Carpal tunnel syndrome is a condition that causes numbness, tingling and other symptoms in the hand because of pressure on a nerve that runs through the carpal tunnel.1 The carpal tunnel is a narrow passageway that allows nerves and blood vessels to pass through the palm side of the wrist into the hand. The nerve involved is called the median nerve and provides sensation to the thumb, index and middle fingers as well as power to the muscles around the base of the thumb.1
Common symptoms of carpal tunnel syndrome include:1
Tingling or numbness in the affected fingers
Weakness in the muscles you use to pinch an object resulting in a tendency to drop things
Occasional discomfort or numbness traveling up from your wrist into the front of your forearm
How do you get carpal tunnel syndrome?
There is no one common cause of carpal tunnel syndrome. It appears that most the cases start for no clear reason. Carpal tunnel syndrome appears to commonly involve women between the ages of 40 and 60 and often affects both wrists to some degree.2
However, many factors may increase the risk of developing carpal tunnel syndrome and include but are not limited to:2
Wrist fractures or arthritis causing bony changes at the wrist that narrows the carpal tunnel
Chronic conditions causing damage directly to the median nerve itself such as diabetes
Conditions causing increased swelling or fluid retention around the wrist such as obesity, pregnancy, menopause, or thyroid disease
It has been thought that work-related activities involving vibrating tools or repetitive or prolonged bending of the wrist may be a risk factor; however, there is little scientific evidence to support this.2
Can you prevent carpal tunnel syndrome?
Because there is no direct cause of carpal tunnel syndrome, it is difficult to identify ways to prevent it from occurring. Managing conditions that cause inflammation, swelling or nerve damage may decrease the risk of developing the problem.2 Taking action and seeking care as soon as you notice numbness, tingling or pain is starting in your hand, wrist, or up into your arm (that does not get better) may help your health-care provider identify a risk factor early on and work to decrease the affects of the condition causing the pressure on the nerve. Active therapy following a wrist fracture or injury may also help keep the joint moving and limit the effects of bony changes or nerve restriction and pressure in the carpal tunnel.
How do you manage carpal tunnel syndrome once you have it?
Management of carpal tunnel syndrome can take two different forms and a physiotherapist can help you with both. The condition can be managed with either a surgical or non-surgical approach. The decision to recommend one or the other often depends on the severity of the symptoms, the duration of the problem, or the presence of muscle weakness and atrophy in the hand.2 Generally, treatment begins with a conservative treatment approach and can include splinting, activity modification, and exercises. Use of anti-inflammatory medications or cortico-steroid injections may be suggested as a means of reducing any inflammation causing pressure on the nerve. There is good evidence to support the use of these medications,3 so they are often included as part of a conservative approach.
If these options are not successful or if more aggressive treatment is required, surgery to release the structures pressing on the nerve may be necessary.3
So how can a physiotherapist help?
If the decision is made to start with conservative treatment, a physiotherapist can help.
The first thing a physiotherapist will do is complete a thorough assessment to determine where the source of the tingling, numbness or pain in your hand comes from. Although carpal tunnel syndrome is a common cause of these symptoms, other sources of nerve impingement can be found in your neck, shoulder or elbow. To get long-term relief, it is important to identify and treat the cause of the problem not just the symptoms. A physiotherapist is trained in musculoskeletal assessment and in analyzing results to arrive at a diagnosis and develop an appropriate treatment plan.
Once a physiotherapist has determined the source of the problem is pressure on the nerve at the wrist, he/she will then identify what activities or positions aggravate your symptoms and help you develop strategies to minimize the affect of these factors to decrease or eliminate the symptoms.
The standard treatment for mild cases of carpal tunnel is splinting.2 The wrist will be splinted in a neutral position, not bent or extended, and the splint will be worn at night and/or during activities that aggravate the symptoms. These splints may be custom made or may be off the shelf wrist splints. A physiotherapist can help you determine which type of splint is appropriate and direct you to sources to obtain them. A physiotherapist is also able to help determine when, how often, and for how long you should use the splint and can help to problem solve any issues that may arise from wearing the splint.
It is very important to identify what activities or resting postures may be causing increased pressure at the wrist. A physiotherapist can help you modify work or leisure activities to minimize the repetitive strain at the wrist or can recommend different tools to change the position your wrist is being held in. Suggestions about taking regular breaks, rotating through different activities and modifying your work station to improve posture may also be part of the physiotherapist’s treatment plan. You may be provided with a set of exercises called tendon and nerve gliding exercises. These exercises are designed to increase movement and mobility of the nerve and tendons through the carpal tunnel. Exercises to strengthen the muscles around the wrist joint and forearm may also be added to your program.
Finally, the physiotherapist may provide a few sessions of hands-on therapy as part of the initial treatment plan. This therapy may include manual mobilization of the wrist bones, the tendons, and the nerve itself. Some may also include electrical modalities such as ultrasound.2 Although the evidence is not clear on the overall effectiveness of these therapies, they may be used as part of the standard treatment program and may provide some short-term relief.3
If surgery is the option chosen, physiotherapy may be part of the post-operative treatment plan as well. The physiotherapist can provide a variety of treatment options to help alleviate pain and hypersensitivity around the scar, keep the scar mobile to prevent further constriction at the site and provide exercises to keep the wrist, hand, and nerves or tendons moving and strong.2 The physiotherapist will continue to offer advice related to splinting and activity modification at work or play during your recovery to prevent symptoms from coming back.
Mayo Clinic Patient Care & Health Information. Carpal tunnel syndrome. Available at: https://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/symptoms-causes/syc-20355603 Accessed February 14, 2018.
Magee DJ, Zachazewski JE, Quillen WS, Manske RC. Hand, wrist and digit injuries. Pathology and intervention in musculoskeletal rehabilitation. 2nd ed. Missouri: Elsevier, 2016. P. 429-431.
Physiopedia. Carpal Tunnel Syndrome. Available at: https://www.physio-pedia.com/Carpal_Tunnel_Syndrome Accessed Feb 14, 2018.
Regulating Alberta's physiotherapy profession and acting as an association by providing member services.