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Carpal Tunnel Syndrome


Carpal 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.

carpal tunnel

In 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.

x-section of CT

Causes of Carpal Tunnel Syndrome:

Various 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 symptoms.

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 tunnel.

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:Edema (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 delivery.

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 below).

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.

Tinel's Test

Phalen's Test

Tinel's 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 duplicated.

Prevention: Certain 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.

Poor wrist posture

Left: Avoid using your wrist in a bent or twisted position for long periods of time.

Neutral wrist postion

Right: Instead, your hand should be "in-line" with your forearm.

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 activities.
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 the force. 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.


Therapy: 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 do. Medications: 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 inflammation.
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: 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.

wrist splint

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.


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