Physical Therapy and Carpal Tunnel Syndrome

By Deborah Holmes, PT

How often do you use your hands? We depend on our hands for most activities of daily living. Carpal tunnel syndrome (CTS) is a common condition of the wrist and hand that can affect the use of the hand and whole arm. It is caused by pressure on the nerve at the base of the palm (median nerve). 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.

Because of the demands that people place on their hands and wrists, CTS is a condition affecting 1 out of 20 Americans. Fortunately for most people who develop CTS, physical therapy treatment can often relieve pain and numbness and restore normal use of the hand, wrist, and arm without the need for surgery.

What Are the Symptoms?

Symptoms usually start gradually, with frequent burning, tingling, or itching, numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers. Some carpal tunnel sufferers say their fingers feel useless and swollen, even though little or no swelling is apparent.

The symptoms often first appear in one or both hands during the night, since many people sleep with bent wrists. As symptoms worsen, people might feel tingling during the day. Decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks.

What Are the Causes?

Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel. The following health conditions can also lead to CTS in some individuals
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)
Diabetes
Certain medicine use (eg, steroids)
Degenerative and rheumatoid arthritis

Physical Therapy Treatment For Carpal Tunnel Syndrome

Physical therapists provide conservative treatment, which includes education on changing wrist positions, proper neck and back posture, how to incorporate stretch breaks in your daily routine and how to substitute hand held instruments to decrease stress to the hand.

Physical therapists also instruct hand strengthening and stretching exercises, heat/cold and other treatments for pain control, and night splinting for positioning. A worksite visit may be necessary to assess your work area and make recommendations to reduce the stress on your hands at work and at home.

Physical Therapy After Surgery

Sometimes the conservative treatment does not eliminate severe symptoms. After surgical release of the median nerve, physical therapy treatment will continue to provide conservative treatment to promote postoperative healing, restoration of hand function in addition to scar management.

The goals of physical therapy are to reduce your symptoms and to enable you to be as active and functional as possible. Talk to your physical therapist about any hand symptoms you may be experiencing.