PT on the Net Research

Carpal Tunnel Syndrome


Question:

I have a client who has Carpal Tunnel Syndrome. Can you suggest any exercises to help?

Answer:

Your client should be seen by a medical provider to ensure proper diagnosis and treatment before participating in an exercise program.

Carpal Tunnel Syndrome (CTS) is known as a repetitive stress injury. The carpal tunnel is a narrow passageway in the palm by the wrist. Running through this area are tendons that bend the fingers and wrist and the median nerve. The median nerve provides sensation to the thumb, index, middle and half of the ring finger as well as motor function to the fingers, especially the thumb. Any condition that reduces the size of the carpal tunnel, increases the size of tissues within the tunnel and places pressure on the median nerve can predispose one to CTS. For example, fluid retention secondary to pregnancy, kidney failure, arthritis, obesity or menopause can increase risk. Changes in the median nerve due to diabetes and alcohol abuse can increase one’s vulnerability. Women are three times more likely to suffer than men. Also, heredity plays a factor in inherited characteristics such as the shape of one’s wrist. Thus, risk factors include poor posture, wrist alignment, vibration, repetition, increased force and temperature changes.

Signs and symptoms of CTS include the following:

CTS is often diagnosed through physical exam including the tests for Tinel's sign and Phalen's sign. For the Tinel’s test, the doctor taps or presses on the median nerve to elicit symptoms. The Phalen’s test involves having the patient hold her forearms upright with the fingers pointed downward, pressing the backs of the hands together to compress the nerve. An electromyogram (EMG) measures the tiny electrical discharges produced by muscles. This test indicates if muscle damage has occurred and can also indicate the severity of CTS.

Early diagnosis is essential so that proper treatment can be initiated. Treatment involves rest for at least two to six weeks and avoidance of activities that worsen symptoms. Certified hand therapists are specialists in this area. They can fabricate splints that immobilize the wrist (especially at night) in a neutral position. Splinting has a success rate of 37 percent. Splinting is more likely to help with mild or moderate symptoms for less than one year. Compared with a placebo, local corticosteroid injection provides symptomatic relief for up to one month and clinical improvement for up to three months. Over 70 percent of the people who receive an injection feel better.

The above are considered conservative treatments. If they fail, carpal tunnel release surgery is commonly recommended for those with symptoms lasting for six months. With a 75 percent success rate, surgery involves cutting the carpal ligament to make room for the nerves and tendons in the carpal tunnel. There are two types of surgery. Keyhole is done through endoscopic surgery leaving a small scar, while open release is performed via a traditional open operation.

There are no proven strategies to prevent CTS, but the following precautions should be followed:

Dr. Housang Seradge at the University of Oklahoma Orthopedic and Reconstructive Research Foundation recommends the following exercises for those with mild CTS symptoms. The purpose is to stretch the tight carpal tunnel area. If you have severe symptoms, please consult your physician as exercise may aggravate the condition. Do a quick warm up such as marching in place before the exercises. Be sure to exercise both hands.

  1. Extend and stretch both wrists and hands up towards you (palms facing down and away from you). Hold for five seconds, gradually increasing the time held. Repeat five to 10 times.
  2. Straighten both wrists to neutral and relax fingers.
  3. Make a tight fist with both hands and release. Repeat five to 10 times.
  4. Hold the fist and bend both wrists down. Hold for five seconds, gradually increasing the time held. Repeat five to 10 times.
  5. Straighten both wrists to neutral.
  6. Gently pull the thumb out and back as if hitch hiking and hold for five seconds. Repeat five to 10 times.
  7. Place hands together in front of the chest, hands together as if you are praying. Raise the elbows out to the side but keep the palms flat against each other. Hold for five to 10 seconds and release.
  8. Sit straight and place the right hand on top of the left shoulder. As you hold the shoulder down, bend your neck towards the right shoulder and hold for five to 10 seconds.
  9. Bring both shoulders up to your ears, then bring them around to the back as you squeeze your shoulder blades together with the shoulders down. Repeat five to 10 times.

Yoga has been found to be a useful type of exercise as it emphasizes stretches and postures that can open up tightened areas. In one trial involving 51 yoga participants, yoga was found to significantly reduce pain and increase grip strength after eight weeks. Iyengar style Yoga was practiced twice a week. The students performed a yoga sequence that stretched and strengthened the wrists, arms and shoulders. However, poses that place all of the weight on the wrists should be avoided (i.e., downward dog). Again, the wrists should be held in neutral as you perform the poses.

References:

  1. Bland, J. Treatment of carpal tunnel syndrome Muscle and Nerve 2007; 36 (2): 167-171
  2. Marshall, S., Tardiff, G.m et al. Local Corticosteroid injection for carpal tunnel syndrome Cochrane Database of Systematic Reviews 2007 Issue 2
  3. Piehl, J. Which Non- Surgical Treatments for Carpal Tunnel Syndrome Are Beneficial? American Family Physician 2003; 68 (4)