Carpal Tunnel Syndrome
Tunnel Syndrome (CTS) is a common and troublesome condition that
interferes with the use of the hand. It is caused when too much pressure is put on a nerve
(median nerve) that runs through your wrist. A variety of anatomical abnormalities may be
responsible for this highly uncomfortable pressure. Once symptoms of pain and tingling
appear, the condition frequently worsens and permanent nerve damage may occur. However,
CTS is quite treatable if diagnosed early.
order to understand CTS, it helps if you understand the anatomy of the carpal tunnel.
Conditions in many parts of the body can cause symptoms in the hands and fingers. In CTS,
the symptoms occur because a major nerve (median) is compressed as it passes through a
narrow tunnel of bone and ligament at the wrist. The result is numbness, tingling,
"pins & needles," burning, and pain in the middle and index fingers and
thumb, and sometimes in all five fingers.
Causes of Carpal Tunnel Syndrome:
conditions cause wrist structures to take up extra space in the carpal tunnel. Since bones
and ligaments have no "give," this puts pressure on the nerve, resulting in
Wear and Tear: The
synovium around the tendons may become thick and sticky due to the normal wear and tear of
the aging process or repetitive hand movements, thus pressing the nerve against the
Bone Dislocation &
Fracture: Previous dislocation or fracture of the wrist causes bone to
protrude into the tunnel. Arthritis may also be present. Consequently, the tunnel becomes
too narrow and puts pressure on the nerve.
(fluid retention) causes swelling of tissue in the carpal tunnel, including perhaps the
nerve itself. This occurs most often during pregnancy, with the symptoms subsiding after
Early Diagnosis: Accurate diagnosis is
important because treatment for this condition is specific for CTS. The sooner you have a
professional evaluation, the sooner your symptoms can be relieved, and the more likely it
is that permanent nerve or muscle damage will be prevented. For your evaluation, your
doctor or therapist will take a medical history followed by a physical exam; you may also
require special tests (Nerve Conduction, Electromyogram, or X-rays).
Physical Examination: The physical exam
helps confirm that symptoms are related to a nerve problem, and then to localize the nerve
problem to the wrist. Your doctor or therapist will examine your wrist for swelling and
signs of previous injury. You may be tested for decreased sensitivity to touch or to pin
pricks. Other simple nerve tests include Tinel's and Phalen's testing (see pictures
Other Tests: Your physician order
additional tests to confirm and document the diagnosis of CTS if surgery is being
considered. These include standard wrist or carpal tunnel x-rays, nerve
conduction test, or an electromyogram. These tests are objective and are used to
make a definitive diagnosis. Ask your doctor for details on each.
Test - Light tapping over the median nerve
will often reproduce symptoms of carpal tunnel syndrome in the hand & fingers.
Phalen's Test -
Patient's wrist is held in a flexed position for a period of time. Again, symptoms may be
repetitive hand activities may put you at higher risk for developing a variety of wrist
and hand problems such as carpal tunnel syndrome. By learning how to modify the way you
use your hands, you may be able to reduce the risk. Whenever possible, keep the following
pointers in mind at home and at the job, and be sure to follow your company's hand and
wrist policies and procedures.
||Left: Avoid using your wrist in a bent or twisted position for long
periods of time.
|Right: Instead, your hand should be "in-line" with your
Minimize Repetition: Even simple, light tasks may eventually lead to injury. If
possible, avoid repetitive movements or holding an object in the same way for extended
periods of time.
|Rest Your Hands: Periodically give your hands a break by letting them rest
briefly. Or you may be able to alternate easy and hard tasks, switch hands, or rotate work
|Reduce Speed and Force: Reducing the speed with which you do a forceful, repetitive
movement gives your wrist time to recover from the effort. Using power tools helps reduce
||Conditioning Exercises: Certain exercises strengthen the hand and arm muscles. They may
help by reducing the need to compensate for these weak muscles with a poor wrist position.
Through therapy, inflammation within the carpal
tunnel can be reduced, thus leading to relief from pain and discomfort. Certain
therapeutic techniques can also promote the healing process to occur at a rate faster than
normal. Your therapist will also show you all the appropriate stretches and exercises to
Medications are used to reduce swelling and
inflammation, and therefore ease pressure on the median nerve. Non-steroidal
anti-inflammatory drugs are taken orally as directed by your doctor. A steroid injection
from your doctor directly into the carpal tunnel may also be effective in reducing
|Custom Splinting: Through the use of custom splints the wrist is kept in neutral. Worn at
night custom splints can eliminate waking due to discomfort and/or pain. Custom splints
are preferred over prefabricated splints because they offer a perfect fit for each
individual. [Below: picture of a custom splint
fabricated by Columbus Physical Therapy.]
Surgery may be recommended if your symptoms
persist after conservative treatment (therapy, custom
splinting, medication) has failed to give results. It is last on the treatment list
and is used to avoid the possibility of developing permanent nerve damage. Your doctor or
therapist can fill you in on the details of surgery.
Prevention is the best treatment
for CTS, and there may be ways for you to reduce your risk at home and at work. Once
symptoms occur, it is important to seek medical attention immediately. Your doctor or
therapist can help you determine whether or not you are developing CTS. Early diagnosis
and treatment can mean early relief from the pressure, pain, and tingling of CTS. Taking
early action can help prevent the risk of permanent damage to your wrist. If you have
questions about CTS you may contact us here at Columbus Physical Therapy. Just click here to submit your questions. We will
reply through e-mail.