What is Carpal Tunnel Syndrome and how do we treat it?

Carpal Tunnel Syndrome is an entrapment/compression of the median nerve as it travels through the wrist’s carpal tunnel, which is a passageway in the wrist that connects the forearm to the hand. The carpal tunnel contains nerves, arteries, veins and tendons. Symptoms will occur (with some variability) in the thumb, index finger, middle finger and half the ring finger and may include pain, numbness, tingling or weakness in the thumb muscles. Progression of carpal tunnel syndrome can result in hand weakness, decreased fine motor coordination, difficulty grasping, and atrophy (muscle wasting) of the thumb muscles. Further, patients often have wider wrists, are older than 45 years of age and report that shaking hands relieves their symptoms. 

Treatments may include:

• Manual therapy to improve mobility of the wrist bones and flexibility of wrist muscles
• Stretches specific to the Median Nerve
• Exercises to increase flexibility of the wrist joint
• Review of sleeping positions and wrist orthosis to lessen night symptoms

Considering the Median Nerve (which is the Carpal Tunnel Syndrome culprit) comes from the neck; treatments may be targeted to the neck and wrist to improve outcomes. Click here if your carpal tunnel syndrome symptoms go up your arm and into your neck. For your neck, we use a combination of:

• Traction of your cervical spine
• Manual therapy to increase neck mobility
• Stretches to increase the neck muscle flexibility 
• Dry needling to reduce neck muscle tone  

Carpal tunnel syndrome maybe a surgical issue if you are experiencing neurological loss. This may include weakness and atrophy of the thumb muscles and loss of sensation. This will be assessed on your first visit and we will refer you to another healthcare provider if needed. 

Citations:

1. Erickson, Mia, et al. “Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome.” Journal of Orthopaedic & Sports Physical Therapy, Vol. 49, No. 5, 2019, https://doi.org/10.2519/jospt.2019.0301. 
2. Wainner, Robert S., et al. “Development of a Clinical Prediction Rule for the Diagnosis of Carpal Tunnel Syndrome.” Archives of Physical Medicine and Rehabilitation, Vol. 86, No. 4, 2005, pp. 609–618., https://doi.org/10.1016/j.apmr.2004.11.008.

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