prevention and physiotherapy can make carpal tunnel syndrome bearable

Carpal tunnel syndrome (CTS) is a common condition that causes pain, numbness, and tingling in the hand and wrist. It occurs when the median nerve, which runs from the forearm through a narrow passageway in the wrist called the carpal tunnel, is compressed. The carpal tunnel is a small space in the wrist that is surrounded by bones and ligaments¹. The median nerve provides feeling to the thumb, index finger, middle finger, and half of the ring finger.

Common symptoms of carpal tunnel syndrome include:

• Numbness in the wrist, hand, or fingers, especially the fingertips¹.
• Pain in the wrist, hand, or fingers¹.
• Tingling sensation¹.
• Weakness in the hand, making it difficult to grip objects or perform fine motor tasks¹.

Carpal tunnel syndrome usually develops slowly. You might first notice symptoms at night, such as wrist pain or tingling that are intense enough to wake you up¹. Over time, the symptoms may start affecting you during the day, especially if you do the same kind of motion a lot at work, like typing, writing, or using tools¹.

Carpal Tunnel Syndrome and Technology

While workplace factors are important, carpal tunnel syndrome is often linked to underlying medical conditions and lifestyle factors, including the use of technology³. Extensive computer use has not been definitively linked to carpal tunnel syndrome, but some evidence suggests that mouse use may be a contributing factor⁵. Excessive smartphone use has also been shown to increase the risk of CTS⁴.

One study found that the risk of CTS increased by 1.292 times with every hour increase in daily smartphone use⁶. Another study found that those who used their smartphones for more than 5 hours a day had more negative effects on the median nerve⁷. Holding a smartphone with both hands was also found to increase the risk of developing CTS⁷.

Carpal Tunnel Syndrome and Remote Work

The rise of remote work, particularly since the COVID-19 pandemic, has brought about new considerations for carpal tunnel syndrome⁸. With more people working from home, it's essential to create an ergonomic workspace to minimize the risk of developing or aggravating CTS symptoms¹⁰.

Studies have shown an increase in musculoskeletal injuries, including carpal tunnel syndrome, since the pandemic, partly due to poor posture and non-ergonomic workspaces at home¹¹. Office ergonomics focuses on how a workstation is set up, including the placement of your desk, computer monitor, paperwork, chair, and associated tools, such as a computer keyboard and mouse¹².

Modern workplace ergonomics focuses on reducing the effort required to complete tasks, improving posture, and minimizing repetitiveness¹³. This can involve adjusting your chair and desk height, using ergonomic accessories, taking frequent breaks, and performing hand exercises¹⁴.

It's also important to be aware of the "coming and going rule" and its implications for workers' compensation claims for remote workers¹⁰. This rule generally states that injuries sustained during a regular commute to and from a workplace are not compensable, but there are exceptions when the home becomes a secondary workplace.

Carpal Tunnel Syndrome and Sports

Carpal tunnel syndrome can also affect athletes, particularly those involved in sports that require repetitive hand and wrist movements or forceful gripping¹⁵. Some examples include gymnastics, cycling, tennis, and golf¹⁵.

Athletes may experience numbness, tingling, pain, and/or weakness in the hand, particularly during or after activity and at night¹⁵. Sports medicine professionals can play a crucial role in diagnosing, treating, and preventing carpal tunnel syndrome in athletes¹⁶.

Treatment for athletes typically involves rest, and further medical intervention is often unnecessary¹⁵. Wrist splints may be worn at night to help with nerve healing¹⁵. Simply adding padding to equipment can also help¹⁵.

Causes and Risk Factors for Carpal Tunnel Syndrome

Carpal tunnel syndrome happens when something irritates or puts extra pressure on the median nerve that runs through your carpal tunnel¹. Anything that reduces the amount of space in the carpal tunnel or increases the size of the tissues within the tunnel can lead to carpal tunnel syndrome⁵. Some common causes include:

• Repetitive hand motions: Repeating the same hand and wrist motions over a prolonged period may aggravate the tendons in the wrist, causing swelling that puts pressure on the nerve².
• Awkward hand and wrist positions: Maintaining extreme flexion or extension of the hand and wrist for an extended time can increase pressure on the median nerve².
• Health conditions: Diabetes, rheumatoid arthritis, and thyroid gland imbalance are associated with carpal tunnel syndrome².
• Pregnancy: Hormonal changes during pregnancy can cause swelling, leading to pressure on the nerve in the carpal tunnel².
• Heredity: Some people have smaller carpal tunnels, which can be hereditary².
• Wrist injuries: A wrist fracture or dislocation, or swelling and inflammation from conditions like rheumatoid arthritis, can narrow the carpal tunnel and irritate the nerve⁵.

While workplace factors have been explored, most studies indicate that CTS is primarily associated with medical or physical conditions³. Some of these conditions include:

• Diabetes: High blood sugar levels can damage nerves, including the median nerve⁵.
• Osteoarthritis: Changes in the small bones of the wrist due to osteoarthritis can affect the carpal tunnel and put pressure on the median nerve¹⁷.
• Hypothyroidism: An underactive thyroid gland can cause fluid retention and swelling, which can compress the median nerve⁵.
• Obesity: Being overweight or obese increases the risk of carpal tunnel syndrome⁵.
• Kidney failure: Kidney problems can lead to fluid retention and swelling, which can affect the carpal tunnel¹⁷.
• Lymphedema: This condition causes swelling in the arms and legs, which can put pressure on the median nerve⁵.

It's important to note that carpal tunnel syndrome can sometimes improve on its own with rest, especially if you avoid repetitive motions with your wrists¹. However, it's more likely that carpal tunnel syndrome won't heal without proper diagnosis and treatment.

Diagnosing Carpal Tunnel Syndrome

Diagnosing carpal tunnel syndrome typically involves a combination of a physical exam, reviewing your medical history, and electrodiagnostic tests¹⁸. The pattern of your symptoms is important in making a diagnosis¹⁹. Carpal tunnel syndrome symptoms usually occur while holding a phone or a newspaper, gripping a steering wheel, or at night, waking you from sleep¹⁹. You may also notice numbness when you wake up in the morning¹⁹. The median nerve doesn't provide sensation to the little finger, so if you have symptoms in that finger, you may have a condition other than carpal tunnel syndrome¹⁹.

Physical Examination 

Your physical therapist will conduct a thorough examination of your wrist, hand, and arm, checking for:

• Personal characteristics: Age, sex, weight, and height¹⁸.
• Range of motion: How well your hand and wrist move¹⁸.
• Physical signs: Any deformity, swelling, atrophy, or skin changes¹⁸.
• Strength: Pinch and grip strength¹⁸.
• Sensation: Testing for changes in feeling in your fingers¹⁸.
• Provocative tests: These tests, such as Phalen's test and Tinel's sign, try to reproduce your symptoms¹⁸.

Electrodiagnostic Tests

Electrodiagnostic tests measure the electrical activity in your nerves and muscles. These tests help your doctor determine if you have carpal tunnel syndrome or something else¹⁹. They can also rule out other conditions and gauge the severity of CTS²⁰. The two main types of electrodiagnostic tests used to diagnose carpal tunnel syndrome are:

• Nerve conduction studies: This test measures how fast electrical impulses travel along a nerve. In carpal tunnel syndrome, the electrical impulses are slowed down as they pass through the carpal tunnel¹⁹.
• Electromyography (EMG): This test measures the electrical activity in muscles. In carpal tunnel syndrome, the muscles in the hand may show signs of damage from the compressed nerve¹⁹.

It's important to note that your doctor will not routinely use new technologies like MRI or CT scans for diagnosis¹⁸. However, an MRI can provide a better view of the median nerve²¹.

Treatment Options for Carpal Tunnel Syndrome

Treatment for carpal tunnel syndrome depends on the severity of your symptoms and your individual preferences²². In many cases, conservative treatments such as splinting, physiotherapy, and activity modification can be effective.

Physiotherapy

Physiotherapy is often recommended for carpal tunnel syndrome. A physical therapist can help you:

• Reduce pain and inflammation: Modalities such as ice, heat, and ultrasound may be used to reduce pain and inflammation²⁴.
• Improve range of motion: Stretching and flexibility exercises can help to improve the range of motion in your wrist, hand, and fingers²⁴.
• Strengthen muscles: Strengthening exercises can help to improve the strength of the muscles in your hand, wrist, and forearm²⁴.
• Improve posture: Your physical therapist can assess your posture and provide guidance on how to improve your posture to reduce strain on your wrists²⁴.
• Develop an ergonomic work environment: An ergonomic assessment of your workspace can help to identify and modify risk factors that may be contributing to your carpal tunnel syndrome²⁴.
• Educate you on safety precautions: Your physical therapist will teach you about safety precautions when using sharp objects due to potential changes in your sensation²⁵.
• Use dry needling: This technique may be used to treat pain and movement impairments²⁵.

Non-Surgical Treatments

• Splinting: Wearing a splint, especially at night, can help to keep your wrist in a neutral position and reduce pressure on the median nerve¹. Different types of splints are available, including those that keep the metacarpophalangeal joint in extension²⁶.
• Medications: Over-the-counter pain relievers such as ibuprofen or naproxen can help to reduce pain and inflammation. In some cases, your doctor may prescribe corticosteroid injections to reduce inflammation¹.
• Activity modification: Avoiding activities that worsen your symptoms can help to reduce pain and prevent further nerve damage¹.
• Yoga: Some studies have shown that yoga can be effective in reducing pain and improving function in people with carpal tunnel syndrome²³.
• Carpal bone mobilization: This is a manual therapy technique that involves moving the bones in the wrist to improve nerve mobility and reduce pressure on the median nerve²³.

Minimally Invasive Surgical Treatments

Minimally invasive surgical techniques are increasingly being used to treat carpal tunnel syndrome²⁷. These procedures offer faster recovery and reduced complications compared to traditional open surgery.

• Endoscopic carpal tunnel release: This procedure involves making one or two small incisions in the wrist and using an endoscope to cut the transverse carpal ligament²⁹.
• Ultrasound-guided carpal tunnel release: This technique uses ultrasound imaging to guide the surgeon during the release of the transverse carpal ligament. It can be performed with local anesthesia in an outpatient setting²⁸.
• Thread ultrasound-guided carpal tunnel release (TCTR): This newer, incisionless treatment uses an abrasive thread looped percutaneously to dissect the transverse carpal ligament²⁷.

Open Carpal Tunnel Release Surgery

If non-surgical treatments are not effective, your doctor may recommend carpal tunnel release surgery. This procedure involves making an incision in the palm of your hand and cutting the transverse carpal ligament to relieve pressure on the median nerve².

Effectiveness of Carpal Tunnel Syndrome Treatments

Studies have shown that both non-surgical and surgical treatments can be effective for carpal tunnel syndrome. The choice of treatment depends on the severity of your symptoms and your individual preferences.

Long-term outcomes research generally indicates that open carpal tunnel release surgery is an effective treatment method. Clinical success is shown to occur at a rate of 75–90%, while recurrence is reported in 4–57% of cases³⁰.

Telemedicine and Carpal Tunnel Syndrome 

Telemedicine can be used for the diagnosis and postoperative management of carpal tunnel syndrome³³. This allows patients to receive care remotely, which can be particularly helpful for those who have difficulty traveling to a clinic.

However, there are challenges and opportunities in using telemedicine for hand and wrist examinations, particularly the sensory examination³⁴. Tactile sensation, two-point discrimination tests, and nerve distribution patterns can be challenging to assess remotely.

Preventing Carpal Tunnel Syndrome

While there are no guaranteed ways to prevent carpal tunnel syndrome, you can take steps to reduce your risk:

• Maintain a healthy lifestyle: Manage health conditions like diabetes, obesity, and arthritis³⁵.
• Practice good posture and ergonomics: Keep your wrists straight and avoid awkward positions. When using a keyboard, do not bend your wrists all the way up or down. A relaxed middle position with the wrists parallel to the floor is best. Keep your keyboard at elbow height or slightly lower⁵.
• Take breaks and stretch: Give your hands and wrists a rest from repetitive motions³⁵.
• Reduce your force and relax your grip: Avoid excessive force when typing or using tools³⁵.
• Keep your hands warm: Cold temperatures can worsen symptoms³⁵.

Conclusion

Carpal tunnel syndrome is a common condition that can cause pain, numbness, and tingling in the hand and wrist. Early diagnosis and treatment are essential to prevent permanent nerve damage. A variety of treatment options are available, including splinting, physiotherapy, and surgery. By taking steps to reduce your risk and seeking medical attention if you experience symptoms, you can effectively manage carpal tunnel syndrome and maintain a good quality of life.

As Dr. Foret emphasizes, "If we can diagnose early, there are more options for non-surgical treatment, and we can hopefully avoid permanent damage of the median nerve, which can lead to loss of grip strength." ³⁷ Dr. Jones adds, "The key to a quick recovery from carpal tunnel syndrome is treatment upon the onset of symptoms. The longer an employee puts off seeing a doctor, the more potential for nerve damage, which leads to a longer recovery and a higher probability of needing surgery." ³⁸

If you are experiencing symptoms of carpal tunnel syndrome, contact CK Physiotherapy for a personalized assessment and treatment plan. Our experienced physiotherapists can help you manage your symptoms and regain function in your hand and wrist.

Frequently Asked Questions About Carpal Tunnel Syndrome

What is the difference between carpal tunnel syndrome and tendonitis?

While both conditions can cause wrist pain, carpal tunnel syndrome (CTS) and tendonitis are distinct conditions. CTS is caused by compression of the median nerve in the carpal tunnel, while tendonitis is inflammation of the tendons that connect muscles to bones in the wrist. CTS typically causes numbness and tingling in the thumb, index, middle, and half of the ring finger, while tendonitis may cause pain throughout the wrist and hand.  

Can carpal tunnel syndrome affect my ability to drive?

Yes, carpal tunnel syndrome can affect your ability to drive. Numbness and tingling in the hands and fingers can make it difficult to grip the steering wheel and control the car. In severe cases, CTS can cause weakness in the hand muscles, making it challenging to turn the steering wheel or use the handbrake. If you experience CTS symptoms while driving, it's important to seek medical attention and consider using adaptive devices or modifying your driving habits to ensure safety.  

How long will it take to recover from carpal tunnel syndrome?

Recovery time after carpal tunnel release surgery varies depending on the surgical technique used and individual factors. Endoscopic carpal tunnel release generally allows for a faster recovery compared to open surgery. Patients typically experience some soreness and stiffness in the wrist after surgery, but most can return to normal activities within a few weeks. Full recovery, including regaining full strength and sensation, may take several months.  

Can carpal tunnel syndrome affect my mental health?

Yes, carpal tunnel syndrome can indirectly affect your mental health. Chronic pain, sleep disturbances, and limitations in daily activities can contribute to stress, anxiety, and depression. It's important to address both the physical and emotional aspects of CTS to ensure a full recovery and maintain a good quality of life.  

What are some therapies for carpal tunnel syndrome?

In addition to conventional treatments, some people find relief from carpal tunnel syndrome through alternative therapies such as yoga, acupuncture, and chiropractic care.

Can I still play sports if I have carpal tunnel syndrome?

Yes, you can often still play sports with carpal tunnel syndrome, but you may need to modify your activities or take precautions to manage your symptoms. Avoiding activities that worsen your symptoms, using proper equipment, and taking breaks can help prevent further injury. If you're an athlete with CTS, it's essential to consult with a sports medicine professional or physical therapist for guidance on safe participation.  

What is the long-term outlook for carpal tunnel syndrome?

With proper treatment, the long-term outlook for carpal tunnel syndrome is generally good. Many people experience significant improvement or complete resolution of their symptoms. However, some people may have persistent symptoms or require ongoing management. Early diagnosis and treatment are crucial to prevent permanent nerve damage and maintain hand function.  

Where can I find reliable information about carpal tunnel syndrome?

Reliable information about carpal tunnel syndrome can be found from various sources, including medical websites(Mayo Clinic, Cleveland Clinic, and Johns Hopkins Medicine), professional organizations (American Academy of Orthopaedic Surgeons (AAOS) and the Chartered Society of Physiotherapy (CSP), government health agencies (National Institutes of Health or NIH and NHS), and peer-reviewed medical journals. 

Works cited

1. Carpal Tunnel Syndrome: Symptoms, Causes & Treatment - Cleveland Clinic, accessed on February 14, 2025, https://my.clevelandclinic.org/health/diseases/4005-carpal-tunnel-syndrome
2. Carpal Tunnel Syndrome - OrthoInfo - AAOS, accessed on February 14, 2025, https://orthoinfo.aaos.org/en/diseases--conditions/carpal-tunnel-syndrome/
3. Carpal tunnel syndrome Information | Mount Sinai - New York, accessed on February 14, 2025, https://www.mountsinai.org/health-library/report/carpal-tunnel-syndrome
4. pmc.ncbi.nlm.nih.gov, accessed on February 14, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC9791704/#:~:text=In%20conclusion%2C%20the%20increase%20in,as%20a%20CTS%20risk%20factor.
5. Carpal tunnel syndrome - Symptoms and causes - Mayo Clinic, accessed on February 14, 2025, https://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/symptoms-causes/syc-20355603
6. The relationship between carpal tunnel syndrome, smartphone use, and addiction: A cross-sectional study - PMC, accessed on February 14, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC9791704/
7. Can Using Your Phone Cause Carpal Tunnel? - Healthline, accessed on February 14, 2025, https://www.healthline.com/health/carpal-tunnel-from-phone
8. Effects of the COVID-19 Pandemic on Hand and Arm Dysfunction: A Google Trends Analysis, accessed on February 14, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC11246766/
9. Working From Home? Here's the Best Ways to Avoid Carpal Tunnel Syndrome, accessed on February 14, 2025, https://www.curepain.net/blog/working-from-home-heres-the-best-ways-to-avoid-carpal-tunnel-syndrome
10. Workers' Comp for Remote Employees: Here's What You Need to Know | Woodruff Sawyer, accessed on February 14, 2025, https://woodruffsawyer.com/insights/workers-comp-remote-employees
11. Here's how to update your home office to avoid costly pain - Star Tribune, accessed on February 14, 2025, https://www.startribune.com/home-office-ergonomic-work-pain-remote-carpal-tunnel/601165595
12. Wrist Care: Preventing Carpal Tunnel Syndrome, accessed on February 14, 2025, https://wa.kaiserpermanente.org/kbase/topic.jhtml?docId=tn9041
13. Ergonomics and Orthopedic Solutions in the Workplace, accessed on February 14, 2025, https://midamortho.com/workers-health-ergonomics-and-orthopedic-solutions-in-the-workplace/
14. Carpal Tunnel at Work? Tips for Ergonomic Relief and Treatment | The Bone & Joint Center, accessed on February 14, 2025, https://www.bone-joint.com/carpal-tunnel-at-work-tips-for-ergonomic-relief-and-treatment/
15. CARPAL TUNNEL SYNDROME - Sports Medicine Today, accessed on February 14, 2025, https://www.sportsmedtoday.com/carpal-tunnel-syndrome-va-27.htm
16. Carpal Tunnel Syndrome - Emerald Coast Sports Medicine, accessed on February 14, 2025, https://www.ecsportsmed.com/conditions/carpal-tunnel-syndrome
17. Is carpal tunnel genetic? - MedicalNewsToday, accessed on February 14, 2025, https://www.medicalnewstoday.com/articles/is-carpal-tunnel-syndrome-genetic
18. Diagnosis of Carpal Tunnel Syndrome - PMC, accessed on February 14, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC5175465/
19. Carpal tunnel syndrome - Diagnosis and treatment - Mayo Clinic, accessed on February 14, 2025, https://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/diagnosis-treatment/drc-20355608
20. Carpal Tunnel Syndrome: Diagnosis and Management - AAFP, accessed on February 14, 2025, https://www.aafp.org/pubs/afp/issues/2016/1215/p993.html
21. Diagnosing Carpal Tunnel Syndrome - NYU Langone Health, accessed on February 14, 2025, https://nyulangone.org/conditions/carpal-tunnel-syndrome/diagnosis
22. Carpal Tunnel Syndrome | Johns Hopkins Medicine, accessed on February 14, 2025, https://www.hopkinsmedicine.org/health/conditions-and-diseases/carpal-tunnel-syndrome
23. Non‐surgical treatment (other than steroid injection) for carpal tunnel syndrome - PMC, accessed on February 14, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC6486195/
24. Physical Therapy Guide to Carpal Tunnel Syndrome - Choose PT, accessed on February 14, 2025, https://www.choosept.com/guide/physical-therapy-guide-carpal-tunnel-syndrome
25. Physical Therapist's Guide to Carpal Tunnel Syndrome, accessed on February 14, 2025, https://www.myactionpt.com/physical-therapist-s-guide-to-carpal-tunnel-syndrome
26. Current options for nonsurgical management of carpal tunnel syndrome - PMC, accessed on February 14, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC2871765/
27. New approaches to carpal tunnel release and treatment of tendinopathy - Mayo Clinic, accessed on February 14, 2025, https://www.mayoclinic.org/medical-professionals/physical-medicine-rehabilitation/news/new-approaches-to-carpal-tunnel-release-and-treatment-of-tendinopathy/mac-20521546
28. Minimally Invasive Ultrasound-Guided Carpal Tunnel Release Improves Long-Term Clinical Outcomes in Carpal Tunnel Syndrome | AJR - American Journal of Roentgenology, accessed on February 14, 2025, https://www.ajronline.org/doi/10.2214/AJR.20.24383
29. What is the Latest Treatment for Carpal Tunnel? - Comprehensive MD, accessed on February 14, 2025, https://comp-md.com/what-is-the-latest-treatment-for-carpal-tunnel/
30. Long-term outcomes of carpal tunnel release: a critical review of the literature - PMC, accessed on February 14, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC3418353/
31. Surgical versus non‐surgical treatment for carpal tunnel syndrome - Lusa, V - 2024, accessed on February 14, 2025, https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001552.pub3/abstract
32. Carpal Tunnel Syndrome: Physical Therapy or Surgery? | Journal of Orthopaedic & Sports ... - jospt, accessed on February 14, 2025, https://www.jospt.org/doi/10.2519/jospt.2017.0503
33. Evaluation of a Comprehensive Telemedicine Pathway for Carpal Tunnel Syndrome: A Comparison of Virtual and In-Person Assessments - PubMed, accessed on February 14, 2025, https://pubmed.ncbi.nlm.nih.gov/34756618/
34. The Hand and Wrist Examination for Video Telehealth Encounters - PMC - PubMed Central, accessed on February 14, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC8077990/
35. Wrist Care: Preventing Carpal Tunnel Syndrome - MyHealth Alberta, accessed on February 14, 2025, https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=tn9041
36. Carpal Tunnel Syndrome Prevention Strategies: Tips to Relieve Pain and Avoid Surgery, accessed on February 14, 2025, https://www.benchmarkpt.com/blog/carpal-tunnel-syndrome-prevention-strategies-tips-to-relieve-pain-and-avoid-surgery/
37. Carpal Tunnel Syndrome Patient Testimonial - Lake Charles, LA & Moss Bluff, LA: Center for Orthopaedics, accessed on February 14, 2025, https://www.centerforortho.com/contents/about/patient-stories/carpal-tunnel-syndrome-patient-testimonial
38. Carpal Tunnel Syndrome in the Workplace - OrthoAtlanta, accessed on February 14, 2025, https://www.orthoatlanta.com/media/carpal-tunnel-syndrome-in-the-workplace