Carpel Tunnel Syndrome (CTS) causes tingling, numbness, and weakness in the wrists and hands. Activities that require repetitive or prolonged bending of the wrist can cause compression of the median nerve. When the median nerve is compressed or inflamed, it causes nerve symptoms. CTS is more common in women, people who work with their hands, and in certain medical conditions that cause fluid retention and inflammation, such as pregnancy, diabetes, and arthritis. If you have CTS, you know how the symptoms can interfere with your daily activities that involve gripping and using your hand. The good news is that a trained physical therapist can evaluate and teach you ways to reduce your symptoms and prevent reoccurrence!
Physical Therapy for Carpal Tunnel Syndrome
A physical therapist (PT) is a medical professional with 6-7 years of education in musculoskeletal disorders. Most PTs have a doctorate and then specialize in specific areas (orthopedics, pediatrics, neurology, hands, sports, etc.) PTS are trained to determine the cause of your symptoms and then provide you with education and an exercise program to reduce your pain and regain strength and mobility. Research has found that carpal tunnel therapy leads to better outcomes in the short term and is just as effective as surgery in the long term. Those who received PT treatment had less pain and better function much earlier than those who had surgery!
Physical Therapy Evaluation
Carpel Tunnel Syndrome (CTS) results from compression of the median nerve at the wrist, causing uncomfortable tingling, numbness, and grip weakness. Your PT will first review your past medical history to see if you have any conditions that cause fluid or inflammation, such as pregnancy, thyroid issues, arthritis, infection, or auto-immune disorders. Increased fluid can cause a reduction in space the median nerve has to pass through the wrist. They will also review your occupational and daily habits to see if an activity or posture can result in overuse or trauma at the wrist.
The PT will then ‘clear your neck .’This means that they will have you move your neck into end rages to see if the position of your neck has any effect on your hand symptoms. Research* has shown that 10% of isolated hand symptoms come from your neck. The bones of your spine protect your spinal cord. The nerves responsible for your arm strength, sensation, and reflexes branch off your upper cervical spine. A nerve can sometimes become compressed at the neck as it exits the spine. Nerve root irritation can cause symptoms anywhere the nerve innervates. For example, the C5 region of your spinal cord branches out to eventually become the median nerve at your wrist. Compression of the C5 nerve root can trigger symptoms in structures innervated by the median nerve and can be mistaken for CTS. Treating the carpal tunnel at the wrist will be in vain. Only treating the neck will reduce symptoms.
After clearing the spine, the PT will then evaluate the wrist. They will assess wrist range of motion, strength, and sensation. They will test the wrist to see what movements/positions reproduce your symptoms. After completing their examination, the physical therapist will provide education to understand the cause of Carpal Tunnel Syndrome and how you can self-treat with physical therapy. The goal is to avoid surgery and get you back to full function with no symptoms.
The role of a PT is to strengthen an individual’s ability to self-manage their condition.
Best Treatment for CTS – Carpal Tunnel Physical Therapy Exercises
1. Behavior change:
Changing your behavior is critical because you can treat the symptoms, but the symptoms will return if you do not remove the problem. Repetitive and sustained wrist compression triggers an inflammatory response. The median nerve runs under a protective ligament at the wrist as it extends into the hand. Inflammation reduces space in this narrow canal and can cause compression on the median nerve, triggering symptoms. You want to create more space to get relief so the nerve is no longer compressed.
2. Splint
Wrist cockup splints open the carpal tunnel area, allowing space for the nerve by placing the wrist in a slightly extended position. Splints are especially beneficial at night because we often have our wrists bent while sleeping. A splint will minimize pressure on the nerve and, by removing stress, allow the nerve to heal.
3. Exercises
Prayer Stretch
Step 1: Put your hands together under your chin in a prayer position.
Step 2: Push your hands down to your waist until you feel a moderate stretch. Hold for up to 30 seconds. Repeat between two and four times.
Medial Nerve Glide
Apply heat to your hand and wrist for 15 minutes prior to doing this stretch. After, use an ice pack for 20 minutes. This will help prevent swelling. Hold each step of this exercise for between three and seven seconds.
Step 1: Make a fist.
Step 2: Extend your fingers, keeping your thumb close to your fingers.
Step 3: Bend your hand backward, towards your arm.
Step 4: Keeping your hand in that position, extend your thumb away from your fingers.
Step 5: Turn your forearm so your hand is palm up.
Step 6: Use your other hand to pull your thumb back, deepening the stretch. Repeat 10-15 times per day.
Tendon Glides: Type One
It is also recommended to use heat for 15 minutes prior to this exercise, and ice or cold for 20 minutes after. Hold each of these poses for three seconds.
Step 1: Hold your hand up in front of you, straightening all of your fingers.
Step 2: Curl your fingers with your knuckles pointing up. Your fingers will be in a hook shape.
Step 3: Curl your fingers further, making a tight fist. Repeat five to ten times per day, a few times each day.
Tendon Glides: Type Two
Use heat on your wrist and hand for 15 minutes before doing this one as well. Ice it for 20 minutes after. Hold each position for three seconds.
Step 1: Hold your hand up in front of you, straightening all your fingers.
Step 2: Make your hand into a tabletop by bending your fingers at a 90-degree angle.
Step 3: Continue bending your fingers, bringing your fingertips to the bottom of the palm.
Safety Considerations
A gentle pulling feeling is OK, but you should not feel any sharp pain when performing carpal tunnel physical therapy exercises. If you do feel a sharp pain, stop doing that exercise immediately and contact your physical therapist.
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