Carpal Tunnel Syndrome

The basics of carpal tunnel syndrome (CTS)

Carpal tunnel syndrome is a common condition where the nerve at the base of the palm is pinched, causing pain, numbness and weakness in the wrist and hand.
Diabetes, thyroid dysfunction, repetitive maneuvers and trauma to the wrist are some contributing causes of carpal tunnel syndrome.
Physical therapy and exercises are often recommended treatments to reduce pressure on the wrist.
In some cases, surgery and medication are also prescribed.

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What is carpal tunnel syndrome?

Carpal tunnel syndrome (CTS) is caused by excessive pressure on the median nerve – a major nerve in the hand – as it travels through the narrow passageway in the wrist called the carpal tunnel. CTS is a common condition that affects from 3%-6% of adults.

Carpal tunnel syndrome can cause a feeling of weakness in the wrist and hand, pain, and a sensation of numbness and tingling. The pain in the wrist can make it difficult for the person to carry on with routine tasks. Moreover, if the condition worsens, it can also affect areas above the wrist to include the forearm, wrist and sometimes the shoulder.

Who can treat carpal tunnel sysndrome?

Individuals can address early and mild cases of CTS with rest, avoiding repetitive activities with the wrist/hand, using non-steroidal anti-inflammatory drugs (ibuprofen), and applying cold packs to reduce swelling.

Physical and occupational therapists offer effective treatments aimed at reducing the pressure on the median nerve as it passes through the carpal tunnel. This may include gentle movement of the tendons that also travel through the carpal tunnel, stretching, massage, strengthening exercises and use of a carpal tunnel brace (see below). Patients can begin physical therapy or occupational therapy without a doctor’s referral.

Physicians will treat more severe cases requiring corticosteroid injections or surgery. It is not uncommon for a physician to order a steroid injection followed by therapy or to order pre- and post-operative therapy for patients who require surgery.

Carpal tunnel syndrome causes

Excessive pressure and a compressed median nerve are the root causes of carpal tunnel syndrome. This is often a result of:

Positioning of the wrist during routine activities, e.g., using a mouse and keyboard.
Repetitive motions of the wrist/hand, e.g., using a hammer.
Excessive and prolonged exposure of the wrist to vibration, e.g., power tools.

Other factors can increase risk of developing CTS:

Chronic conditions such as diabetes, high blood pressure or autoimmune disorders.
Dysfunction of the thyroid gland.
Fluid retention caused by pregnancy, menopause or medications.

Carpal tunnel symptoms

Signs of carpal tunnel start gradually and include:

Tingling and numbness in the hand, especially in the index finger, thumb and middle finger.
Weakness in the hand or inability to grip objects.
Feeling of shock-like radiations in the middle finger, index finger and thumb.
Stiffness in the fingers.
Feeling that the fingers are getting swollen, with no signs of swelling.
Unable to distinguish hot and cold by touch.

Preventing CTS

There is no way to prevent CTS entirely, but there are many ways to reduce symptoms:

Avoid excessive grip and relax the hands when completing everyday activities, such as driving, to reduce force on the wrists.
Take frequent breaks during repetitive tasks.
Maintain proper wrist and hand posture while using a mouse or keyboard.
Ensure the patient’s workstation has a proper ergonomic setup, especially if at a computer or desk.
Use a carpal tunnel brace to neutralize wrist position.

Risks of not treating carpal tunnel syndrome

Many people with CTS wait too long to seek care, often waiting until their hand has gone completely numb. This can lead to more severe and even permanent nerve damage. Taking care of this condition early can prevent irreversible nerve damage and reduce the risk of CTS causing more severe weakness and lack of coordination.

Carpal tunnel tests and diagnosis

A doctor or physical therapist will perform various carpal tunnel tests to arrive at a diagnosis. The exam with a physical therapist begins with a discussion of medical history and specifics of the CTS symptoms, followed by a thorough examination of the patient’s forearm, wrist and hand. The therapist may also examine the shoulder and neck to rule out any other factors that may cause similar symptoms. From there, a plan of care is developed with the patient.

If the patient’s condition is more severe, a physician may order additional testing to include:

Electromyography test that evaluates the electrical activity in muscles to detect damage.
Nerve conductivity test.

Carpal tunnel physical therapy treatment

Treating carpal tunnel depends on the severity of the condition. If diagnosed early or if the patient is only experiencing minor symptoms, changes in lifestyle factors (see preventing CTS above) and exercises prescribed by a medical professional can greatly improve function. For this reason, physical or occupational therapy is often the first and preferred method of treatment.

The Spine & Sport physical therapy team will emphasize patient education on ways to improve the condition, recommending changes in wrist positioning, regular stretching and proper posture. In addition the team will recommend prevention techniques so CTS does not recur.

Carpal tunnel exercises

The physical therapist will prescribe stretching exercises that may help relieve the pain as well as multiple strengthening exercises for the forearm, wrist and hand.

Patients may feel a gentle pull or stretch during the exercises, but they are generally not painful. Exercises and stretching are sometimes prescribed along with other treatment methods, such as medication or steroid injection.

Carpal tunnel brace

The patient’s therapist may also recommend wearing a carpal tunnel brace to help restrict the wrist’s movement. This is particularly important at night because most people bend their wrists when they sleep, putting pressure on the median nerve and causing more pain in the morning upon waking up. The brace will keep the wrist in a neutral position in order to prevent that.

Wearing the carpal tunnel brace when doing activities that bring on symptom flare-ups can also help. A carpal tunnel brace can be a good idea for use at work that involves repetitive wrist motions.

Learn more about physical therapy exercises

When to see a doctor for carpal tunnel syndrome

Patients should seek evaluation by a physician for these reasons:

An acute injury caused the CTS symptoms, often requiring an X-ray.
If symptoms restrict normal activities and make sleeping difficult.
Symptoms do not improve over several weeks or more of nonsurgical treatments.

Doctors might prescribe anti-inflammatory drugs and steroids in some cases. If the condition worsens and any of the above treatments do not work, the last option is surgery. The surgery for this condition is called carpal tunnel release and it removes the pressure on the median nerve by opening up the carpal tunnel.