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Carpal Tunnel Syndrome Hand Therapy
Untreated carpal tunnel syndrome, showing how the muscles at the base of the thumb have wasted away (atrophied)
Carpal tunnel syndrome (CTS) is actually a very common condition of the wrist and hand
that can affect the use of the whole arm. The main cause of carpal tunnel syndrome is pressure on
the nerve at the base of the palm (median nerve).
Because of the demands
that people place on their hands and wrists, CTS is a common condition
affecting 1 out of 20 Americans (that's a 5% rate). Surgery for this condition is commonly
performed on the wrist and hand (called "carpal tunnel release surgery").
Fortunately for most people who develop
CTS, hand physical therapy treatment can often provide
- pain relief
- numbness relief
- restore normal use of the hand, wrist, and arm without the need for
carpal tunnel release surgery
What is Carpal Tunnel Syndrome?
Every one has a very narrow/tight tunnel in the wrist, and this is
called the carpal tunnel (because it's a tunnel at/near the carpal bones
of the wrist). There is a number of structures (including the median
nerve) that goes into and through this tight tunnel, and what the carpal
tunnel does is that it protects the median nerve and
the tendons that bend your fingers.
However, due to a variety of
causes/injuries, there can be a build-up of pressure on the median
nerve that when compressed, will cause
- pain and weakness in your wrist and hand
- numbness or tingling from your thumb to the long half of your index finger
If the pressure is unresolved, over time it will lead to carpal tunnel syndrome.
Extreme wrist positions, as well as a lot of finger use, especially
with a lot of force or vibration (such as holding the steering wheel
when driving heavy machinery), can all contribute to CTS.
CTS is common in professions such as assembly-line work, particularly
meat packing; and jobs requiring the use of hand tools, especially
tools that vibrate.
Yes, eventhough excessive mobile phone, keyboard and computer use is
often associated with carpal tunnel syndrome, those performing assembly line work are 3
times more likely to develop CTS than those who perform data entry work.
Some leisure activities can also create CTS, such as
- sewing and stitching
such as racquetball and handball and
- playing string instruments such as
the violin and guitar
The following health conditions can also lead to CTS in some individuals:
- 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 (eg, during pregnancy)
- Certain medicine use (eg, steroids)
- Degenerative arthritis and rheumatoid arthritis
And yes, direct injuries and traumas like falls and blows can cause CTS too.
Signs and Symptoms of carpal tunnel syndrome
CTS usually starts gradually, with symptoms such as
- "pins and needles"
- numbness in the palm of the hand and
Often the symptoms are more noticeable during the night, and
individuals often report being wakened with symptoms. Many people feel
the need to "shake / shake out" their hands to try to relieve the uncomfortable CTS symptoms.
As the condition progresses, the symptoms are noticed during the
daytime and are noticeable or becomes worse when using their hands with a repetitive/resistance/weighted activity such as
- chopping/cutting things
- using scissors
- typing on the keyboard or mobile phone
- holding onto a device such as mobile phones, laptops, bags
- carrying grocery bags
- brushing/combing hair
Patients with carpal tunnel syndrome may experience weakness of the hand and more constant numbness may occur
if the pressure on the median nerve continues (and if still not treated with hand therapy). Some patients report that they drop
objects unexpectedly or have a weakness in their grips without realizing it.
How Is carpal tunnel syndrome Diagnosed?
Our senior hand therapists work closely with doctors
to accurately diagnose and treat CTS.
Symptoms of CTS are typical, and
it is often possible to diagnose it without extensive testing. Our senior hand therapists are experts in the movement and function of the body and
will conduct an evaluation to determine all of the factors that may be
contributing to your condition.
These are several tests that may be used to help diagnose CTS:
- Examination of your neck and entire upper extremity to rule out
other conditions. Many patients have been told they have CTS, only to
find out that the pain is coming from another body area (done by our senior physiotherapists).
- Grip strength of fingers and thumb
- Sensory tests
- Wrist and hand range-of-motion
- Wrist flexion (Phalen) test: We will have you
push the backs of your hands together for 1 minute. Tingling or
numbness in your fingers that occurs within 60 seconds may be an
indication of CTS.
- Tinel's Sign: We will use a reflex hammer or
finger to tap over the median nerve at your wrist. Tingling in the thumb
and index and middle fingers may indicate CTS.
- Electrical studies (electromyogram/EMG) and nerve conduction
velocity (NCV): These tests determine the transmission of the nerve and
the severity of the CTS.
- X-rays: When trauma has occurred or if there is reason to suspect anatomical abnormality, x-rays may be ordered.
In some cases, our senior hand therapist may refer you to a physician
or our senior physiotherapist for additional testing or treatment.
How Can our senior hand Therapists Help?
After the evaluation, we will prescribe your treatment plan based on your specific case.
If your evaluation confirms early-stage CTS, conservative care will
be recommended as a first step.
Hand therapy treatment can be
effective in reducing your symptoms and getting you back to performing
normal activities. During your first visit with our senior hand therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
Depending upon the causes of your CTS, your hand therapy program may include:
- Education regarding:
changing wrist positions (ie, avoiding prolonged bent wrist positions)proper neck and upper back posture (ie, avoiding forward head or slouching)safe use of sharp utensils, tools, or other implements, if sensory changes are identified"stretch breaks" during your work or daily routine
- Ultrasound therapy to accelerate the healing of soft tissues in the carpal tunnel including the median nerve
- Exercises to increase the strength of the muscles in your hand,
fingers, and forearm—and in some cases, the trunk and postural back
- Stretching exercises to improve the flexibility of the wrist, hand, and fingers
- Use of heat therapy and cold therapy treatments to relieve pain
- Use of a customized night splint to reduce discomfort
- An ergonomic worksite visit to assess your work area. For example, if you sit
at a desk and work on a computer, it's important for the keyboard to be
in proper alignment to help avoid working in a bent wrist position.
- Median nerve gliding and stretching to "allow" the median nerve to breath and be less compressed
- Increasing the size of tool and utensil handles by adding extra material for a more comfortable grip
- Anti-vibration gloves or anti-vibration wraps around tool handles, if vibration is a factor at your workplace
We will also consider your home and leisure
activities, with recommendations such as wearing gloves to keep the
wrist/hands warm and limiting sports that aggravate the condition, such
as racquet sports, until symptoms resolve.
The goals of hand therapy are to reduce your symptoms without the
need for surgery, to enable you to be as active and functional as
possible, and to help you resume your normal work, home, and leisure
Hand Therapy Following Surgery
If the evaluation reveals that your CTS is more severe, or if your
symptoms persist, our senior hand therapists and physiotherapists may refer you to a physician
for a surgical consultation. If necessary, surgery will be performed to
release the band of tissue that is causing pressure on the median nerve.
Hand therapy treatment is important after surgery to help restore
strength to the wrist and to learn to modify habits that may have led to
symptoms in the first place.
Your hand therapy treatment may
- Exercises to improve the strength of the wrist/hand muscles and improve function
- Stretching to improve mobility of the wrist/fingers and improve function
- Scar management to keep the scar and skin supple and flexible
- Education regarding appropriate posture and wrist position to avoid carpal tunnel compression in home/leisure activities
- A worksite visit or simulation to optimize postures and positions
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Phoenix Rehab Group works with specialist physiotherapists and rehab therapists who are highly trained, qualified, experienced and passionate to provide high level of expert care to our patients.
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See all the conditions our principal physiotherapists treat.
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Patients who sustained injuries to their elbows, forearms, hands, wrists
(sprains and fractures) and fingers, usually will benefit / require Hand Therapy to
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following injuries or post-operations
Commonly treated hand pain injuries includes
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Read the benefits of regular deep tissue release therapy here.
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At the first session, our specialist physiotherapists will carry out a thorough
assessment, helping them to select the most appropriate treatment to
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Follow up sessions are inline to provide
expert treatment for your pain as well as prescribing specific
exercises to reduce your risk of re-injury and giving you a long term
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