Recently you’ve begun to feel numbness, tingling, and occasional burning pain in your hand and your co-worker proclaims, “Oh no, you have carpal tunnel syndrome!” If that indeed is true, don’t feel like you’ve been struck with a bit of bad luck, as carpal tunnel syndrome (CTS) is an extremely common entrapment neuropathy. A study by the University of Manchester estimates that CTS affects 1% to 3% of the general population. A nerve, called the median nerve, runs from your neck (nerve roots C6-T1) throughout your arm and all the way down into your hand and if there is an issue with it you may experience CTS symptoms. In this article, we are going to explain what carpal tunnel is and how to manage it!
What Is The Median Nerve?
The median nerve provides both sensory and motor functions to the upper extremity. Compression of the median nerve by the transverse carpal ligament in the carpal tunnel is what typically causes the common symptoms of tingling, numbness, and/or pain in the hand. These symptoms may be constant or intermittent, and pain could also potentially radiate up into the forearm as well. What can be challenging is that there are other conditions that can refer pain in our hands; therefore, it is important to receive a proper evaluation from a trained healthcare professional who is well equipped to evaluate orthopedic hand conditions. These practitioners include either a certified hand therapist, occupational therapist, or orthopedic surgeon who specializes in upper extremity conditions.
Carpal Tunnel Syndrome Information
Sample Wrist Rehab Program Education Video
Entrapment neuropathies, like CTS, compromise the neurovascular microcirculation of the nerve itself. Much like compressing a water hose or “kinking” it, any form of compression or excessive pressure on a nerve decreases its available blood supply and hinders its ability to properly function. Nerves and the brain, in particular, demand an extremely high amount of blood. The brain and the spinal cord make up only 2% of our body mass, yet they consume almost 20% of our circulating blood!
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How Does Carpal Tunnel Occur? Receive The Right Diagnosis
Improper neural circulation and nutrition to the median nerve underlie the cause of symptoms associated with CTS. The clinical signs and symptoms associated with CTS are very specific, and care must be taken to differentiate CTS from a host of other neurological disorders that can present in the hand and forearm. The best way to do this, of course, would be to see your local physical therapist! Ideally, try to look for a PT who is a certified hand specialist (C.H.T.). A physical therapist can easily differentiate among other common neurological disorders, such as cervical radiculopathy, pronator syndrome, ulnar tunnel syndrome, or Wartenberg’s syndrome, just to name a few.
Distribution of Median Nerve
For a quick self-diagnosis, ensure that your symptoms in the hand are within the cutaneous distribution of the median nerve shown below: the palmar surface and fingertips of the thumb, index, middle, and radial half of the ring fingers.
Additional symptoms on the backside of the hand, or in the pinky finger, can indicate other pathologies, such as cervical radiculopathy, Thoracic Outlet Syndrome, or ulnar tunnel syndrome. If symptoms consistently radiate from the forearm into the hand, it can possibly be a sign of similar median nerve pathology, but with a nerve entrapment at a different location higher up near your elbow called pronator syndrome. Now if you’re still with me, and you’ve self-diagnosed yourself with CTS, there are a host of conservative treatment options that can help alleviate your symptoms. All of the following interventions aim to improve circulation and/or relieve pressure off of the median nerve.
Typical Signs and Symptoms of Carpal Tunnel
Listed here are some of the common signs and symptoms individuals with carpal tunnel will typically describe.
- The onset of symptoms is generally gradual, with tingling or numbness in the median nerve distribution
- May notice aggravation of symptoms with gripping activities, but also at night or the early morning
- Improvement in symptoms with shaking or flicking of the hand
- Progressive symptoms include
- More constant numbness and tingling with a burning sensation
- Weakness and atrophy of thenar muscles
- A combination of sensory deprivation and weakness may result in a complaint of clumsiness or loss of grip/pinch strength as well as a subjective report of dropping objects
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How To Treat Carpal Tunnel: Splinting
Pressure within the carpal tunnel is lowest when the wrist is held in a neutral (0°) wrist position, while wrist flexion and extension increase pressure. As discussed earlier, when pressure increases, circulation to the nerve decreases and causes pain. An easy fix to maintaining lower levels of pressure in the carpal tunnel is to use a wrist splint. These can be worn both during the day and at night, although it is not apparent in the literature that the addition of daytime wearing of splints further improves symptoms or function. A wrist splint also helps limit excessive hand movements, which is often associated with an aggravation of symptoms.
How To Treat Carpal Tunnel: Exercise
Individuals tend to benefit from conservative treatment if they are having intermittent symptoms that are not rapidly worsening. Exercises that help to promote movement of the tendons in the carpal tunnel, as well as the median nerve itself, are recommended for patients with mild to moderate CTS. Research has shown that light to moderate wrist and finger movement exercises can actually decrease carpal tunnel pressures, in part by facilitating venous return or edema dispersion in the median nerve. However, these exercises should only be implemented once symptoms regress or subside.
Median Nerve Glides
Image by Dr. Dan Kirages
Nerve glides also referred to as sliders are different than nerve tensioners. If a nerve is already hot and irritated, we do not want to provoke that nerve! Therefore, sliders tend to be better in the acute phase of rehab. Sliders are going to provide movement to a nerve, where it is slacked on one end and tight on the other end. Think of dental floss! On the contrary, nerve tensioners will provide tension throughout the entire nerve, stretching it as much as possible. This is better in a later phase of rehab when pain is not a primary complaint!
Median Nerve Slider
Sample Wrist Rehab Program Exercise Video
- HOW: To glide your median nerve- extend your elbow, wrist, and hand while keeping your shoulder elevated to about 90 degrees and you’re bending your neck towards the arm you are extending. Then slowly flex or bring in your hand, wrist, and elbow as your bend your neck away from the arm that is reaching outwards. Slowly repeat back and forth.
- FEEL: You will feel the stretch likely in your forearm and bicep region, if it is creating some numbness and tingling in the arm you can go through a slightly less range of motion to avoid irritating this nerve.
- COMPENSATION: Avoid moving the neck away from you as you extend the arm away from you.
How To Treat Carpal Tunnel: Therapeutic Modalities
Modalities that promote healing and increased circulation, such as heat, therapeutic ultrasound, and laser have all demonstrated success in treating CTS. Heat induces vasodilation, increasing local circulation and flushing out “toxic by-products” to decrease pain. Therapeutic ultrasound increases cell wall permeability and proliferates the healing processes. Laser encourages more proficient oxygen uptake by cells. All in all, these therapeutic modalities aim to improve nerve function and decrease your symptoms. With that being said, the evidence for modalities in regard to carpal tunnel is not very high, and other options for treatment should also be considered, including splinting and exercise.
Therapeutic Ultrasound For Wrist Pain
What About Injections?
Previously, injections were a popular option for individuals with carpal tunnel; however, orthopedists and other healthcare practitioners are moving away from injections. The reason being is that evidence for the long term benefits of injections is poor. Furthermore, repeated injections tend to cause tissue breakdown, and if an individual were to elect surgery as an option down the line, outcomes may not be as good if the tissue quality is not good. Therefore, injections are lower on our list of recommendations for those who have carpal tunnel.
If you are beginning to have wrist pain, be sure to receive a proper diagnosis from a trained healthcare professional. Carpal Tunnel is a fairly common wrist pathology that is prevalent especially in middle-aged females. Individuals will typically experience some tingling in numbness in the median nerve distribution of the hand, and if it becomes progressive, weakness of the hand may also occur. Some of the current evidence for treatment of carpal tunnel includes carpal tunnel release, rehabilitation from a trained certified hand therapist or occupational therapist, and splinting. See your local physical therapist and give these conservative treatment interventions a shot!
Take Ownership Of Your Elbow, Wrist, and Hand Health
The function of the elbow, wrist, and hand is not truly appreciated until discomfort comes along and limits its use. The shoulder girdle helps initiate movement of the arm but the lower part of the arm is the finisher! The lower arm gives us access to fine motor control and we cannot forget about the aspect that makes us human: opposable thumbs. Your brain perceives the hand to be so important that it dedicates a large chunk of the sensory area specifically to the hand. We are following the brain’s lead here and dedicating a program to regaining full lower arm function!
- Carpal Tunnel Syndrome Fact Sheet.” : National Institute of Neurological Disorders and Stroke (NINDS). National Institute of Neurological Disorders and Stroke, 17 Apr. 2015. Web. 18 Aug. 2015.
- Michlovitz, Susan L. “Conservative Interventions for Carpal Tunnel Syndrome.” J Orthop Sports Phys Ther Journal of Orthopaedic & Sports Physical Therapy 34.10 (2004): 589-600.
About The Author
Michael Lau, PT, DPT, CSCS
[P]rehab Co-Founder & Chief Product Officer
Michael was born and raised in Northern California but now currently resides in Sunny SoCal ever since attending the University of California, Los Angeles as an undergraduate majoring in physiology. After his undergraduate studies, he received his Doctorate in Physical Therapy from cross-town rival the University of Southern California. As a licensed physical therapist with a strong background in strength and conditioning, Michael likes to blend the realms of strength training and rehabilitation to provide prehab, or preventative rehabilitation, to his patients. A common human behavior is to address problems after they become an issue and far often too late, which is a reactionary approach. He believes the key to improved health care is education and awareness. This proactive approach-prehab-can reduce the risk of injuries and pain in the first place. He is a huge proponent of movement education and pain science. Clinically, he has a special interest in ACLR rehab and return to sport fo
Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.