Waking at night with a numb hand? Fingers go to sleep when driving? Burning or shooting pain up your arm? Weak grip? You might be suffering from carpal tunnel syndrome. Hand therapy can have significant benefits for pain reduction, a better night sleep and increased ability to use the hand as normal.

What is carpal tunnel syndrome?

Carpal tunnel syndrome is a condition resulting from poor nerve function and is caused by pressure on the median nerve as it passes through a tunnel at the wrist – the carpal tunnel! People commonly complain of pain, numbness and a tingling which often worsens at night time causing them to wake up frequently. You may also experience poor finger dexterity and sometimes reduced grip strength.

What causes carpal tunnel syndrome?

Pressure may develop within the carpal tunnel for several reasons. A common cause is from inflamed tendons or tendon sheaths which pass through the tunnel alongside the median nerve. Repetitive wrist and finger movements may inflame the tendons as they glide through the tunnel. Another cause for the pressure is fluid retention during pregnancy. Yet another cause is arthritis or wear and tear on the bones in and around the wrist which may change the shape and space of the carpal tunnel.

How do I know if I have carpal tunnel syndrome?

There are several clinical tests that therapists use to determine whether someone has carpal tunnel syndrome.  The tests focus on assessing the integrity of the median nerve as it passes through the wrist at the carpal tunnel. Hands on assessments are also important to rule out other causes of the symptoms such as compression or referred pain from the elbow, neck or shoulder. We quite frequently see patients who believe that they have carpal tunnel syndrome, when after thorough testing we determine that this is not the case.

What makes carpal tunnel syndrome worse?

Your symptoms may worsen if you grip a lot during the day or repetitively move your fingers and wrist. The position of your wrist may also play a role – if you have your wrist bent forwards or backwards the median nerve may not function as well causing more pain, numbness, and tingling. This is because the median nerve gets squashed in the carpal tunnel when your wrist is bent forwards or backwards. Activities that commonly aggravate carpal tunnel include repetitive tool use, gripping tasks, driving, holding a book, mouse/computer work.

What makes carpal tunnel syndrome better?

It almost every case we see hand therapy can have significant benefits for pain reduction, a better night sleep and increased ability to use the hand as normal. Hand therapy strategies may include splinting / bracing / strapping to maintain a straight wrist position which prevents ongoing compression of the nerve; exercises to help the tendons and nerves to glide easily through the hand, wrist and arm, paraffin wax bath treatments and hands on massage techniques to the hand, wrist and forearm can further reduce pain. Once the carpal tunnel symptoms have settled your hand therapist may provide strengthening exercises to help you regain grip. 

What if I need surgery?

The aim of hand therapy for carpal tunnel syndrome is to avoid the need for surgery, however in certain cases our therapist may recommend you have a carpal tunnel release. During a carpal tunnel release surgery, the transverse carpal ligament is cut, which releases pressure on the median nerve and relieves the symptoms of carpal tunnel syndrome. After the ligament is cut, the skin is closed with stitches. The gap where the ligament was cut is left alone and eventually fills up with scar tissue. Following surgery, hand therapy aims to facilitate healing and recovery and may include wound care, scar management, gloves or bandages to prevent and control swelling, gentle mobilisation, advice regarding movements and actions to avoid and finally, strengthening at the appropriate point following your operation. 

Image credit - Dr Lauren Squires