Most people will occasionally experience hand or wrist pain, especially if their profession requires repetitive fine hand movements. Fortunately the pain and achy sensation quickly subsides, but for some people hand pain and numbness can become chronic and even debilitating. One of the most common reasons people experience pain and numbness in their hand is carpal tunnel syndrome (CTS). In fact, it’s estimated that CTS affects approximately 3-6 percent of the adult population in the United States.
The carpal tunnel is a structure located in your wrist which surrounds and protects nerves, blood vessels and tendons. The actual tunnel is formed by the bones that make up the wrist and a strong thick ligament called the flexor retinaculum. CTS often occurs because of excessive amounts of pressure that is placed on the carpal tunnel. As a result everything inside the carpal tunnel, including the nerves are compressed. The nerve that runs through the carpal tunnel is called the median nerve. After exiting the carpal tunnel the median nerve spreads out to the thumb, index, middle and partially to the ring finger. As this nerve is compressed or pinched neurological symptoms such as burning, numbness and tingling will be experienced in the thumb and the aforementioned fingers. The pressure in the carpal tunnel can increase due to a traumatic injury such as a fracture of the wrist. This will lead to an increase amount of swelling and therefore increase the overall pressure of the carpal tunnel. In addition, the pressure can also increase if anything inside the tunnel becomes larger. If any of the wrist muscles become overused, thickening of these tendons can occur which will increase the pressure of the carpal tunnel.
A person with CTS may experience several symptoms. Besides experiencing pain, burning and numbness in their wrist, thumb and fingers a person may become aware that their pain is worse at night, especially while sleeping. A person may also notice that shaking their wrist when they are symptomatic may provide relief. Bending the wrist may also provoke symptoms. The wrist may even appear swollen. If symptoms are left unchecked the muscles that surround the thumb may actually begin to weaken and shrink in size. This will translate to a weaker and painful grip. This may result in a person frequently dropping items and feeling clumsy.
There are many risk factors that go along with this disorder as well. Women are more likely to develop CTS than men. Diseases associated with inflammation such as rheumatoid arthritis can increase the likelihood of developing CTS. Pregnancy and menopause often cause swelling of the wrist which subsequently increasing the pressure in the carpal tunnel. Diabetes and obesity also increases the likelihood of sustaining damage to the median nerve. Occupations that require using one’s hands and wrist (i.e. typing) or vibrating tools may contribute to developing CTS.
Before a physical therapist can begin treating the patient, they have to make sure that the patient’s symptoms are actually originating from the wrist. When a person complains of numbness and tingling in the hand more often than not the neck is responsible. If a nerve in the neck is being pinched then this may replicate symptoms of CTS. This is crucial, not only for the physical therapist, but especially if the patient is contemplating surgery. If an accurate diagnosis is not made then any treatment or surgery for the carpal tunnel will certainly fail.
If sleeping is aggravating a patient’s symptoms then a night split may be recommended to help lock the wrist in a neutral position. This prevents the patient from bending or rolling the wrist as they sleep, which will reduce the amount of pressure on the median nerve. The physical therapist will also perform hands on techniques that help decrease any built up tissue tension around the carpal tunnel. Often if the patient is experiencing pain, the muscles will become guarded and can potentially entrap or squeeze the median nerve even further. By relaxing these muscles the patient’s symptoms can be further reduced. A physical therapist may also perform techniques that increase the mobility of the median nerve. Nerves are similar to muscles in the fact that they can both become tight and they both can be stretched. If the nerve is stretched carefully the overall mobility of the nerve will increase and this will ensure that the nerve is moving freely and is unrestricted.
The physical therapist will also instruct the patient on how to perform exercises that help glide or stretch the median nerve in a safe manner. To reduce the pressure on the carpal tunnel further exercises focusing on stretching the flexor retinaculum will also be incorporated. As the patient begins to improve and becomes less irritable exercises focusing on strengthening the wrist and forearm will be incorporated. This will aid in restoring the patient’s pain free grip strength. To reduce symptoms further, the therapist will also focus on proper posture and ergonomics. Here the therapist will provide advice on how to minimize their symptoms at work and will make sure their work environment is not perpetuating their symptoms.
Individuals with mild to moderate cases of CTS typically do quite well with conservative management. Individuals with severe cases or chronic cases of CTS may require surgery, but some of these patients may still benefit from conservative management. It’s important to remember that one of the most determining factors on whether a patient will have a positive outcome with physical therapy is if they seek treatment early on.
If you’ve been experiencing hand or wrist pain, don’t wait contact Total Performance Physical Therapy for an examination today.