With an estimated 1 in 20 Americans affected by carpal tunnel syndrome (CTS), there’s a good chance that you or someone you know will need treatment for this common condition. If you think your options for treating carpal tunnel syndrome are limited to wrist braces or surgery, then you need to know how physical therapy can help manage and treat carpal tunnel syndrome.
What Exactly is Carpal Tunnel Syndrome?
The median nerve traveling through the “tunnel” in the wrist (the carpal) can become compressed when the pressure increases. Generally, either the median nerve, blood vessels and tendons inside the carpal tunnel become enlarged, or the tunnel size decreases because of injury, causing swelling.
Compression is typically a result of repetitive movement. The most common cause of CTS by far is from working on an assembly line, but using a computer also accounts for additional cases. Vibration from handheld tools can also result in carpal tunnel syndrome.
Symptoms of Carpal Tunnel Syndrome
Carpal tunnel syndrome is a condition that progresses gradually. You should watch for these signs in order to take action early. Compression of the median nerve results in a variety of symptoms. You might experience only some of these:
- Numbness, especially at night
- Pin and needles
- Burning sensation
- Weakness in the wrists
- Chronic pain or aching in the hands
Because symptoms are often worse at night, using a splint on the wrist at bedtime will prevent you from bending your wrist while you sleep. But if your wrist and hand pain are keeping you up at night, it’s time to do something about it.
If you’ve noticed that your grip isn’t what it used to be and you’re frequently dropping items, you need to investigate whether your clumsiness is actually a symptom of carpal tunnel syndrome.
Start with getting a proper diagnosis. Not all problems with the wrist and hands are necessarily carpal tunnel syndrome. Some of the symptoms of CTS overlap with the symptoms of arthritis in the wrist, but proper treatment for these conditions are not identical. So if it is CTS, the sooner you are diagnosed, the sooner you can start treatment for carpal tunnel syndrome.
Diagnostic tests typically include:
- Checking the strength of your grip
- Checking the range of motion for your wrist and hand
- Checking wrist flexion (your physical therapist might refer to this as the Phalen test)
- Checking the median nerve (or Tinel’s test)
- Checking the lower neck
Additional tests could include EMG (electromyogram), ultrasound, or x-ray. EMG checks nerve conduction, while ultrasound examines median nerve enlargement. X-ray might be used in cases of injury to the wrist.
When Carpal Tunnel Syndrome Is Actually Double Crush Syndrome
Symptoms of carpal tunnel can arise from compression of the median nerve elsewhere, especially in the neck. If this is the case, you have double crush syndrome. Your physical therapist should always check for the source of your symptoms. This means checking the cervical spine, particularly the C5, C6, C7 and T1 vertebrae.
It’s essential to pinpoint the source of your wrist and hand pain. Some patients continue to experience pain in their wrist following carpal tunnel surgery. Surgery for carpal tunnel won’t alleviate the pain if you actually suffer from double crush syndrome.
Treating Carpal Tunnel Syndrome
Except in severe cases, carpal tunnel syndrome can be effectively managed with physical therapy alone. As soon as you experience symptoms of carpal tunnel, there are simple techniques you can use immediately to alleviate your pain.
Start with simple exercises
To begin with, use the right repetitive movements! These exercises might be simple, but they are effective. Repeat them throughout the day, anytime, anywhere!
- Spiders doing push-ups on a mirror. This childhood amusement delivers real benefits. Press your palms together as if you were praying. Spread your fingers apart. Push your palms apart, keeping your fingertips together. Press the palms back together. This is a great stretching exercise for anyone!
- Shake it up! Loosen up your wrists by gently shaking them as if you were shaking water off to dry your hands. You can do this exercise wherever you are throughout the day. It’s great for temporary relief.
If you are sitting at a computer, you should be giving your eyes a break every 15 minutes or so to refocus from near to far sight and back. Make it a habit to exercise your wrists at the same time!
Improve your ergonomics
While you’re on the computer, check your ergonomics! Adjust the chair and keyboard heights so your wrists are protected. Ideally, your arms should be at least at a 90-degree angle with the forearms, wrists and hands forming a straight line.
If you still are unable to minimize the strain on your wrists, consider investing in a keyboard which angles outward. And remember, a computer keyboard doesn’t need the heavy banging of an old manual typewriter. Keep your motions gentle.
Protect your wrists
Work gloves can help stabilize your wrists, and equally important, gloves can keep your wrists warm. Warm muscles are less susceptible to injury.
You might want to use a wrist brace when you are engaging in an activity that places stress on the wrist. You can also protect your wrists with a splint to prevent bending them at night while you sleep.
Interventions for the Next Stage
While these simple exercises and ergonomics work well on the early symptoms, if your condition worsens, you need to consider seeking professional treatment for carpal tunnel syndrome.
Other exercises your physical therapist, especially one trained in manual therapy, can offer include these:
- Nerve and tendon gliding exercises
- Carpal bone mobilization
- Muscle and soft tissue extensibility
- Grip and pinch exercises, such as thumb abduction and forearm strengthening
- Wrist and hand range of motion exercises to improve strength and endurance
Your physical therapist can also assist you with improving your overall posture and advise you on finding ways to accomplish daily tasks that reduce impact on your wrists.
Surgery for Severe Carpal Tunnel Syndrome
Researchers agree that for mild to moderate symptoms of carpal tunnel syndrome, physical therapy is as or more effective than surgery. You should exhaust all treatment options before considering surgery. If surgery is still indicated, it will likely be done on an outpatient basis. Typically, the ligament around the wrist is cut to alleviate pressure on the median nerve.
Sooner Rather than Later
Because carpal tunnel syndrome is highly treatable with physical therapy in the mild to moderate stages, don’t delay seeking treatment! Your physical therapist is here to help you improve your quality of life.
Midland Physical Therapy will help you with diagnosing, assessing, and managing your carpal tunnel syndrome. We will:
- Put together a personalized approach to coping with your symptoms
- Teach you exercises to improve range of motion and strengthen your grip
- Use manual therapy techniques to reduce your pain
- Offer tips to protect your wrists while you perform everyday tasks
Our therapists offer you a full range of treatment options. If you’re tired of the pain and discomfort of carpal tunnel syndrome, then contact Midland Physical Therapy today to schedule an appointment.