Hand in Hand: Physiotherapy Solutions for Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is a painful condition involving the nerve that travels through the wrist to supply the hand and fingers (the median nerve). This nerve is compressed where it passes over the carpal bones through a passage on the palm side of the wrist due to a narrowing of the tunnel, enlargement of the tunnel contents or swelling of the wrist.

Symptoms

The onset of carpal tunnel syndrome is usually gradual and is characterised by tingling or numbness in the palm, thumb and first 2 and a half fingers. As symptoms progress a burning pain may become present and then finally weakness and muscle atrophy in the hands. This often causes a feeling of clumsiness as loss of grip and pinch strength results in frequently dropping objects.
Symptoms are generally aggravated by gripping objects such as phones and steering wheels and improve with shaking or flicking of the hand.

Risk factors

The onset of CTS occurs more commonly with increasing age, during pregnancy and in conjunction with conditions such as wrist arthritis, wrist fracture, thickened tendons, tendon inflammation and hand trauma causing swelling.

Diagnosis

CTS is often diagnosed by a physiotherapist, general practitioner or hand therapists who will complete a clinical assessment including range of motion of the wrist, strength and sensation of the wrist and fingers and grip. Palpation over the palm side of the wrist may cause pain and/or reproduction of symptoms. This will be compared to the unaffected side to highlight any differences.
A positive Phalen’s or reverse Phalen’s test is highly diagnostic as it compresses the affected nerve as it runs through the carpal tunnel.
Occasionally a nerve conduction study is required.

Treatment

A range of interventions are available for the treatment of CTS. The most successful outcomes are achieved when management is commenced early as the condition can become chronic and debilitating if left untreated.

Physiotherapy management may involve:

• Education on risk factors and aggravators
• Splinting to relieve pressure off the nerve
• Tendon and nerve exercises
• Swelling management
• Strengthening of hand muscles once symptoms have subsided

Some examples of modifying posture and exercises can be found below:

It is recommended to begin carpal tunnel exercises under the guidance of your physiotherapist, to ensure the program is right for you!

Surgical management

A small percentage of people with CTS will require surgery. This is indicated when there is a loss of sensation or inability to contract the muscles supplied by the affected nerve.