Physical Therapy for Carpal Tunnel Syndrome

by Tom Toothaker, DPT

Carpal Tunnel Syndrome is caused when the medial nerve of the wrist becomes compressed or trapped by inflammation. The Carpal tunnel actually is a space in the wrist where nine tendons travel from the wrist to the hand to control hand and finger movement. Bones cover the bottom and sides and a large tendon forms the roof of the tunnel. When irritated these tendons become inflamed and can pinch the medial nerve against the large tendon at the top. This is the condition we call Carpal Tunnel Syndrome or CTS.

CTS is characterized by pain and numbness or a “pins and needles” feeling in the hand, usually in the thumb, index and middle fingers, often while using the hand. An individual may shake their hand to relieve the uncomfortable feeling. At later stages, grip strength is reduced and the hand becomes less functional, the large muscle at the base of the thumb can atrophy and it can cause one to awaken in the night with discomfort.

There is much debate over what causes CTS. Women get CTS more often than men do. Repetitive motion, such as typing or using vibrating tools, can exacerbate the condition but has not been proven to cause it. Women can get CTS when they are pregnant or in menopause, as there is a definite correlation between the increase/decrease in hormones and CTS. Some conditions, like diabetes or arthritis, can make you more likely to get CTS.

Physical Therapy can be used to help patients who have CTS. When employed by skilled therapists, the following techniques and modalities can help to relieve the inflamed nerve and tendons, allowing for healing:

1. Ultrasound – a deep and penetrating therapy which, when pointed directly at the carpal tunnel can provide an anti-inflammatory action helping to improve function

2. Splinting is the most common non-surgical form of treatment for CTS. The splint holds the wrist in a neutral position which provides the most space in the Carpal Tunnel, allowing the tendons and nerve to move more freely.

3. Gliding exercises – these are used in conjunction with other therapies to provide the most relief. The patient moves their fingers in specific patterns which help the tendons to glide more smoothly over one another.

4. Instrument-assisted tissue massage – soft tissue manipulation that is assisted by using special instrumentation to release scar tissue and loosen tight tendons.

5. Manual therapy – Active Release Technique can help to loose tight muscles and tendons.

If you suspect that you have CTS, it is important to be seen by a physician to get a definitive diagnosis, and to rule out other conditions, like a pinched nerve in the neck, that can mimic CTS.

Working together with your physician, we can develop a treatment plan and exercise regimen that addresses your needs, lifestyle and activities to ensure that you feel better quickly.