Carpal Tunnel Syndrome Physical Therapy

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 Carpal Tunnel Syndrome from Computer Worknumbness 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
  • Diabetes
  • 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!

Follow Me @

Alice Holland, DPT

Doctor of Physical Therapy, Director at Stride Strong Physical Therapy
Alice earned her Doctorate of Physical Therapy from USC in 2007, and have practiced Physical Therapy for 12+ years in the Outpatient Orthopedic Setting. Certified in ASTYM, she also has been a featured expert on Physical Therapy on numerous publications including health.com, healthline.com and yahoo.com.
Follow Me @

Latest posts by Alice Holland, DPT

Ana Lucia Pinheiro
Ana Lucia Pinheiro
02:18 20 Oct 17
This place is amazing. I am so happy I found Stride Strong PT. Alice pays attention to all of the details, she watches every single move I make, my posture, and the way I move through every exercise. She is very knowledgeable, she was able to pin-point the problems in my back and she has a plan to help me become stronger where I need. The place is brand new, huge, and has nice exercise machines. I tried a few physical therapists in the area, and Alice is TOP, second to none, and I feel super lucky to have found her. Highly recommended!!
Prashant Gupta
Prashant Gupta
01:00 02 Oct 17
Dr. Alice at Stride Strong is one of the best PTs I have come across. Her attention to detail and assessment of the root cause of injury is very good. She is excellent in evaluating pain patterns and giving a training schedule for a rehab & injury prevention, she is extremely knowledgeable. I would strongly recommend Stride Strong to anyone looking for PT. It is easily the best PT clinics in Hillsboro area.
steven zollin
steven zollin
20:57 14 Sep 17
Highly recommend Stride Strong Physical Therapy , Alice showed me proper form to assist in recovery with my shoulder and is very knowledgeable.
Lindsay Nied
Lindsay Nied
23:33 18 Dec 17
I recently had a massage from Joel at the Hillsboro location. He was able to work on an ongoing issue I have been experiencing with my back after a sports injury, and I left feeling so much better. The whole facility looked incredible, and everyone I met was friendly and welcoming. I would highly recommend Stride Strong for massage and physical therapy.
JoAnn Hatch
JoAnn Hatch
08:20 08 Nov 17
Dr. Sydney is by far the absolute best physical therapist I've worked with ever! Her expertise in designing highly effective and efficient exercise plans is beyond compare. I feel so much better as my strength and function increases. She comes up with the most brilliant and fun ideas to motivate. To my delight she even offered to come to my home in Vancouver and work with me on my own equipment including a Stott Pilates Reformer. Talk about going above and beyond! Couldn't be more grateful I found her!!!
Clare Perry
Clare Perry
21:58 23 Oct 17
A full hour of a dedicated PT professional's time without aides or techs? That's just one of the things that sets this clinic apart from others. Competent, professional, and amiable, Dr. Alice Holland and her team are the best in the area. While I generally see them at the Cedar Mill Clinic on Cornell, situational constraints took me to their new Hillsboro clinic today near Intel Jones Farm. Beautifully furnished, spacious with easy parking and access. May you continue to grow and thrive, Stride Strong!
Joyce Heideman
Joyce Heideman
08:28 11 May 18
After foot surgery I went to Stride Strong for therapy with Alice Holland. She helped me reach my full mobility again by continuously introducing new and challenging exercises. The entire staff is friendly and professional. They are always on time and do not rush. I look forward to doing 1/2 marathons again and riding my recumbent trike. Thank you Stride Strong for your care and high level of expertise.
Suad Daher
Suad Daher
20:48 28 Feb 18
The best physical therapy ever. Both JP and Sydney were a great PT, they helped me understand how I can help treat my injury and how it may have caused. And also they informed about so many techniques that I can use to help my injuries or any other injuries I get in the near future. They are both friendly and nice to talk too, and verbunformative. And there is also Krystal, she is the best front desk receptionist ever, she is nice and friendly and can easily manage your schedule based on the patients comfort if they want to schedule or not. She can help and she replies fast to any patients email. And she is easy to talk to. Thank you Stride Strong Physical Therapy.
Amanda O'Rourke
Amanda O'Rourke
21:38 15 Jun 18
In just a month I've seen great progress! I've been incorporating the exercises taught to me into my daily workout routine. Im very happy with my continued results.
Albert Szal
Albert Szal
23:43 10 Jun 18
Mary Szal here: I've had three sessions with Brittany at the Hillsboro location. I can say that she has been the most effective and instructive physical therapist I've ever experienced. Her personality, energy, knowledge and results are top notch.
Osa Phiangdae
Osa Phiangdae
00:05 22 Mar 18
Awesome place for PT. Hillsboro location has plenty of parking and very spacious. I had the pleasure to work mostly with Dr. Alice Holland and JP. I came in with a shoulder injury and thank goodness they understood what I was going through. They are the best of what they do, I would recommend Stride Strong to anyone who needs PT.
See All Reviews

© Copyright 2019 STRIDE STRONG