Patient Guide: Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is a common disorder that arises due to compression of a nerve called the ‘median nerve’ at the wrist. The median nerve resides within the carpal tunnel (a ‘tunnel’ formed by the ‘carpal’ or wrist bones and a ligament of the wrist). This tunnel has very little space for its nerve, vessel, and tendon contents to pass through as the hand moves and flexes. For some individuals this space can become restrictive enough to compress the nerve thereby resulting in numbness and pain in the hand.

Numerous aggregating activities can provoke the onset of this syndrome, particularly repetitive wrist actions. Not surprisingly, this condition is common in heavy computer users. In addition to aggravating activities, various contributing factors including pregnancy can initiate a flare-up. Pregnant women often experience increased fluid retention and swelling in the extremities. As pregnant women retain fluid (usually in the later stages of pregnancy), this can increase the pressure in the wrist tunnel, thus compressing and irritating the median nerve, resulting in Carpal Tunnel Syndrome.

For severe cases of Carpal Tunnel Syndrome corticosteroid injections or surgery may be warranted. However, a variety of treatment options have been demonstrated to generate good results. These include Physiotherapy techniques such as splinting, manual therapy techniques, modalities such as acupuncture and ultrasound, and activity modification. Simple self-help measures outlined below can help reduce your risk of flare-ups and decrease symptoms.

Symptoms of Carpal Tunnel Syndrome:

• A sensation of numbness, tingling, burning pain, or dull ache felt in all or part of the wrist, palm of the hand, thumb, index, middle and ½ of the ring finger.
• Pain can be sharp with certain wrist movements or positions, and can radiate up the arm in some cases.
• Pain and numbness may be worse overnight, and may wake you from sleep.
• Some people experience weakness in their grip strength, or a clumsy feeling in the affected hand.
• Can affect one or both hands.
• Activities that may aggravate pain:  repetitive wrist movements, computer use including typing or mousing, falling asleep with wrists in a curled position.

Self-Help Treatment Tips for Carpal Tunnel Syndrome:

• Wear wrist braces specific for Carpal Tunnel Syndrome, which prevent flexing the wrists overnight while asleep (an aggravating position for nerve compression).
• Take frequent breaks from repetitive tasks involving the wrists and hands, such as computer work, mousing, cooking, cleaning, knitting, etc.
• Adjust your computer workstation so that the wrists are as close to flat as possible.
• Ice packs and anti-inflammatories may help to temporarily decrease symptoms.

Physiotherapy Treatment of Carpal Tunnel Syndrome:

• Physiotherapy modalities such as ultrasound or acupuncture to help reduce irritation in the carpal tunnel and of the compressed nerve.
• Nerve mobilization techniques to decrease and disperse inflammation surrounding the nerve and improve its flexibility as it travels through the neck, arm, and carpal tunnel.
• Postural education, especially for computer users, with a focus on neck and thoracic posture, as well as wrist position and overall workstation set-up.
• Education on wrist positions to avoid, and the use of wrist braces or taping techniques that prevent adopting aggravating wrist positions.
• Hands-on manual therapy techniques at the cervical spine if a nerve entrapment issue at the neck is found to be a contributing factor.
• Stretching and strengthening exercises to decrease muscular tightness and weakness in the forearm, wrist, hand, and postural muscles, which may be contributing to symptoms.