Symptoms usually begin gradually with pain or aching in the wrist that can extend into the hand and fingers. Tingling and/or numbness may be felt in the thumb, index, middle and ring fingers. The little finger is not normally affected. Over time these symptoms may worsen and weakness or dropping of objects is often reported, particularly at night or first thing in the morning when swelling is at its greatest. Loss of grip strength and numbness is often found on examination.
These symptoms are caused by compression of the median nerve in the compartment between the wrist bones and the ligament that runs across them. The site of nerve compression needs to be diagnosed as nerve irritation at the elbow or Cervical spine can cause similar symptoms. Repetitive use of the hand in sporting, recreational or work activity causes increased pressure within the carpal tunnel leading to compression. This condition is also common in pregnancy due to increased fluid retention.
Physical Therapy treatment involves increasing wrist flexibility through joint mobilization of the carpal bones, and stretching exercises to the wrist flexor muscles. Gentle nerve glide exercises will be used to maintain mobility of the median nerve and prevent adherence to other structures in the carpal tunnel. A night splint may be used to limit movement and decrease inflammation. Oral anti-inflammatory medication and/or a steroid injection can be useful to decrease swelling. Rest or technique modification needs to be addressed. Assessment and treatment of the neck and elbow can improve overall nerve mobility and symptoms. If symptoms prevail, surgical decompression of the median nerve may be required.