject to degenerative changes but the parts that move the most will suffer the most. Therefore the neck and lower back are the areas greatest affected.
Family history can account for significant degeneration of the joints of the spine and stress to the spine will compound pre-existing weakness. As mentioned above frequent loading of the spine in static postures is the greatest offender. Sitting most of the day and getting very little variety of exercise will increase the strain on the low back and neck. Bending without taking a break if working in the garden or doing DIY all add to the problems. Obviously lifting poorly and items beyond your capability all adds to the problem.
Spondylosis is the name given to degeneration of the joints of the spine. This usually results in small increases in boney growth in the joints as the cartilage covering the bone starts to wear away. These bony projections, known as osteophytes, cause the spaces in the joints to narrow and the spine to become stiff. This stiffness leads to increased strain on the spine and further degeration will continue.


The stiffness in the spine can be mild at first and not always painful. Indeed some people can have very stiff spines with hardly any pain. Most people unfortunately will have increasingly painful backs as the degeneration progresses. If you have read the information above you will now know that this degenerative process will cause mechanical back pain, increase the chances of developing a trapped nerve and possibly a prolapsed disc.
There are options to help. Early intervention is key. A good exercise program to improve strength and improve flexibility is essential. Regular changes in position to reduce the load on the spine and a good diet to improve bone strength and reduce weight will all help. A physiotherapist can guide you through these stages and also mobilise or manipulate the spine to decrease pain and improve movement. Occasionally a course of pain killers may be necessary but it is best to try and treat arthritis of the spine with physiotherapy and exercise.
If the degeneration becomes too severe pain killing injections may help, such as a nerve block or epidural. Surgery is a final answer but is required in very few cases. It will usually involve fusing together with metal rods and screws the joints of the back that are causing the most problems. It can help to reduce the pain but it will greatly stiffen the spine and therefore should be considered only when necessary.
How can you prevent or reduce significant degenerative changes to the spine:
- Sit up properly and arrange your work station to best suit your height and shape.
- Stand up every 15-20 minutes to recover the arch in your spine, both at home and at work.
- Go for a long walk (40 minutes) per day, ideally in one go or split it in two, 20 minutes at lunch and 20 minutes when you finish work.
- Try to stretch regularly through the day.
- Don’t drive for greater than one hour without getting out to stretch your legs.
- See a Chartered Physiotherapist if you have pain that doesn’t settle down in 48 hours.
Spinal Stenosis
As mentioned with Spondylosis the joints of the spine are susceptible to degenerative wear and tear. This wear and tear is at the small joints at the side of the spine where the nerves exit the vertebrae to travel into the arms and legs. Spinal stenosis occurs when the large central space in the middle of the vertebrae containing the spinal cord starts to narrow as a result of increasing bone growth.
The pain of spinal stenosis is very similar to that of trapped nerves and / or disc prolapse but may affect one of both, arms or legs. Pain is usually worse when walking and relieved by sitting. This is the opposite to mechanical back pain, arthritis of the spine and disc prolapse.
Spinal stenosis can be a serious problem and professional help is advised as soon as possible. Investigations should be carried out such as an x-ray and perhaps a scan to see the extent of the narrowing of the spinal canal.

Trigger point

When a muscle is been used or overused a lot of the time it may develop what is known as a trigger point. A trigger point is defined as a taut band within a muscle that on palpation will generate a local twitch response and causes a deep aching pain radiating from the region. These are commonly known as ‘knots’. All muscles are susceptible to developing trigger points and many muscles have what are known as dormant trigger points. A trigger point is active when it is causing pain and twitches when compressed.

A common area of the body susceptible to trigger points are the muscles connecting the shoulders to the neck or upper trapezius muscles. The Upper trapezius muscles are responsible for keeping your head up straight, rotating your head away and bringing your ear down to your shoulder or vice versa bringing your shoulder up to your ear.
Commonly when sitting at a computer for long periods of the day the trapezius muscles are working to maintain your head position. If your work station is unsuitable you may be increasing the load on these muscles because you are looking down at the screen, particularly the lap top, or your head is rotated slightly to one side more than the other. Not quite as common nowadays is holding the phone between your ear and shoulder but if you do this especially when using a mobile, that is most likely to cause the development of a trigger point in the muscle.
In the upper trapezius muscles the trigger point will produce an aching pain deep in the shoulder blade area and can refer down the arm to the back of the elbow. It may even cause pins and needles locally. It can also radiate up the skull behind the ear and be responsible for tension headaches.
In order to treat a trigger point it is essential to find the route cause of the problem. This may be something so subtle that you won’t be aware of it until it is pointed out to you. It is best to get someone to observe you as they can see you move, or not as the case may be, than you can see yourself. Common faults are the computer being at the incorrect height or angle, poor posture sleeping, having your arm up on the window frame when driving, television being in the corner of the room so you have to turn your head to see it, etc.
Once the main cause is established, this of course can be altered. To treat the trigger point the physiotherapist has a couple of options. They may try some myofascial release which will involve deep tissue palpation of the trigger point in order to desensitise it. Another option is to treat the area with what is known as trigger point needling. This involves putting a fine needle (usually an acupuncture needle although it is not acupuncture) into the muscle to deactivate the trigger point. An acute spasm is felt in the muscle and a release of tension follows.
You will then be shown how to stretch the muscle and this will have to be carried out regularly. Trigger point needling may be very effective in one session or may take a number of sessions to fully resolve the pain depending on the severity of the problem.

Impingement

Shoulder impingement is not a diagnosis, it is a symptom. When we talk of impingement there is a catching or pinching of structures underneath the Acromioclavicular joint (joint on top of the shoulder where the collar bone meets the shoulder blade).
Any one or more of a number of structures can get pinched in this space. Usually one of two structures are involved. Most frequently it is a tendon of the rotator cuff. The rotator cuff is a group of four muscles coming from the spine and shoulder blade. They wrap around the shoulder joint to suck the ball of the shoulder into the socket of the joint. They give stability to the joint and are also involved in the movements of the arm particularly rotation as the name would suggest.


The tendon that is most exposed in the rotator cuff is the supraspinatus tendon. This tendon lifts the arm away from the body and helps rotate it away from the body. When the arm is lifted overhead the tendon can become squeezed between the shoulder joint and the Acromioclavicular joint on the top of the shoulder. If this happens once or twice it is not a great problem. Repeated catching of this tendon will cause it to become inflamed. That results in a tendonitis making the shoulder painful, weak and increasingly stiff.
If the tendonitis is not treated early it can cause a chronic impingement of the shoulder. Prolonged inflammation will weaken the tendon and could eventually cause the tendon to fray or tear. The tendon can also be torn as a result of trauma such as a fall on an outstretched hand or onto the shoulder. If the arm is suddenly forced backwards or rotated this could also tear the tendon or by lifting something too heavy or repetitive overhead lifting. A torn rotator cuff tendon is a painful and debilitating injury that can take months to years to resolve.
It is important to ask why the tendon would become squeezed between the shoulder and AC joints in the first place. Normally there is enough space between these joints for the arm and tendons to function properly. So what would cause the space to narrow? The most common reason is posture. If you allow your shoulders to slouch forward as when sitting at a PC or folding your arms in front of your chest, this will narrow the joint space. This is a gradual process and slowly causes the shoulders to become rounded and will eventually cause an impingement. Another possibility is degenerative wear and tear of the AC joint. If the AC joint becomes worn, Small boney projections called osteophytes can protrude from the joint. These act like little daggers into the soft tissues under the joint. Both of the scenarios above will result in a shoulder impingement.
The other structure in the Acromioclavicular joint space that gets squeezed is the sub acromial bursa. This is a fluid filled sack much like an airbag that sits between the rotator cuff and the point of the shoulder. It is there to act like a shock absorber in the joint. If there is repetitive squeezing of the bursa it can slowly become inflamed. It will also become acutely inflamed as a result of direct trauma such as a fall onto the arm compressing the joint or if something falls onto the shoulder from above.
The swollen bursa will reduce the space between the shoulder joint and the Acromioclavicular joint and will be squeezed or pinched when the arm is raised. This also causes an impingement syndrome.
Depending on the source of the impingement there are different ways to treat the problem. Firstly it is important to establish the correct diagnosis. The physiotherapist has a number of clinical tests they can carryout to help achieve this. If they are unsure or need to confirm the diagnosis it may be necessary to carry out other tests. An x-ray of the shoulder can identify or rule out the possibility of an osteophyte. An MRI scan may be able to establish a tear in the rotator cuff or a swollen bursa. Ultrasound scans are also useful to see the rotator cuff in various positions as it is possible to move the shoulder while carrying out an ultrasound scan. This is not possible when performing an MRI scan. One or more of these tests may be required to finalise a diagnosis.
Once the correct diagnosis is established the treatment begins. An acute tendonitis can be treated with Ice, anti-inflammatories and an exercise program. A traumatic rotator cuff tear needs to be placed in a sling and rested for about 3 weeks. Also during this time the physiotherapist will work on the tendon to prevent the formation of scar tissue and then rehabilitate the shoulder girdle complex when appropriate.
A bursitis may need a cortisone injection to kill the inflammation but the physiotherapist can normally reduce the pressure on the bursa by mobilizing the joint and strengthening the shoulder. Impingements as a result of posture or osteophyte formation need a lot of work on improving posture and mobilising the Acromioclavicular joint to improve joint space. The underlying tendonitis or bursitis also needs to be treated and the shoulder rehabilitated.
If conservative management is not effective then other interventions such as injection therapy or surgery are available. Most surgeons will tell there patients to try conservative management for at least 3 months before resorting to surgery and will often insist on waiting a year before operating. The earlier treatment begins the greater the success.

Frozen Shoulder

. figure: Frozen shoulder sometimes known as adhesive capsulitis.
Often over or misdiagnosed a frozen shoulder is a painful and stiff joint that can not move beyond 50% of its normal range of movement. A shoulder X-ray will be normal and it is usually of unknown cause or idiopathic.
There are two types of frozen shoulder. Primary or idiopathic frozen shoulder is of unknown cause. It classically occurs in females more than males and in those usually over 45 years of age. It will normally be in the non dominant arm and is more likely to occur in those in a sedentary profession. Secondary frozen shoulder follows significant trauma to the shoulder such as a fracture, dislocation or severe burn. However this injury may have occurred some years previously.
The shoulder joint is surrounded by a capsule, which is like a layer of cling-film covering the joint. It provides fluid to the joint to lubricate it and allow the 360degrees of movement we enjoy in the shoulder. In frozen shoulder it is believed that this capsule starts to shrink and be come stuck or adhere to the shoulder joint. There is some evidence to say that in the early stages this capsule is inflamed and it is sometimes referred to as an adhesive capsulitis. There is other evidence to say that the capsule is not inflamed but that the capsule shortens similarly to that of a Dupuytren's contracture in the hand and that this will have to take its own time to burn itself out.

A frozen shoulder will run 3 stages. Stage 1 is the freezing phase where the shoulder becomes increasingly stiff and painful. Phase 2 is the frozen phase where the shoulder is so stiff that it will not move above shoulder height. This is often the most painful stage and it is then people will usually seek help for the shoulder. It is painful to sleep on and the shoulder usually becomes very sensitive even to small changes in movement. The third and final stage is the thawing phase when the pain reduces and the movement slowly improves.
Each stage of a frozen shoulder will last from 4 to 8 months. Therefore taking anywhere from 1 to 2 years to resolve. Frozen shoulders will solve themselves eventually and will never occur again in them same shoulder. There is unfortunately a 13% chance of it occurring on the other arm, usually within a year of the initial shoulder resolving.
Treatment for a frozen shoulder will vary depending on what stage you are at. In the early phase it is important to try to maintain the movement and control the pain. Anti-inflammatory medication may be useful or even a cortisone injection. There is some debate as to the presence of inflammation in frozen shoulder but research is split on the topic. Physiotherapists can help to control pain and maintain movement.
In the second and most painful stage aggressive manual therapy is counter productive. Patients try a variety of modalities to help ease the pain such as ice or heat or electrotherapy. There is evidence for and against each of these. Whatever works best for the individual should be continued. The aim of treatment at this phase is to control the pain. Acupuncture has been shown to be the most effective. Your physiotherapist may be able to perform this for you or refer you to a suitably qualified person.
In the third phase the pain drifts away and it is then time to get the joint moving. Mobilisation of the joint should be carried out by the Physiotherapist and an exercise program established to get you back to full function.
There are surgical options for frozen shoulder but these are carried out rarely and like everything else in frozen shoulder are debatable. Manipulation under anesthetic is carried out to try to break any adhesions in the joint and kick start the movement. Other more invasive procedures attempt to release the capsule covering the joint in order to free some movement.

Tennis Elbow

The tendons that extend or straighten our fingers all come from the same point of the elbow. This area is known as the lateral epicondyle or extensor tendon origin. Pain in this region is often described as lateral epicondylitis or tennis elbow. There are a number of tendons all originating from the same point and moving out into different directions to get to the fingers. As these tendons overlap and are working to move the hand and fingers particularly in gripping activities they can rub against each other creating friction, inflammation and eventually become scarred.

The tendon that moves the middle finger sits on top of all the other tendons and is the one that can rub the most. This tendon is called Extensor Carpi Radialis Brevis. In tennis elbow it is this tendon that is affected. There are other tendons that can be affected or other areas of pain on the lateral aspect of the elbow, however it is not tennis elbow unless the middle finger is involved.
Classically the tendon will be rubbing and slowly fraying for months. It usually takes about 6 months for the process to lead to pain or inflammation. Tennis elbow is characterized by pain in the lateral or outer aspect of the elbow. The pain often originates behind the elbow joint and radiates out from there over the outer upper one third of the forearm. It is intermittent at first and gradually deteriorates becoming increasingly stiff and painful. Most patients present with symptoms occurring for approximately 3 months at which time the tendon has become scarred and very weak. In all they have had the problem for 9 months by this time.
It is necessary to establish the source of the problem. With careful questioning a source is usually identified which more than likely will involve an increase in gripping activity in the previous 6-9 months. Classic examples are a short intense spell of DIY, gardening, gripping sports such as tennis or golf or perhaps a lot of right clicking with the mouse using the middle finger.
This intense period of activity may have started the scarring process and although not painful at the time, slowly degenerates resulting in the pain of tennis elbow 6 months later. If the cause can be identified this will greatly improve the chances of recovery.
Physiotherapy can conservatively manage tennis elbow and will result in full pain free and functional recovery in 70-80% of cases. The physiotherapist will break down the scar tissue and start the patient on a graduated exercise program. It will take 12 weeks to fully recover and the patient will need on average 8 sessions in that time.
The physiotherapist may consider a brace to help reduce the pain during treatment. Most of these are ineffective. The best tennis elbow supports are those that stop the hand from moving rather that restrict elbow function as it is gripping of the hand that is responsible for the damage in the first instance. The physiotherapist may also try acupuncture to control the pain during treatment.
If physiotherapy is unsuccessful the next option is to have one or a series of cortisone injections. There is much debate over the effectiveness of cortisone in tennis elbow as there are many who believe that there is no inflammation. There is also debate as to how many and where exactly these injections should be administered. The general consensus is that 3 injections would be the maximum over a 6 month period.
Surgery is the final resort and this will either involve debridement of the scar tissue or a tendon transfer. Tendon transfers are the more successful surgical procedure as it changes the angle at which the tendon pulls. This relieves the stress on the tendon and should reduce it’s recurrence in the future. Post surgical rehabilitation with a Physiotherapist is essential for good long term results

Carpal tunnel syndrome

Carpal Tunnel Syndrome is when the median nerve gets trapped or squeezed in the wrist as it works its way down the front of the forearm from the elbow to the fingers. The wrist is a gutter of 8 bones that is formed into a tunnel by a layer of connective tissue over the top. Inside this tunnel various structures pass through from the forearm to the hand including the tendons that flex the fingers, some blood vessels and the median nerve.
The median nerve is one of many nerves in the arm. It supplies power to some of the muscles in the hand and also sensation to the thumb, index finger, middle finger and half the length of the ring finger on each hand.. When the space inside this tunnel is compromised the median nerve is squeezed and this results in pain and pins and needles in the thumb and 2 and a half fingers of the hand.
The nerve can be squeezed if there is an increase of swelling in the area such as fluid retention in pregnancy or if there is a tendonitis and inflammation. The nerve can also be squeezed if the carpal tunnel itself starts to narrow if there is some arthritis or wear and tear in the bones or if the wrists are extended / bent back for long periods of the day when typing or using a mouse. The connective tissue covering the bones can also shorten as we get older and this may be the cause.
Most people with carpal tunnel syndrome complain of pins and needles in the hand and fingers especially in the morning and this may even wake them at night. The hand or hands often feel heavy and numb and they will have to shake them out to “get them going in the morning”. The symptoms may also be aggravated throughout the day if there is a build up of pressure in the wrists for any of the reasons mentioned above.

In order to treat carpal tunnel syndrome the main cause needs to be established. In an office environment incorrect keyboard or mouse use can be a very significant factor. Adjusting the hand, wrist and forearm position so that the hand is in a relaxed and neutral position allows all the structures to pass through the carpal tunnel with the greatest of easy. If you are unsure of how to achieve this contact a Chartered physiotherapist who can arrange a work station assessment for you.
If sleeping is the biggest problem wrist splints can be useful which help keep the wrist in a neutral position overnight so that the median nerve does not get squeezed during the night if you bend your wrist while you sleep. However, if localised swelling is the source of the problem, such swelling is often worse at night and splints may be of limited use. If swelling is a factor then the source of that swelling needs to be address either with appropriate medication as prescribed by your GP or a steroid injection by a specialist.
Physiotherapy can help to identify the correct diagnosis and cause of the problem and may also be able to treat the source of the problem. If all else fails there is a simple surgical procedure which can release the pressure in the tunnel and “fix” the problem.
Remember that carpal tunnel syndrome is not the only cause of pins and needles in the fingers and a thorough assessment is necessary to establish the correct diagnosis