A Physical Therapy Guide to Carpal Tunnel Syndrome
Carpal Tunnel Syndrome (CTS) is a common condition that can cause pain, numbness, and tingling in the hand and arm. Seeking medical attention as soon as possible is crucial to reduce the risk of chronic debilitating symptoms — especially since we use our hands for most activities.
Over 90% of neuropathies (nerve dysfunction), are categorized as carpal tunnel syndrome.1 CTS can lead to dysfunction that affects work, hobbies, and everyday activities that involve use of the affected wrist and hand.
In this guide, we will discuss symptoms of CTS, common causes, how to diagnose it, what conservative treatment options are available, and prevention tips.
- Understanding Carpal Tunnel Syndrome
- Symptoms of CTS
- Common Causes of Carpal Tunnel Syndrome
- Diagnosing Carpal Tunnel Injury
- What to Expect from Physical Therapy for Carpal Tunnel Syndrome
- What If Conservative Care Doesn't Work?
- Prevention Tips for CTS
- When to Seek Treatment
The carpal tunnel is a small space (smaller than the tip of your pinky finger) in the wrist surrounded by bones and ligaments. It is designed to protect the median nerve and nine flexor tendons that cross the wrist. The tendons bend (flex) the fingers and wrist, while the median nerve controls movement and sensation in the thumb and first three fingers.
CTS occurs when the median nerve becomes compressed from anatomical changes in the wrist (such as aging) or inflammation (from disease, injury, etc.). This compression can cause pain, numbness, tingling, and weakness in the hand and wrist. With increasing severity, muscles can start to atrophy, leading to weak gripping and pinching that cause the hand to feel clumsy.
Symptoms usually start gradually and may only occur at night or when the wrist and fingers are used for extended periods of time. As symptoms worsen, they can interfere with work and everyday activities.
Repetitive use of the wrist and hand is a major contributing factor in developing CTS. Some activities are more risky than others. For example, top risk factors include having a job that involves a lot of vibration, force, or extreme positions of the wrist, such as meat packing assembly or construction. On the other hand, typing on a keyboard is not as strongly correlated as once thought.1
Other risk factors include:
- Thyroid disease
- Trauma or injury to the wrist
- Autoimmune disease
- Frequent hand and wrist use
- Repetitive tablet, phone, and keyboard use
- Racquet sports
- Playing a string instrument
If you are experiencing symptoms of CTS, the first step is to book a consult with a CityPT physical therapist. You can schedule same-day appointments without a referral from your primary care doctor.
We will take a medical history and ask about your symptoms. Then, we will conduct an examination of your wrist and hand, looking for areas of tenderness, swelling, or weakness. We'll also assess your endurance and coordination. Finally, we will perform some special tests to confirm and rule out other hand and wrist pathologies, such as cervical radiculopathy, tendonitis, and other areas of nerve entrapment (such as at the elbow).
If needed, imaging can be ordered from your doctor to help rule out other diagnoses and confirm where the nerve is entrapped. Additionally, electromyography (EMG) tests including a nerve conduction test, can be ordered to determine nerve integrity.
The goal of physical therapy is to reduce symptoms and improve function to get you feeling more normal. Treatment will be focused on reducing inflammation and swelling, as well as improving any lost strength, range of motion, and flexibility.
Your therapist will work with you to create a personalized plan of care that may include:
Education: Most important of all, you will be taught about your condition and how to manage your symptoms.
Ergonomics: When relevant, you will learn how to adjust your workspace and other activities to reduce stress on your wrist and hand.
Activity modification: You will be given guidance on which activities to avoid or modify to prevent further injury. This is of particular importance to reduce inflammation and allow the nerve tissues to heal. Often, a splint or cast will be utilized to intentionally reduce use of the hand, at least temporarily.
Exercise: A personalized program will be designed to address any deficits in range of motion, flexibility, and strength. Specialized exercises to mobilize the median nerve may also be utilized as needed. Exercises will likely be started in a pain-free range and gradually progressed as tolerated.
Manual therapy: Including joint and soft tissue mobilizations and dry needling with the goal of reducing inflammation and allowing the nerve to move better within the carpal tunnel. These should be performed by an experienced clinician as improper technique can further irritate the median nerve.
Passive modalities: Such as ultrasound, electrical stimulation, and laser therapy. These will provide short term pain relief at the most, although evidence for this is sparse1 except for laser therapy.2
Physical therapy can be paired with anti-inflammatory medications such as corticosteroids, NSAIDs, and even Vitamin B3 to effectively reduce symptoms in the short term and get you on track with recovery. However, if your symptoms do not significantly improve with conservative care, you may be a candidate for surgery.4 Chronic carpal tunnel symptoms that don't respond to physical therapy are best addressed with this relatively simple surgery.
Carpal tunnel release is the most common type of surgery performed to treat this condition. If you have surgery, you can discuss the best post-surgical management options for your wrist with your CityPT physical therapist and surgeon.
There are several things you can do to reduce your risk of developing carpal tunnel syndrome:
- Maintain good posture and ergonomics (a neutral wrist whenever possible) when working at a computer or desk and using handheld electronics.
- Reduce repetitive activities as much as possible, such as typing, gripping, and use of tools.
- Take frequent breaks from repetitive activities and/or static postures to stretch your hands, wrists, and arms.
- Avoid excessive gripping of objects throughout the day, such as steering wheels, knives (for cooking), etc.
- For certain occupations, consider shock absorbing gloves, braces, and other tools to reduce hand vibration.
- Stay active and maintain good range of motion in your wrists and fingers.
- Maintain a healthy weight to reduce pressure on your wrists and hands, particulary if your occupation requires you to be on your hands and knees.
- Reduce your body's overall inflammation with healthy lifestyle choices, such as good nutrition, adequate hydration, high quality sleep, and proper stress management.
- Keep any chronic conditions well managed with medication and habits.
If you are experiencing any pain, numbness, tingling, or weakness in your hands or wrists — especially if it is interfering with your daily activities or sleep — contact us to discuss your symptoms.
An CityPT physical therapist will be able to determine if carpal tunnel syndrome is the root cause of your problems. They will also craft a personalized plan of care to reduce your symptoms. If you wait too long, the condition may progress and require more aggressive treatment options such as injections or surgery.
If you suspect you have carpal tunnel syndrome and are looking for an experienced physical therapist to help you recover, book an appointment with a CityPT expert today.
This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.
Ezzati K, Laakso EL, Saberi A, Yousefzadeh Chabok S, Nasiri E, Bakhshayesh Eghbali B. A comparative study of the dose-dependent effects of low level and high intensity photobiomodulation (laser) therapy on pain and electrophysiological parameters in patients with carpal tunnel syndrome. Eur J Phys Rehabil Med. 2020 Dec;56(6):733-740. doi: 10.23736/S1973-9087.19.05835-0. Epub 2019 Nov 18. PMID: 31742366. ↩
O’Connor D, Marshall SC, Massy-Westropp N, Pitt V. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome (Review). The Cochrane database of systematic reviews. 2012; volume (7):1-106. ↩
Tang CQY, Lai SWH, Tay SC. Long-term outcome of carpal tunnel release surgery in patients with severe carpal tunnel syndrome. Bone Joint J. 2017 Oct;99-B(10):1348-1353. doi: 10.1302/0301-620X.99B10.BJJ-2016-0587.R2. PMID: 28963157. ↩