Are Your Fingers Tingling? It May Be Carpal Tunnel Syndrome
Physical Therapy for Carpal Tunnel Syndrome
Getting Control of Your Carpal Tunnel Syndrome with Physical Therapy…
WHAT IS CARPAL TUNNEL SYNDROME?
Have you been experiencing numbness, tingling, or burning in your palm, thumb, index or middle fingers? In the beginning maybe you would wake up with these symptoms and be able to relieve them quickly but now they are occurring more often during the day, especially after you’ve been using your hands for a while. The numbness might linger and eventually you start noticing some weakness in your hands. If this sounds familiar, you might be experiencing carpal tunnel syndrome (CTS).
Carpal tunnel syndrome refers to a group of symptoms that are caused by pressure on the median nerve as it passes through the carpal tunnel of the wrist. The carpal tunnel is a narrow passageway on the palm side of the wrist created by a ligament called the transverse carpal ligament that crosses from left to right between several wrist bones. The median nerve and several tendons travel through and are protected by the carpal tunnel.
The median nerve arises from the neck region of the spinal cord and travels through the muscles and tissues of the upper arm and forearm, through the carpal tunnel and it’s branches travel into the hand. The median nerve supplies motor impulses to several forearm and hand muscles and transmits sensory information between the thumb, index, middle, and half the ring fingers, their corresponding palm areas, and the brain.
You can see why pressure on the median nerve as it travels through the carpal tunnel would cause numbness, tingling or burning in the first 3 (and sometimes part of the 4th) fingers. In fact many people find themselves shaking their hands out frequently to relieve these sensations. If the compression is prolonged or severe, it can interfere with the nerve’s ability to transmit motor signals to corresponding muscles and a person can notice weakness in their hands and grasp and more difficulty performing fine motor tasks such as typing, writing, or handling small objects.
WHO IS AT RISK FOR DEVELOPING CTS?
While nerves are pretty resilient against occasional pressure and compression, prolonged pressure can cause the types of symptoms we see with CTS. Because of the nature of this condition, repetitive forceful finger use, prolonged vibration through the hands, and extreme wrist positions can raise your risk of developing CTS. Data shows that women are more than three times more likely to develop CTS and that certain professionals such as assembly line workers, manufacturing, sewing, cleaning, and meatpacking workers develop CTS at higher rates. Even repetitive typing and keyboarding, if the wrists are angled less than optimally, can cause CTS.
CTS is also associated with certain health conditions in some people:
Trauma or injury to the wrist that causes inflammation such as a fracture or sprain
Diabetes
Overactive pituitary gland
Underactive thyroid gland
Rheumatoid arthritis or gout
Fluid retention during pregnancy or menopause
Hand or wrist deformities
HOW IS THIS CONDITION DIAGNOSED?
A thorough subjective exam is often adequate to diagnose CTS. Your physical therapist will ask you about the duration and nature of your symptoms and what kinds of activities you do in your job, for recreation and in your daily tasks. This information gives the physical therapist insight into potential underlying causes and helps rule out other conditions that may cause symptoms in the hand and fingers.
Once they have interviewed you, you can expect to undergo a physical exam to evaluate your strength, sensation and coordination of your affected hand and forearm. Your PT will likely also examine your neck and shoulder as the median nerve originates in the neck and at times conditions of the neck can mimic symptoms of CTS. They may also perform certain special tests to detect compression and irritation of the median nerve:
Phalen’s test: gently pressing the backs of your hands together to flex both wrists for one minute. Tingling or numbness in the fingers that occurs within 60s is suggestive of CTS
Tinel sign: your physical therapist may tap over the median nerve where it passes through the wrist. Tingling that results in the thumb, middle or index finger may indicate CTS
If you see a specialist physician such as a Neurologist, they may recommend specialized electrical and nerve function testing such as an electromyogram (EMG) to determine how well motor impulses are traveling through the nerve. A nerve conduction velocity test may also be utilized to assess how well the median nerve transmits sensory information. These tests can identify and assess severity of CTS. In some cases an x-ray or MRI may be ordered to assess for possible trauma or deformity in that area.
HOW CAN PHYSICAL THERAPY IMPROVE MY SYMPTOMS?
Physical therapy can be helpful in improving symptoms as a form of conservative care or as part of a post-surgical rehabilitation plan. Non-surgical treatments are typically recommended first and may include physical therapy, corticosteroid injections or non-steroidal anti-inflammatory medications prescribed by a physician, and splinting. If the condition is severe or does not respond to conservative treatment then surgical intervention may be recommended to create more space within the carpal tunnel to relieve the pressure on the median nerve.
A physical therapist will always create an individualized plan to meet your specific needs but generally aims to reduce your pain and help prevent surgery, increase your ability to be functional and active, and help you resume your normal work, home and leisure activities. If PT is recommended after CTS surgery then additional goals will include minimizing scar formation and restoring normal strength and range of motion.
Due to the nature of CTS, you can expect that education and activity modifications will be an important part of your custom physical therapy program. Understanding what specific activities and hand/wrist positions may have caused your symptoms to develop in the first place is an important step in improving symptoms and reducing the likelihood of recurrence. Modifying the tools you use, taking breaks, adjusting your workspace to allow for a more neutral wrist position and reducing the force that you put repetitively through your wrist and hands are just a few of the suggestions your PT may make to help prevent return or worsening of CTS.
If you start to notice any of these symptoms developing it is important to seek treatment early, however, much can still be done even if you’ve had these symptoms for a while. A physical therapist at Evolve is trained to help identity signs and symptoms of CTS and can recommend modifications you can make immediately to start improving your symptoms but perhaps more importantly, can prescribe a plan of treatments to help you recover the strength and sensation you have lost, reduce your pain and get you back to your regular activities with the confidence in knowing how to prevent carpal tunnel syndrome from returning.
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