Managing Symptoms of Carpal Tunnel Syndrome

Carpal Tunnel Syndrome occurs when the small passageway that runs the length of the forearm to the palm compresses the median nerve.

What is carpal tunnel syndrome?

In the United States, carpal tunnel syndrome (CTS) is one of the most common upper extremity musculoskeletal disorders. CTS has an incidence of one to three people per thousand people annually and occurs ten times more often in women than men. Osteoarthritis (OA) is the most common form of arthritis.

The Centers for Disease Control and Prevention (CDC) cite the hand as the second most prevalent host for osteoarthritis. Both CTS and OA can be managed with conservative measures.

Recommended course: The Use of Physical Agents in Improving Range of Motion: An Evidenced Based Approach

Cause of carpal tunnel syndrome

CTS occurs when the small passageway that runs the length of the forearm to the palm compresses the median nerve. Swelling from a wrist fracture, arthritis, or repetitive everyday activities can cause the compression of the median nerve in the carpal tunnel. The cumulative effect of one or more activities can compress the median nerve and cause CTS. If left untreated, CTS can cause permanent nerve damage.

What are the symptoms of carpal tunnel syndrome?

CTS symptoms include:

• Hand, wrist, or forearm pain
• Numbness and/or tingling of the thumb, index, middle, and ring fingers of one or both hands
• Hand weakness
• Difficulty with finger coordination

How to prevent carpal tunnel syndrome

Although refraining from using your hands may not be an option, there are ways to prevent CTS. One way is by making minor environmental changes to your daily routine. Some of those small changes include:

• Creating an ergonomic workspace that reduces pressure on the median nerve. Find more information about workspace ergonomics here.
• Taking rest breaks that include hand and wrist stretches
• Alternate tasks to reduce repetitive movements
• Using a pillow to neutrally position your wrists while sleeping in the bed or using a neck pillow while sleeping on the train

Another option is to wear splints to keep the wrists neutral. Research shows that splinting can significantly relieve CTS symptoms after weeks of use. Research has also indicated that wearing a splint only at night is as effective as whole-day splinting.

Certified hand therapists (CHTs), such as occupational therapists (OTs) or physical therapists (PTs), can recommend and customize wrist splints for daily use.

Although OTs play a key role in the conservative care of CTS to prevent surgery, OTs can also provide other non-surgical and post-surgical interventions, such as recommending adaptive equipment. Adaptive equipment recommendations can include:

• Ergonomic pens
• Keyboard wrist cushion
• Enlarged handled eating and cooking utensils
• Equipment to modify leisure items such as golf clubs and baseball bats.

Causes of osteoarthritis

While the conditions are distinct, arthritis and carpal tunnel do share some symptoms. Osteoarthritis, or OA, is caused by the breakdown of tissue and cartilage in the joint. OA develops gradually over time. OA symptoms can include:

• Joint swelling
• Joint pain
• Joint stiffness

Recommended course: Conservative and Surgical Management of the Osteoarthritic Hand and Wrist, 3rd Edition

Exercise options

Clients with OA may hesitate to exercise when concerned about inflamed, unstable, or healing joints. Low-impact exercises such as swimming, walking, and biking help strengthen the muscles that support the joints.

Clients experiencing pain, or those whose full range of motion is contraindicated, may prefer isometric exercises. Isometric exercises can increase muscle strength without moving the joint through the full range of motion.

Using proper body mechanics

Proper body mechanics are important for protecting joints and preventing muscle injury to support the already compromised joints. Three meaningful ways to initiate proper body mechanics are:

1. Push instead of pulling an item
2. Lift with the knees
3. Carry items close to the body

Environmental modifications

Joint protection is vital to decrease the incidences of joint deformities and slow the progression of joint damage or carpal tunnel syndrome for clients. A client-centered approach to joint protection is modifying the environment to suit the needs and abilities of the client. Environmental modifications can include:

1. Place frequently used and heavy items where they can be retrieved from waist level.
2. To reduce neck strain, place items such as televisions, computer screens, or books at eye level to promote neutral neck positioning. This is an essential modification for a client that has spondylosis.
3. Use an ergonomic setup for the office.

Activity modifications

Activity modifications allow clients to engage in meaningful activities with less joint strain. Task modifications enable clients to participate in desired activities while protecting their joints. Here are a few easy ways to alter duties.

• Use the voice feature on the television remote control. This will decrease repetitive finger motions, sustained, controlled finger isolation, and improper wrist positioning.
• Use a stylus to push cell phone buttons and/or use the talk-to-text feature to send messages
• Include an activity break

Adaptive equipment

Adaptive equipment can assist clients with OA or carpal tunnel syndrome with self-care activities while reducing the workload for the joints.

• Enlarged handled eating and cooking utensils for meal prep and meals
• Use wheeled carts to transport groceries from the car to the house
• Use a stylus to push buttons on a remote or cell phone

Orthotics

The joints sometimes need additional reinforcement to keep them stable and prevent deformities. A client with arthritis may benefit from a ring splint to prevent a swan neck deformity in the finger joints. Ankle splints and wrist braces can help protect joints.

Non-conservative measures

There are numerous conservative measures to address the signs and symptoms of CTS and OA. However, clients and therapists may need to explore surgical options if CTS or OA cannot be managed with adaptive equipment, task modifications, or exercise.