PT Tip of the Month

Carpal Tunnel Syndrome (CTS)

Carpal tunnel syndrome (CTS) is the most commonly reported nerve entrapment disorder of the upper extremity. The prevalence is reported as being 5.3% in women and 2.1% in men. CTS is one of the most common disorders of workers’ compensation costs as well as one of the top reasons for lost productivity and disability.

CTS is associated with localized compression and ischemia of the median nerve as it passes through the carpal tunnel. This results in sensory and motor deficits within the median nerve distribution. Open carpal tunnel release procedures lead to alleviation of symptoms 75-99% of the time. However, the potential complications associated with surgery are significant morbidity risks for these patients. Of the patients with failed primary surgical interventions, up to 12% may require a second surgery. Furthermore, persistent symptoms after a second surgery range from 25-95%. According to empirical evidence, most patients with CTS respond well with non-operative conservative treatments, and the American Academy of Neurology recommends conservative treatment of CTS before surgical intervention.

Anatomy

The carpal tunnel is a narrow passageway formed by bones and ligaments and located on the palmar side of the wrist. The tunnel consists of nine tendons that allow for the fingers to bend. The tunnel also consists of the median nerve, which when compressed, produces symptoms of numbness, tingling, pain, and weakness in the hand.

Risk Factors

Task-related risk factors include: jobs involving repetitive and forceful hand activity, jobs involving non-neutral wrist postures and hand-arm vibration activities, and sustained work activities (inability to take breaks). The most common cause of CTS is typing on a computer keyboard, however other causes include: assembly line work, painting, writing, playing racket sports, and playing musical instruments. CTS is often seen in people ages 30-60, with a higher incidence in women than men. Possible individual risk factors associated with CTS include: age, gender, body mass index (BMI), posture, pregnancy, and other medical conditions such as a thyroid disorder. Nerve damage resulting from diabetes or chronic alcoholism, can also damage the median nerve. Traumatic events, such as a wrist fracture, or a systemic disorder, like rheumatoid arthritis, can also irritate the median nerve and cause CTS.

Symptoms

Characteristic symptoms of CTS are pain, paresthesia, and numbness in the palm, thumb, index finger, middle finger, and thumb side of the ring finger. Pain may be localized in the wrist and hand, but may also sometimes radiate to the elbow. A person with CTS may find it difficult to perform fine motor and/or gripping activities. In long-term CTS, wasting away of the muscles under the thumb is also seen.

Treatment

Treatment of CTS involves manual therapy techniques to release tissue adhesions and increase wrist ROM, which helps to alleviate compression of the median nerve. Research indicates that joint mobilizations to the wrist carpal bones and median nerve mobilization and finger flexor tendon mobilization exercises are effective in restoring function of the wrist and hand. In-clinic, modalities such as paraffin or therapeutic ultrasound may be used. The use of a night splint may also be recommended. Your physical therapist will be able to suggest activity or workplace modifications as well. If you think you are experiencing signs and symptoms of carpal tunnel syndrome and would like to be scheduled for a physical therapy evaluation, please contact 617-232-PAIN (7246) for our Brookline office and 617-325-PAIN (7246) for our West Roxbury office.

References

  1. Burke J, Buchberger DJ, Carey-Loghmani T, Dougherty PE, Greco DS, Dishman JD. A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. J Manipulative Physiol Ther. 2007;30:50-61.
  2. Horng Y-S, Hsieh S-F, Tu Y-K, Lin M-C, Horng Y-S, Wang J-D. The comparative effectiveness of tendon and nerve gliding exercises in patients with carpal tunnel syndrome: a randomized trial. Am J Phys Med Rehabil. 2011;90:435-442.
  3. Huisstede BM, Hoogvliet P, Randsdorp MS, Glerum S, van Middelkoop M, Koes BW. Carpal tunnel syndrome. Part I: effectiveness of nonsurgical treatments–a systematic review. Arch Phys Med Rehabil. 2010;91:981-1004.
  4. Piazzini DB, Aprile I, Ferrara PE, et al. A systematic review of conservative treatment of carpal tunnel syndrome. Clin Rehab. 2007;21:299-314.

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33 Pond Avenue, Suite 107B Brookline, MA 02445 Tel: (617) 232-PAIN (7246) Fax: (617) 232-5196
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