Written By: Adrienne Driggers Riveros, MOTR/L
So you have carpal tunnel syndrome…what now? You and your physician will decide whether conservative treatment will be effective or if surgery is necessary to relieve your symptoms. Either way, it is likely that you will encounter an occupational or physical therapist at some point during your recovery. This article will discuss carpal tunnel syndrome from a therapy perspective so that you, as a healthcare consumer, will be better able to understand various treatments and play an active role in the course of your recovery.
The carpal tunnel refers to a canal located at the base of the hand. It is bound on three sides by the carpal bones. The transverse carpal ligament covers the canal and can be thought of as the “roof” of the carpal tunnel. The tendons that flex your fingers and thumb pass through the carpal tunnel, in addition to the median nerve. As the carpal tunnel is unable to expand, inflammation or an injury to this area may cause pressure on the median nerve. If this occurs, some common symptoms you may experience are numbness, tingling, pain, and/or muscle weakness. You may also have difficulty in moving your thumb toward the base of the small finger, as this motor action is controlled by the median nerve. As these symptoms can have a profound effect on the performance of daily activities, the eventual result is usually a visit to the physician.
In determining the most appropriate course of treatment, many things will be taken into consideration by you and your physician:
- What is the severity of the condition?
- The severity of the condition is often affected by the length of time that the nerve has been compressed. If the compression is not relieved, symptoms can worsen over time, directly affecting your treatment options. If the condition is a result of a direct injury, such as falling on an outstretched wrist, the severity of the injury will vary.
- What caused the condition?
- Many factors can contribute to the symptoms of carpal tunnel syndrome and include, but are not limited to, the following:
- Repetitive stress (i.e. assembly line work)
- Trauma to the carpal tunnel itself (falling on an outstretched wrist; hitting wrenches with the heel of your hand during machine/mechanic work)
- Swelling in the area of the carpal tunnel (i.e. pregnancy)
- Prolonged hyperextended or hyperflexed positions of the wrist (i.e. sleeping with your wrist(s) in awkward positions)
- What previous treatments have been attempted?
- How is your overall health?
- What are the demands of your job/daily activities?
- What is your treatment preference?
With answers to the above questions in mind, either conservative or surgical treatment will be elected by you and your physician.
“Conservative treatment” refers to types of interventions that are non-invasive or those that are minimally invasive. Often times, a combination of these treatments will be attempted before surgery is considered. These types of interventions include, but are not limited to the following:
- Decreasing repetitive activity
- Activities that are repetitive in nature often put increased strain on the wrist. Decreasing the frequency or intensity of these activities can often reduce or even alleviate your symptoms.
- Night splinting is a common treatment in the early stages of carpal tunnel syndrome. If symptoms continue to get worse, splinting during the day may also be appropriate. The function of the splint or brace is to keep your wrist in a neutral position. This avoids the hyperextended or hyperflexed positions that strain the wrist and put pressure on the median nerve.
- Range of motion/nerve gliding exercises
- Exercises can be given for conservative treatment and after a surgical treatment to help relieve your symptoms. However, it is important that you are educated properly in the correct exercises for your personal condition. A physician or therapist should prescribe a home exercise program that is specific to your personal needs.
- Nonsteroidal anti-inflammatory drugs (NSAIDS)
- If your symptoms are a result of inflammation in the area of the carpal tunnel, anti-inflammatories may provide some relief. These should be taken under the direct supervision of your physician.
- Cortisone injections
- If splinting and other conservative treatments are not effective, a cortisone injection may provide symptom relief. The drug that is injected will help to decrease inflammation in the soft tissue and this will help to relieve pressure on the median nerve. Symptom relief can last up to 6 months and sometimes longer. These injections are administered by a physician.
“Surgical treatment” refers to the release of the transverse carpal ligament. The surgery itself is called a “carpal tunnel release.” Structurally, this allows for an expansion in the area of the carpal tunnel, thus decreasing the pressure on the median nerve. It is a relatively short, surgical procedure that is performed by a qualified surgeon. Common symptoms after surgery are pain, swelling, stiffness, and weakness. To manage these symptoms and guide your recovery, the physician will often send you for therapy.
Here at The Orthopaedic Institute, we have a specialized hand therapy center that currently staffs 5 occupational therapists that specialize in rehabilitation of the hand and upper extremity. No matter which course of treatment is chosen by you and your physician, our goal is to assist you through your recovery in a caring and professional manner. It is our mission to help you achieve the best possible outcome and resume your appropriate role in your normal daily activities.