Carpal tunnel syndrome is a common condition that causes pain, numbness, and weakness in the wrist and hand. CTS can affect the use of the entire arm. It is caused by pressure on the nerve at the base of the palm (median nerve). Because of the constant demands people place on their hands and wrists, surgery may be needed when symptoms are severe. For many people with CTS, however, physical therapy treatment can relieve pain and numbness. It often can help restore normal hand, wrist, and arm use without the need for surgery.
The carpal tunnel is a narrow passageway (about the size of a dime) on the palm side of your wrist. The tunnel protects the median nerve and the tendons that bend your fingers. When the tunnel narrows due to injury or other conditions, or the tendons and nerves in the tunnel swell and take up more space, pressure on the nerve increases. A wrist fracture or arthritis can cause the size of the tunnel to become smaller. The tendons or nerves can enlarge due to either inflammation or tendon changes with age. Pressure on the nerve can cause pain and weakness in your wrist and hand and numbness or tingling in some fingers. The most affected fingers are the thumb, index, middle, and sometimes, the ring finger. If this increased pressure continues over a long period, it can lead to CTS.
Extreme wrist positions and repeated finger use with a lot of force or vibration can contribute to CTS. CTS is common in professions such as assembly-line work (meatpacking in particular). It also is common among people with jobs requiring the use of hand tools, especially tools that vibrate. Although too much keyboard computer use can cause CTS, people who do assembly-line work are more likely to develop it. Using hand-held mobile devices, sewing, video gaming, and playing racquet sports or string instruments like the violin also can cause CTS.
The following health conditions also may lead to CTS in some people:
- Inflammation and swelling of the tendons of the wrist
- Injuries to the wrist (strain, sprain, dislocation, fracture)
- Hormone or metabolic changes (pregnancy, menopause, thyroid imbalance)
- Fluid retention
- Diabetes
- Medications (such as steroids or chemotherapy)
- Degenerative and rheumatoid arthritis
Signs and Symptoms
CTS usually starts gradually. Many people report waking up with numbness, tingling, or burning in their thumb, index, and middle fingers. Sometimes, the ring finger is affected. Many people feel the need to “shake out” their hands to try to relieve their symptoms.
As the condition worsens, the symptoms become more noticeable during the day.
Symptoms often are worse when:
- Grasping heavy objects.
- Using a computer.
- Holding a cell phone.
- Gripping anything for a long period of time.
Hand weakness and more constant numbness may occur if the pressure on the nerve continues. You may find that you drop objects unexpectedly.
How Is It Diagnosed?
Physical therapists work together with other health care providers to accurately diagnose and treat CTS. Symptoms of CTS are typical. It is often possible to diagnose it without extensive testing. Your physical therapist will conduct a thorough evaluation to determine all the factors that may be contributing to your condition.
They will begin by asking you questions to gather information about your health history and condition. The interview will become more specific to the symptoms of CTS. They may be helped by forms you fill out before your first session. Your physical therapist may ask you:
- Did you experience an injury to the area?
- If so, how did your injury occur?
- Do you perform repetitive tasks for your work, or for sport?
- How have you taken care of the condition, such as seeing other health care providers? Have you had imaging or other tests, and received their results?
- What are your current symptoms, and how have they changed your activities?
- Do you have pain. If so, where and how intense is your pain? Does pain vary during the day?
- Do you have trouble doing any activities? What activities are you unable to do?
This information lets the physical therapist better understand what you are experiencing and helps to determine the course of your physical exam.
The physical exam will vary depending on your interview. Your physical therapist will observe the region of your symptoms and any movements or positions that cause pain. They also may examine other areas of your body, such as your neck and upper extremity. They may:
- Watch you reach for objects.
- Ask you to grip different-sized objects and hold them in certain positions for an amount of time.
- Assess the mobility and strength of your forearm, wrist, and hand. This will help to determine if other areas of the body need treatment to improve your condition.
- Gently, but skillfully, feel around your arm and wrist region to find exactly where it is most painful.
Several tests may be used to help diagnose or rule out CTS, including:
- An examination of your neck, shoulder, and arm and down to your fingers to rule out other conditions. Many patients have been told they have CTS, only to learn that the pain is coming from another area.
- A grip strength test of your fingers and thumb.
- Sensory tests.
- Wrist and hand range-of-motion tests.
In some cases, your physical therapist may refer you to a doctor or other health care provider for additional testing or treatment.
Please take a moment to view this video with information on EMG testing available at West Park Rehab:
After the evaluation, your physical therapist will discuss their findings with you and may work with you to begin a treatment program to improve your condition.
How Can Our Physical Therapists Help?
The physical therapists at West Park Rehab will develop a personalized treatment plan based on your specific case.
Conservative Care
With early-stage CTS, conservative care is recommended as a first step. Physical therapy treatment can be effective to reduce your symptoms and help you get back to your everyday activities.
Depending on the causes of your CTS, your physical therapy program may include patient education. Your physical therapist will teach you ways to improve your condition and keep it from getting worse. This may include education on the importance of:
- Changing wrist positions (such as avoiding bent-wrist positions for long periods).
- Proper neck and upper-back posture (avoiding forward-head posture or slouching).
- Safety precautions when using sharp utensils, tools, or other implements. This is especially important if your physical therapist detects changes in your levels of feeling.
- “Stretch breaks” during your work or daily routine.
- Stretching exercises. Your physical therapist will teach you gentle stretching exercises to improve your wrist, hand, and finger flexibility.
- Strengthening exercises. Your physical therapist may teach you exercises to strengthen muscles to help you keep better posture. Once your symptoms have decreased, strengthening exercises for the hand, wrist, and forearm may be prescribed.
- Splinting. Your physical therapist may recommend that you use a splint at night to reduce discomfort.
- Cold and heat treatments. Your physical therapist may use cold or heat treatments or recommend you use ice or heat to relieve pain.
They may also recommend options for your work, home, and leisure activities as part of your treatment plan. These may include:
- A worksite assessment. If you sit at a desk and work on a computer, it is important to properly align your keyboard to avoid working in a bent-wrist position.
- Increasing the size of tool and utensil handles by adding extra material for a more comfortable grip.
- Using special gloves or wraps around tool handles to reduce vibration if it is a factor at your workplace.
- Wearing gloves to keep your wrist and hands warm.
- Reducing or stopping activities that increase your symptoms until they are less frequent or intense.
The goals of physical therapy are to:
- Reduce your symptoms without the need for surgery.
- Allow you to be as active and functional as possible.
- Help you resume your normal work, home, and leisure activities.
Physical Therapy After Surgery
If the evaluation reveals that your CTS is more severe, or if your symptoms persist, your physical therapist may refer you to consult with a surgeon. If surgery is needed, the surgeon will release the band of tissue that forms the roof of the carpal tunnel. This will decrease the pressure on the median nerve.
Physical therapy treatment is important after surgery to:
- Prevent scar tissue formation.
- Help restore strength to the wr.ist
- Help you learn to change habits that may have led to symptoms in the first place.
Your physical therapy treatment after surgery may include:
- Scar management to keep the skin supple and flexible.
- Exercises to glide the nerve within the healing tunnel.
- Stretching exercises to improve mobility of the wrist and fingers and improve function.
- Strengthening exercises to improve the strength of the wrist and hand muscles and improve function.
- Education about proper posture and wrist position to avoid carpal tunnel compression in home/leisure activities.
- A worksite visit or mock-up to show you proper workstation set-up. This can help with posture and positions to prevent CTS from recurring. It also can reduce your risk for developing other nerve injuries.
West Park Rehab has been successfully treating Carpal Tunnel Syndrome for over 20 years. Help is available.
You can request an appointment using this link. https://sites.webpt.com/1660/reactivation-offer
Or call their offices at Franklin: 814-437-6191 or Seneca 814-493-8631
