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Physical Therapy & Carpal Tunnel Syndrome

Carpal tunnel syndrome is a common condition that causes pain, numbness, and weakness in the wrist and hand. CTS can affect the use of the entire arm. It is caused by pressure on the nerve at the base of the palm. Because of the constant demands people place on their hands and wrists, surgery may be needed when symptoms are severe. For many people with CTS, however, physical therapy treatment can relieve pain and numbness.

What Is Carpal Tunnel Syndrome?

The carpal tunnel is a narrow passageway on the palm side of your wrist. The tunnel protects the median nerve and the tendons that bend your fingers. When the tunnel narrows due to injury or other conditions, or the tendons and nerves in the tunnel swell and take up more space, pressure on the nerve increases. A wrist fracture or arthritis can cause the size of the tunnel to become smaller. The tendons or nerves can enlarge due to either inflammation or tendon changes with age.

CTS is common in professions such as assembly-line work. It also is common among people with jobs requiring the use of hand tools, especially tools that vibrate.

The following health conditions also may lead to CTS in some people:

  • 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.

  • Diabetes.

  • Medications (such as steroids or chemotherapy).

  • Degenerative and rheumatoid arthritis.

Signs and Symptoms

Many people report waking up with numbness, tingling, or burning in their thumb, index, and middle fingers. Sometimes, the ring finger is affected.

As the condition worsens, the symptoms become more noticeable during the day. Symptoms often are worse when:

  • Grasping heavy objects.

  • Using a computer.

  • Holding a cell phone.

  • Gripping anything for a long period of time.

Hand weakness and more constant numbness may occur if the pressure on the nerve continues. You may find that you drop objects unexpectedly

How Can a Physical Therapist Help?

Depending on the causes of your CTS, your physical therapy program may include:

  • Patient education. Your physical therapist will teach you ways to improve your condition and keep it from getting worse. This may include education on the importance of:

    • Changing wrist positions (such as avoiding bent-wrist positions for long periods).

    • Proper neck and upper-back posture (avoiding forward-head posture or slouching).

    • Safety precautions when using sharp utensils, tools, or other implements. This is especially important if your physical therapist detects changes in your levels of feeling.

    • "Stretch breaks" during your work or daily routine.

  • Stretching exercises. Your physical therapist will teach you gentle stretching exercises to improve your wrist, hand, and finger flexibility.

  • Strengthening exercises. Your physical therapist may teach you exercises to strengthen muscles to help you keep better posture. Once your symptoms have decreased, strengthening exercises for the hand, wrist, and forearm may be prescribed.

  • Splinting. Your physical therapist may recommend that you use a splint at night to reduce discomfort.

  • Cold and heat treatments. Your physical therapist may use cold or heat treatments, or recommend you use ice or heat to relieve pain.

Can This Injury or Condition Be Prevented?

  • Improve your posture. Make sure your posture is appropriate to the task you are doing. Proper alignment of your trunk, neck, and shoulders can prevent too much strain and improper positioning of the wrists and hands.

  • Take frequent breaks. When doing repeated activities, give your hands a break by doing occasional stretching exercises. If possible, alternate your hands when completing some tasks. Spread your fingers apart to avoid constantly being in a gripping position.

  • Reduce force. Most people use more force than needed when working with their hands. Decrease the force you use to type. Relax your grip to avoid muscle fatigue and strain. When writing by hand for long periods, use a larger-handle pen or soft gel grip.

  • Neutral wrist position. Avoid bending your wrists for long periods. Keep your wrists in a straight or neutral position when doing lengthy tasks. This means your wrist should not be bent up (extended) or down (flexed).

  • Work-area adjustments. Have a physical therapist examine your work area to make sure it fits your height, posture, and tasks. Make sure not to rest your wrist on the edge of your desk. Simple adjustments can help avoid unnecessary strain.

  • Keep your hands warm. You are more likely to develop hand pain and stiffness if you work in a cold environment. If you cannot control the temperature, 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 active and keeping a healthy weight may help control diseases and conditions that may lead to CTS.

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