Carpal Tunnel Syndrome (CTS)
The carpal tunnel is a small fibrous canal running down the palm side of the wrist; it protects the tendons of the fingers and thumb along with the median nerve that runs through the carpal tunnel. CTS is a condition in which the median nerve has been compressed or pinched, which can lead to weakness and numbness in the hand and/or fingers.
Causes of CTS
- Keeping the wrist flexed, extended, or in unnatural positions for long periods of time
- Using the hands and fingers repetitively for long periods of time (e.g. driving vehicles or heavy machinery, typing on a keyboard, meat-packing, assembly line work, playing sports involving repetitive swinging motions)
- History of wrist injuries or sustained wrist injuries
- Fluid retention (e.g. during pregnancy) that can crowd the carpal tunnel
Signs and Symptoms of CTS
- Gradual onset of numbness, “burning” sensation, and/or tingling in the palm of the hand and fingers
- onset of these symptoms tend to flare up more at night, but as the condition persists, it is common to start noticing the symptoms throughout the day
- Weakness in grip (sometimes to the point of dropping objects)
- Flare up in symptoms (and even pain) when holding objects
Your physical therapist will use a variety of tests to confirm whether you have CTS or you have another issue in the neck or shoulders that is presenting similar symptoms to carpal tunnel syndrome. Sometimes, he/she will also work with orthopedic doctors and/or hand specialists to confirm your diagnosis.
Physical Therapy Treatment for CTS
Mild to Moderate Cases (no surgery necessary):
- Pain management– heat can be used to loosen up stiffness in the joint an dwarm up the muscles in the wrist. Electric stimulation can be used for temporary pain relief.
- Strength exercises– Strength exercises are important for reversing any weakness in the wrist caused by CTS.
- Stretching exercises- stretching exercises are important to maintain or improve movement in the wrist.
- Posture education– your physical therapist will teach you proper wrist positions for various activities and go over ways to change your work and home environments to prevent relapse or worsening of symptoms.
- Functional training– your physical therapist may set up a mock work station set-up to help you practice proper posture and wrist positioning.
Severe Cases (following surgery):
In some cases, a person’s CTS is too severe for conservative treatment such as physical therapy to be as effective. In the event that a patient does have surgery to relieve pressure off of the carpal tunnel, the following physical therapy treatments are used for post-operative treatment
- Pain management– heat therapy to loosen up stiffness in the wrist and relieve pain
- Manual therapy– used to restore movement in the wrist. Techniques such as soft tissue mobilization, scar tissue mobilization, myofascial release, and wrist mobilization are useful in reducing stiffness in the joint, especially if it had been confined in a cast or brace for a couple of weeks following surgery.
- Strengthening exercises– important to improve wrist and hand strength and restore function
- Stretching exercises– used to restore movement and function to the wrist and hand
- Posture education– your physical therapist will teach you proper wrist positions for work, leisure, and home activities to avoid risk of developing CTS again
- Functional training– your physical therapist will set up a mock work station to practice implementing proper wrist positions while working
While there is no evidence for specific ways to prevent CTS, there are ways to reduce stress on the hands and wrists, which is a contributing factor to CTS.
- Reduce the amount of force when doing work that requires smaller movements and less effort (i.e. loosening your grip when hand-writing or being gentler on the keyboard when typing). If you have to write for long periods of time, consider using a pen with a larger grip area or purchasing a soft grip to put on your pens.
- Take breaks to stretch your hands
- Maintain a neutral (straight) wrist position as much as possible. This may require you to change your work or home office settings to be conducive to practicing maintaining a neutral wrist position.
- Keep your hands and wrists warm to avoid stiffness and pain.
- Monitor your overall health- weight management and lifestyle can reduce your chances of getting diseases or injuries that can contribute to CTS