Let’s Talk About Carpal Tunnel Syndrome

What is carpal tunnel syndrome?
Carpal tunnel syndrome includes symptoms of pain, numbness, tingling, or weakness in the hand due to compression of the median nerve. Other symptoms may consist of dropping items, clumsiness with the hands, or difficulty lifting heavier items such as boxes or a skillet. The median nerve runs from the cervical spine down the arm and into the hand. Where the median nerve passes through the wrist, there is a ligament called the Transverse Carpal Ligament that lays across the opening called the carpal tunnel, and this is typically where the most restriction or narrowing causes issues. The carpal tunnel can narrow and compress the median nerve which is sometimes due to swelling, and this causes the symptoms of carpal tunnel syndrome. Repetitive motions, repetitive use of a vibrating tool such as jack-hammer, or sustained positions of the wrist into flexion or extension, arthritis or previous damage or breaks of the carpal bones can lead to carpal tunnel syndrome. Some people may be predisposed to this type of condition or have genetically inherited traits such as narrow or small wrists or certain diseases such as rheumatoid arthritis.

How can Physical Therapy help carpal tunnel?
Physical therapists will assign wrist, forearm, and hand stretching and strengthening exercises as well as nerve glides. Depending on the severity of forward posture which can make carpal tunnel worse they may also add postural exercises to restore normal posture and correct tight chest muscles/weak posterior thorax postural muscles. ASTYM therapy may also be established for tight tissues throughout the forearm and palmar surfaces that can increase tension on the transverse carpal ligament and narrow carpal tunnel space.

What can I do for myself to get better?
+Splints can be worn during the night if symptoms occur at this time.
+Splints can also be used during the day if repetitive motion or job duties contribute to symptoms.
+Consistently perform exercises prescribed by your Physical Therapist.
+Avoid activities that increase your symptoms if possible.
+Adjust ergonomics of workspace if needed.
+Try to avoid activities that hold you in extension/flexion of the wrist for long periods.

Severe cases:
Your physician may also prescribe over the counter medications or provide a steroid shot to reduce the inflammation in conjunction with the above-listed recommendations of splints, changes to lifestyle or ergonomics/tools of job or hobbies, and physical therapy. Severe cases of carpal tunnel that do not respond to other treatments may require surgery. During surgery, the transverse carpal tunnel ligament is cut to release tension over the median nerve. Recovery from the surgery may take anywhere between a few weeks to months and during that time will require the use of splints and following precautions of weight limits which means avoiding pushing through hand such as to get up from a chair or open a door. If compression or pinching of the median nerve is bad enough to cause weakness and atrophy of the hands and wrists the recovery may take longer as the muscles must be worked back up to strength, for your physician may prescribe this physical therapy.

While surgery is a good option for those who have not responded to traditional conservative treatments, it is not a good option for people who have not received any other form of treatment. To quote Dr. Peter Amadio M.D. a hand surgeon from Mayo Clinic, “It’s important to remember that most people who have carpal tunnel syndrome if you ask them closely, will say that they do have some residual problems in that hand. The hand is not perfectly, completely normal like it was when they were younger and healthier. There might be some tenderness in the palm, there might still be some numbness or tingling in the fingers with activities, there might be some weakness of grip or some easier fatigue ability in that hand, so it’s important to remember that the result is not a perfectly normal hand as if nothing were ever wrong with it.”

Content provided by Lauren Cahn, PTA
Source Citation:
Amadio, Peter. “Video: Results of Surgery for Carpal Tunnel Syndrome.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 14 July 2018, www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/multimedia/carpal-tunnel-syndrome/vid-2008469