Carpal tunnel syndrome (CTS) is a common condition of the wrist and hand that can affect the use of the whole arm. It is caused by pressure on the nerve at the base of the palm (median nerve). Because of the demands that people place on their hands and wrists, CTS is a common condition affecting 1 out of 20 Americans. Surgery for this condition is commonly performed on the wrist and hand. Fortunately for most people who develop CTS, physical therapist treatment can often relieve pain and numbness and restore normal use of the hand, wrist, and arm without the need for surgery.
About the width of your thumb, the carpal tunnel is a narrow channel on the palm side of your wrist. The tunnel protects the median nerve and the tendons that bend your fingers. Pressure on the nerve can cause pain and weakness in your wrist and hand and numbness or tingling in some of your fingers. This pressure is caused by crowding or irritation of the median nerve in the carpal tunnel and can lead to CTS.
Extreme wrist positions, as well as a lot of finger use, especially with a lot of force or vibration (such as holding the steering wheel when driving heavy machinery), can all contribute to CTS.
CTS is common in professions such as assembly-line work, particularly meat packing; and jobs requiring the use of hand tools, especially tools that vibrate. Although excessive keyboard and computer use is often associated with CTS, those performing assembly line work are 3 times more likely to develop CTS than those who perform data entry work. Some leisure activities can also create CTS, such as sewing, sports such as racquetball and handball, and playing string instruments such as the violin.
The following health conditions can also lead to CTS in some individuals:
CTS usually starts gradually, with symptoms such as burning, tingling, “pins and needles,” or numbness in the palm of the hand and fingers. Often the symptoms are more noticeable during the night, and individuals often report being wakened with symptoms. Many people feel the need to “shake out” their hands to try to relieve the symptoms.
As the condition progresses, the symptoms are noticed during the daytime and are often worse when holding items such as a heavy book or a hairbrush. Weakness of the hand and more constant numbness may occur if the pressure on the nerve continues. You may find that you drop objects unexpectedly or have a weakness in your grip.
Physical therapists work closely with other health care professionals to accurately diagnose and treat CTS. Symptoms of CTS are typical, and it is often possible to diagnose it without extensive testing. Physical therapists are experts in the movement and function of the body and will conduct an evaluation to determine all of the factors that may be contributing to your condition.
These are several tests that may be used to help diagnose CTS:
In some cases, your physical therapist may refer you to a physician or other health care professional for additional testing or treatment.
After the evaluation, your physical therapist will prescribe your treatment plan based on your specific case.
If your evaluation confirms early-stage CTS, conservative care will be recommended as a first step. Physical therapy treatment can be effective in reducing your symptoms and getting you back to performing normal activities. During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
Depending upon the causes of your CTS, your therapy program may include:
Your physical therapist will also consider your home and leisure activities, with recommendations such as wearing gloves to keep the wrist/hands warm and limiting sports that aggravate the condition, such as racquet sports, until symptoms resolve.
The goals of physical therapy are to reduce your symptoms without the need for surgery, to enable you to be as active and functional as possible, and to help you resume your normal work, home, and leisure activities.
If the evaluation reveals that your CTS is more severe, or if your symptoms persist, your physical therapist may refer you to a physician for a surgical consultation. If necessary, surgery will be performed to release the band of tissue that is causing pressure on the median nerve. Physical therapy treatment is important after surgery to help restore strength to the wrist and to learn to modify habits that may have led to symptoms in the first place. Your physical therapy treatment may include:
There are no proven strategies for preventing CTS, but there are ways to minimize stress to your hands and wrists. Since there are contributing factors to developing CTS, one single solution may not be effective.
The following strategies are effective ways to minimize stress to your hands and wrists: