Carpal tunnel syndrome is a common condition of the wrist and hand that is caused by pressure on the nerve at the base of the palm. This condition can affect the use of the whole arm. CTS is a common condition affecting 1 out of 20 Americans. 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 is carpal tunnel syndrome?
The carpal tunnel is a band of tissue at the base of the palm that forms a “tunnel” and protects the median nerve and the tendons that flex your fingers. Pressure caused by crowding or irritation of the median nerve in the carpal tunnel can lead to CTS. Extreme wrist positions, sustained pressure at the wrist, or prolonged improper positioning of the wrist during activities like driving or keyboarding have been attributed to the development of this condition. CTS is common in professions that require assembly-line work or excessive keyboard and computer work. The following conditions also lead to CTS in some individuals:
- Inflammation and swelling of wrist tendons
- Injuries to the wrist
- Hormone or metabolic changes
- Diabetes
- Fluid retention (eg. During pregnancy)
- Degenerative and rheumatoid arthritis
Symptoms
Symptoms of CTS include burning, tingling, “pins and needles”, or numbness in the palm of the hand and fingers. Symptoms are often worse at night but still noticeable during the day or with activity. Muscle weakness of the hand is also present and can become worse over time. Patients will often report grip weakness and sometime dropping objects.
Diagnosis
A doctor of physical therapy can often diagnose the presence of CTS. During the physical examination, a battery of physical tests including range of motion, strength assessment, sensation testing, and provocative maneuvers will reveal the presence of CTS and the limitations that must be addressed with treatment. During this exam, your doctor of physical therapy will also rule out other conditions that can produce similar symptoms such as a pinched nerve at the neck. After your exam, you may be referred for additional testing such as electromyogram (EMG) and nerve conduction velocity (NCV).
Treatment
Fortunately, CTS is often successfully treated with non-surgical or conservative treatment. Physical therapy treatment can be effective in reducing your symptoms and getting you back to performing normal activities. Depending upon the causes of your CTS, your physical therapy program may include:
Dry needling – the insertion of a “dry” needle, or one without injectate, inserted into muscles innervated by the median nerve may produce a significant reduction in pain and other physiologic responses that are therapeutic for this condition.
Infrared therapy – promotes circulation, tissue healing, and soft tissue flexibility.
Carpal tunnel splint – this splint can help decreased compression of the median nerve by placing the hand in a neutral position during sleep or other activity.
Joint mobilization – this procedure can improve mobility and ROM at the wrist thereby reducing pressure on the median nerve. This treatment can also significantly decrease pain.
Therapeutic exercise – specifically prescribed exercises can help to improve ROM and strength.
Worksite assessment – evaluation and possible modification of your workstation to minimize stress to the median nerve and facilitate healing.
Physical therapy after surgery
If conservative treatment fails surgery will often be recommended. Surgery releases the band of tissue compressing the median nerve. Physical therapy is needed after surgery to restore normal strength and ROM.
If you think that you may be suffering from symptoms related to carpal tunnel, you should call your doctor of physical therapy to schedule an evaluation.
Dr. Leonard J. Somarriba D.P.T., C.S.C.s., is owner of ProFysio Physical Therapy LLC. For more information, call 732-201-7450 or visit www.profysionj.com. ProFysio has two locations: 1212 Route 34, Suite 24-25 in Aberdeen; and 2124 Route 36 South in Holmdel.