What the heck is the Carpal Tunnel? It’s not something you drive your car through, but a narrow tunnel on the palm side of our wrists, about the width of your thumb. It’s an important part of our anatomy because it protects the nerve and tendon that helps bend our fingers. Pressure on the nerve can cause pain and weakness in your wrist and hand and numbness or tingling in some of your fingers. This pressure is caused by crowding or irritation of the median nerve in the carpal tunnel and can lead to a painful and debilitating injury called Carpal Tunnel Syndrome or CTS.
CTS is a common condition affecting 1 out of 20 Americans. CTS is common in professions where repetitive and stressful demands are placed on a workers hands. 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. Some leisure activities can also create CTS, such as long-term keyboard use, sewing, sports such as racquetball and handball, and playing string instruments such as the violin.
Other contributing factors to CTS may be injuries to the wrist such as strains, fractures and dislocations, fluid retention, such as at pregnancy, diabetes and long-term steroid use.
CTS usually starts gradually, with symptoms such as burning, tingling, “pins and needles,” or numbness in the palm of the hand and fingers. Often the symptoms are more noticeable during the night, and individuals often report being wakened with symptoms. Many people feel the need to “shake out” their hands to try to relieve the symptoms.
As the condition progresses, the symptoms are noticed during the daytime and are often worse when holding items such as a heavy book or a hairbrush. Weakness of the hand and more constant numbness may occur if the pressure on the nerve continues. You may find that you drop objects unexpectedly or have a weakness in your grip.
Your health care provider usually diagnoses CTS with a clinical examination. Occasionally a specialized test called an electromyogram or EMG may be ordered. If your evaluation confirms early-stage CTS, conservative care will be recommended as a first step.
Physical therapy treatments can be effective in reducing your symptoms and getting you back to performing normal activities. We often find success in physical therapy using manual therapy techniques, (massage, joint mobilizations, Soft tissue Instrumentation) as well as gentle nerve gliding and stretching of the wrist, forearm, shoulder and neck.
Wrist splints to be worn at night are also commonly recommended as they help keep the wrist in a straight alignment while you sleep, thus reducing compressive forces on the nerve.
If your CTS is more severe, or if your symptoms persist, a visit to an orthopedic specialist is advised for a surgical consultation. If necessary, surgery will be performed to release the band of tissue that is causing pressure on the median nerve. Surgery has proven to be a very effective way to treat CTS that does not respond to conservative measures. Physical 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.
Darren Marchant, PT,MSPT,OCS
FIT Physical Therapy