Carpal tunnel syndrome is a phrase that most people have heard of from a friend or have experienced for themselves. In fact, 6.7% of the working U.S. population will experience carpal tunnel symptoms during their lifetime. The level of serverity of symptoms varies widely, but at its worst, carpal tunnel syndrome can require surgical intervention. It’s important to know how carpal tunnel syndrome is diagnosed, treatment options, and ways to avoid it.
To differentially diagnose carpal tunnel syndrome, the clinician is looking for the subjective and objective findings, during the initial evaluation, to coincide with the typical carpal tunnel presentation. Subjectively, a patient will report that they are experiencing pain and/or numbness/tingling into his palm and fingers; especially the thumb and first and second digits. The numbness and tingling occurs as the median nerve gets compressed in the wrist. Patients will report that they are experiencing diminished grip strength and the ability to complete fine motor tasks. This is again because the median nerve is part of the power supply to the muscles in the hand. Much like when a hose is kinked and water cannot flow out of the end, if the median nerve is pressed the power to move the muscles in the hand is also diminished. Sometimes patients will report that their hands go to sleep at night, which occurs from sleeping with their wrist bent and causing compression to the median nerve. Other times patients report that they get their symptoms with typing at their computer or while using the mouse.
Objectively, the clinician will use tests and measures to assess if the symptoms reported are consistent with carpal tunnel syndrome. The clinician will perform a grip test, with a dynamometer, to check strength of muscles in the forearm and hand. They will test for fatigable weakness in the muscles innervated by the median nerve. A specialist may also perform a nerve conduction study which will record the electrical impulse of the nerve and identify where the impulse is less and thus where the nerve is damaged. The clinician my also perform a Phalen’s test and Tinel’s test to try to illicit the same symptoms the patient is reporting. Finally, the clinician should also work up the chain to the forearm, shoulder, and neck as the median nerve could be compressed from other spots other than the wrist such as at the forearm from the pronator teres muscle or at the nerve root in the neck. Once multiple sites have been ruled out and the objective tests match the subjective reports of the patient, carpal tunnel syndrome can then be described as the most-appropriate diagnosis.
A physical therapist can help assist you if you are experiencing carpal tunnel syndrome. Treatment can first start with resting the affected wrist for a period of time. This can include immobilizing the wrist with use of a brace. Ice is often recommended to decrease any swelling that could be increasing the compression on the median nerve. Once the patient’s symptoms start to subside, the therapist will help progress return of full wrist motion and strength. Finally, the physical therapist will attempt to make sure that this situation does not happen again by identifying the activities that are being performed on a daily basis which are causing the median nerve to be compressed. This often entails an ergonomic assessment of the work-station. The therapist will give tips and special devices that will help keep the wrists in a neutral position when typing or using a mouse, and improve posture in sitting by adjusting the work chair or monitor height if necessary. If work is done without the use of a desk, the physical therapist can still make recommendations to the setting to reduce the chances of symptoms recurring.
It is vital to get carpal tunnel symptoms treated as soon symptoms start to appear. The longer one waits, the more damage can occur to the median nerve. Other treatment options include surgery if the patient has been experiencing symptoms for longer than 6 months. The surgeon may release the retinaculum of the wrist that creates the roof of the tunnel that the median nerve runs under. Though this does help improve symptoms most of the time, it also will decrease grip strength.
If you are experiencing any of the symptoms that are consistent with carpal tunnel syndrome, please contact your physical therapist to begin treatment.
1. Prevalence and work-relatedness of carpal tunnel syndrome in the working population, United States, 2010 National Health Interview Survey.
Luckhaupt, Sara E. Dahlhamer, James M. Ward, Brian W. Sweeney, Marie H. Sestito, John P. Calvert, Geoffrey M.