The carpal tunnel is a compartment in the wrist which various hand and wrist tendons pass through. Also, passing through this tunnel is the median nerve which gives sensation to the thumb, index, and part of the middle fingers. Carpal tunnel syndrome occurs when excessive pressure is put on the median nerve causing numbness or pain in the hand.
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.
There is not definitive cause for carpal tunnel syndrome, but more so a combination of various factors. Excessive pressure can be placed on the carpal tunnel through differing mechanical wrist positions. Prolonged positioning with repetitive tasks like typing can create restrictions in the wrist leading to excess pressure on their median nerve as well.
Individuals experiencing carpal tunnel syndrome typically experience numbness and tingling in their thumb, index, and part of the middle fingers. In certain cases they can experience pain in that area as well, especially at night. Individuals may also complain of weakness in their hand and grip and may be prone to dropping items with the effected hand.
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.
Carpal tunnel syndrome can be diagnosed by a PT through a thorough physical examination. Physical therapists are trained in identifying restrictions and deficits that are consistent with those present in carpal tunnel syndrome. They also have specific test designed to identify nerve entrapment at the wrist.
Carpal tunnel is also diagnosed through primairy care provider’s and neurologist by typically utilizing ultrasound, EMG’s, and MRI’s. In cases of trauma, your physician may order x-rays to rule out a wrist fracture.
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.
Physical therapists are trained to identify and treat the restrictions associated with carpal tunnel syndrome. Manual therapy can help improve hand, wrist, and elbow mobility to help reduce pressure to the median nerve. Physical therapist can also help provide exercises to help keep the wrist and hand moving appropriately and to make sure strength is functional for the patient’s daily demands.
Gentle stretching to the wrist and hands can help prevent the development of carpal tunnel syndrome. Individuals with desk jobs are encouraged to take breaks form prolonged typing throughout the day to allow for relief on the carpal tunnel.