Carpal tunnel syndrome affects 1 in 20 Americans and is a common condition affecting the nerve of the wrist and hand. The carpal tunnel is a space at the palmar aspect of the wrist where a series of tendons and nerves travel through to innervate and control for movements of the hand and fingers. Because of the demands that people place on their hands and wrists during daily work and activities, excessive pressure on this part of the wrist can cause pain and numbness or tingling. Forearm physical therapy is very effective in treating carpal tunnel syndrome, especially when symptoms are caught early, but surgery may be needed for conditions that cause extreme disability, or are very chronic in nature.
What is Carpal Tunnel Syndrome?
The carpal tunnel is a narrow channel at the palmar side of the wrist that is about 1cm wide. This tunnel serves as a roof that protects the median nerve and flexor tendons responsible for bending your fingers. External pressure on this median nerve can cause pain and weakness in the wrist, and potentially numbness and/or tingling in some of your fingers. Excessive external pressure can be caused by overcrowding on the median nerve by bending the wrist in extreme positions or bearing weight onto the palmar side of the wrist for a prolonged period of time. Excessive vibration or force onto the wrist, such as in the case of holding the steering wheel or operating heavy machinery and tools, could cause carpal tunnel syndrome. It is known that those in professions in assembly-line work are 3 times more likely to develop carpal tunnel syndrome than those who type on a computer keyboard all day.
Other health conditions may contribute to the development of carpal tunnel syndrome. These are:
- Wrist tendon inflammation and swelling
- Wrist sprains, dislocations, and fractures.
- Pregnancy and other hormone-related metabolic changes that cause joint changes and fluid retention
- Steroidal use
- Rheumatoid arthritis
Carpal tunnel syndrome starts gradually with feelings of burning, tingling, "pins and needles," or numbness traveling into the palm of the hand and some select fingers (thumb, pointer, and middle fingers). Symptoms are usually most noticeable at night and patients are sometimes awakened feeling the aforementioned symptoms. Many patients report feeling the need to shake out their hands to alleviate the nerve symptoms.
Signs and Symptoms
As carpal tunnel syndrome worsens, symptoms get more pronounced during the daytime and can affect the patient’s ability to hold items such as heavy books or pot handles. If pressure on the median nerve is not alleviated by physical therapy or proper care, then weakness of the hand the numbness sensation can progress to be more constant and noticeable. When weakness is more pronounced, you may find yourself dropping objects to the ground as you slip in grip strength.
How Is Carpal Tunnel Syndrome Diagnosed?
Often carpal tunnel syndrome can be diagnosed with extensive testing as symptoms are typical and easily identified. But involvement in other nerves must be ruled out to make sure the median nerve is accurately treated.
These are several tests that may be used to help diagnose carpal tunnel syndrome:
- Thorough PT examination of your neck and entire upper extremity to rule out other conditions that may elicit similar symptoms.
- Measuring the grip strength and range of motion of fingers and thumb.
- Sensory tests along the entire arm.
- Phalen test: Your physical therapist will instruct you to push the backs of your hands to each other for 1 minute. The test is positive for carpal tunnel syndrome if you report tingling or numbness in your fingers within 60 seconds.
- Tinel's Sign: Your physical therapist will use a reflex hammer to tap over the median nerve at the wrist. Tingling in the thumb, pointer and middle fingers may hint to carpal tunnel syndrome.
- Electromyograms (EMG) and nerve conduction velocity (NCV) tests can determine the conduction of the nerve upstream and downstream of the wrist. The conduction tests can determine the severity of carpal tunnel syndrome from measuring the signal strength transferred down the nerve (much like an electric wire).
In some severe cases, your physical therapist may refer you to a physician for additional diagnostics.
Physical Therapist For Carpal Tunnel Syndrome
Conservative treatment for carpal tunnel syndrome is recommended as physical therapy has been very helpful in alleviating symptoms and helping patients protect their wrists further from aggravation.
A typical Physical Therapy plan of care for carpal tunnel syndrome will include:
- Patient Education regarding:
- avoiding prolonged bent wrist positions (see night splint below)
- proper neck and upper back posture and avoiding slouching that would only serve to tension nerves even more
- modified, safe use of sharp utensils or tools if sensory changes are identified during the evaluation
- Stretch and rest breaks during work or daily routine to allow the wrist to rest
- Resistive exercises to improve muscle strength in the hand, fingers, and forearm
- Stretching exercises to improve the flexibility of the wrist, hand, and fingers
- Heat and/or cold therapy to relieve pain
- Recommended use of a night splint or wrist brace to reduce prolonged bent wrist positioning
- Recommended worksite visit or workstation adjustments. For example, fixing computer keyboard alignment to avoid bent wrist positions, or excessive external pressure on the wrist can alleviate symptoms dramatically during work.
- Increasing the size of hand tools and utensil handles for a more comfortable and easier grip.
- Recommendation of anti-vibration gloves if vibration is a factor for causing carpal tunnel syndrome at your workplace.
Your physical therapist may also recommend that you temporarily avoid racquet sports, and excessive gripping activities until symptoms resolve.
Physical Therapy Following Surgery
If your symptoms are severe, your physical therapist will refer you out to a surgeon for a surgical consultation. Surgery involves a release of the band of tissue that serves as the base of the carpal tunnel. This would alleviate pressure on the median nerve. Physical therapy treatment after surgery is important after surgery to help reduce excessive scar tissue formation and help gradually restore strength to the wrist and hand. You will still need to be coached to modify bad posture and habits that may have led to carpal tunnel syndrome to start in the first place. Your physical therapy treatment after surgery will include:
- Strengthening exercises to improve hand function
- Stretching and range of motion exercises to restore mobility of the whole wrist and hand to improve function
- Scar management to avoid excessive skin formation on the carpal tunnel
- Posture and habit coaching to avoid carpal tunnel syndrome recurrence
- Coaching through worksite or workdesk changes so carpal tunnel syndrome is avoided further
Can this Injury or Condition be Prevented?
Following are tips that can help minimize stress to your hands and wrists:
- Reduce grip force.. Most people use more force than needed when doing activities. Relax your grip so you can minimize muscle fatigue and strain. For prolonged handwriting, a larger-handle pen can help reduce the need the grip.
- Take frequent rest breaks. Give your hands a break and reduce inflammation by taking rest breaks during repeated activities. Another idea would be to alternate hands if possible.
- Keep a neutral wrist position. Avoid bending your wrists excessively by keeping them in a straight position - this is called wrist neutral position.
- Worksite adjustment. Your work area should be appropriately adjusted for your height and build. This may mean subtle difference in angles - which produce a big effect in reducing hand and wrist strain. This would also help improve posture and reduce strain in other parts of your body like your neck and back.
- Keep your hands warm. Cold environments more often begets pain and stiffness in the hands. Be sure to keep muscles, tendons and hands supple and circulation going by keeping them warm with gloves.
If you are experiencing pain from a hamstring pull or other leg injury, please contact one of our Portland Physical Therapy Clinics and get treated today!