One of the fastest growing diagnoses in the country, Carpal Tunnel Syndrome affects millions of Americans each year.
Symptoms of carpal tunnel syndrome include both motor and sensory changes in the thumb and first two fingers. Most patients have moderate to severe pain, often preventing them from getting a full night's sleep. Strength loss, which is common in chronic cases will make opening jars, holding a plate of food, grasping the handlebars on a bike or writing with a pen nearly impossible.
In CTS, the median nerve that passes through the tunnel in the wrist is compressed. Compression of this nerve causes a patient to have pain, sensation changes and, in severe cases, loss of motor strength. The median nerve is extremely sensitive to even the smallest amount of pressure. Whether the compression originates from scar tissue inside of the tunnel or thickening of wrist tendons (from overuse) outside of the tunnel, the result is the same.
In order to treat CTS, your physical therapist must know the mechanism of injury as there are many ways to acquire the condition. Cashiers, clerks and people who use computers are at high risk whereas people that do not repetitively use their wrists, change positions frequently and demonstrate proper ergonomics are at low risk.
If left untreated, carpal tunnel syndrome may cause permanent loss of function. This is seen in patients who have atrophy or withering (shrinking) of the large muscle of the thumb. In these cases, it is extremely important for a patient to seek medical attention because the disease is beginning to do irreparable damage.
There are a number of treatment options, both surgical and non-surgical, for carpal tunnel syndrome. First-line defense is to wear a brace that prevents bending and extending the wrist. Repeated movement of the wrist adds to tunnel compression — the origin of symptoms. When the wrist is kept in a neutral position, the inflammation is reduced and eventually dissipates.
It is especially important to wear the brace at night. During the night, we curl the covers and our wrists to 'snuggle in.' Several consecutive hours of sustained compression multiplies the damage done to the nerve.
Occasionally, the cause of carpal tunnel originates higher up in the arm. A physical therapist will inspect your entire arm and neck to ensure no tight spots are overlooked. While infrequent, some cases of carpal tunnel syndrome are resolved with neck and arm mobilization and manipulation. If this is the case, a physical therapist can design a home program focusing on alleviation of stiffness and regaining strength, often sparing a patient a lot of pain.
The success rate of carpal tunnel release surgery is amazingly high. While almost all outcomes are associated with pre-injury status, recovery after surgery is often difficult, and patients should not expect full use of their hand for at least two months. Patients that have lost the bulk of their thumb muscle or rate their pain as a five out of ten or higher should consider surgery mandatory to salvage use of their hand.
There are three examination techniques you can try at home to help you decide if you need medical attention. These tests are used by physicians and physical therapists alike and can effectively rule in CTS without the need for additional tests such as an MRI. Anyone who tests positive in each test should strongly consider seeing a physical therapist.
If caught in time, your therapist can prevent carpal tunnel syndrome from spiraling out of control. If your symptoms match the description in this article, see a PT soon.
Joe DiVincenzo is a physical therapist and clinical specialist in manual therapy. He works in the outpatient division of Beverly Hospital and writes "On the Mend" weekly.¬ Questions may be submitted to On the Mend, c/o Salem News, 32 Dunham Road, Beverly, MA 01915 or e-mail firstname.lastname@example.org.