Carpal Tunnel Syndrome (CTS) is a common disorder of the Carpal Tunnel that begins in the hand and wrist, but may affect the entire arm. It is a narrow passageway in your wrist that protects the median nerve and tendons that allow your fingers to bend. Overuse and excessive pressure on the nerve causes this condition and is very common. This is especially true in professions that require extensive hand work or extreme wrist positions, such as assembly line workers. Even leisurely activities like sewing and sports using a racquet can cause pressure and possibly lead to CTS. Certain health conditions may also cause CTS for some people; such as:
- 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 (eg, during pregnancy)
- Certain medicine use (eg, steroids)
- Degenerative and rheumatoid arthritis*
Some individuals may experience a “pins and needles” sensation, tingling, numbness or burning in the fingers and palm in the beginning stages of CTS. The gradual progression of the condition can make it difficult to hold things like a hair brush or heavy book. Continued weakness and numbness in the hand may cause a decrease in grip strength and inadvertently dropping items held in the affected hand.
A physical therapist will perform a complete evaluation and has several tests available to help determine if someone has Carpal Tunnel Syndrome and the extent of the condition. Tests include:
- Examination of your neck and entire upper extremity to rule out other conditions. Many patients have been told they have CTS, only to find out that the pain is coming from another body area.
- Grip strength of fingers and thumb
- Sensory tests
- Wrist and hand range-of-motion
- Wrist flexion (Phalen) test: Your physical therapist will have you push the backs of your hands together for 1 minute. Tingling or numbness in your fingers that occurs within 60 seconds may be an indication of CTS.
- Tinel’s Sign: Your physical therapist will use a reflex hammer or finger to tap over the median nerve at your wrist. Tingling in the thumb and index and middle fingers may indicate CTS.
- Electrical studies (electromyogram/EMG) and nerve conduction velocity (NCV): These tests determine the transmission of the nerve and the severity of the CTS.
- X-rays: When trauma has occurred or if there is reason to suspect anatomical abnormality, x-rays may be ordered.*
There may be instances a PT may recommend you see a physician for further testing and/or treatment.
Early-stage CTS can be easily treated effectively through physical therapy. Your PT will devise a program specific to your level of symptoms and will include strength exercises for your hand, wrist and forearm muscles. They will also educate you on different wrist positions, proper posture and stretching to lessen symptoms. It may be recommended for you to use heat/cold treatments and/or to wear a splint at night to decrease pain and discomfort. Consideration is also given to your leisure and home activities that may aggravate the condition.
Physical Therapy is geared toward restoring normal home, leisure and work activities by reducing symptoms without surgery. If your symptoms persist or are too severe, surgery may still be necessary. PT will be just as important post-surgery and will follow much of the same strategies above, with the added attention to scar management to prevent scar tissue build up and inflexibility.
Although there are not any confirmed means to preventing CTS altogether, there are ways to reduce hand and wrist stress.
The following strategies are effective ways to minimize stress to your hands and wrists:
- Reduce force. Most people use more force than needed when performing work with their hands. Relax your grip to avoid muscle fatigue and strain. For prolonged handwriting, use a larger-handle pen or soft gel grip.
- Take frequent breaks. When doing repeated activities, give your hands a break by performing stretching exercises once in a while. If possible, alternate your hands when completing some tasks.
- Neutral wrist position. Avoid bending your wrists by keeping them in a straight or “neutral” position. This means your wrist should not be bent up (extended) or down (flexed).
- Work area adjustment. Have a physical therapist examine your work area to make sure it fits your height, posture, and the tasks required. Simple adjustments can help avoid unnecessary strain.
- Improve your posture. Make sure your posture is appropriate to the task you are performing. Believe it or not, proper alignment of your trunk, neck, and shoulders can prevent excessive strain and improper positioning of the wrists and hands.
- Keep your hands warm. You are more likely to develop hand pain and stiffness if you work in a cold environment. If you can’t control the temperature, be sure to wear gloves to keep your hands and wrists warm.
- Maintain good health. Paying attention to your general health is an important step in preventing CTS. Staying physically fit and maintaining a healthy weight may help control diseases and conditions that may contribute to the onset of CTS.*
If you find yourself struggling with symptoms of Carpal Tunnel Syndrome, contact any one of our 19 locations nearest you to schedule an evaluation with a highly qualified certified physical therapist. Our Lionville/Exton and Paoli clinics also have Certified Hand Therapists.
*Move Forward PT – Physical Therapist’s Guide to CTS