 Physical therapy treatment for carpal tunnel first depends on whether you have had surgery or not. Non-surgical If you have not had surgery, the first thing a physical therapist will do is determine if all your symptoms are coming from the carpal tunnel. Carpal tunnel symptoms are usually numbness and tingling in the thumb, index, middle, and sometimes the ring finger. Other common complaints are hand swelling, sensation of pins and needles, pain at night, hand clumsiness, and hand weakness. It is also possible that the median nerve, the nerve that is compressed with carpal tunnel, is compressed at another location in the arm. This can be determined through a physical therapist’s exam as well. Once it is determined that your symptoms are related to carpal tunnel, the therapist can take some baseline measurements of your sensation and strength to track progress and to make sure your symptoms of nerve compression are not worsening. This also allows the therapist to screen and determine if or when you need to be further evaluated by a surgeon. One key for physical therapy is to start treatment early. The goal of any treatment of carpal tunnel is to decrease the pressure on the median nerve and therefore improve blood flow to the nerve. Therapy often begins with educating patients about night time splinting, tendon and nerve gliding exercises, posture, pain relieving modalities, and activity modifications including changes that can be made to the work place. When giving my patients splints, the most common questions I receive are what position should my wrist be in and how often do I need to wear them. Research recommends that the splint hold the wrist in neutral and that the patient needs to wear the splints every night. Splints are only needed during the day if you have numbness or tingling with work or daily tasks. The length of time you have to wear the splints really differs for each individual. Basically if you stop wearing your splints and the symptoms come back you need to start wearing your splints again. Surgical If you have had a carpal tunnel release, early physical therapy is also recommended. Once again the goal of treatment is to relieve pressure on the median nerve and improve blood flow. The surgeon does this by releasing the transverse carpal ligament that is lying over top of the nerve and increasing the space in the carpal tunnel where the nerve and tendons live. Physical therapy treatment after surgery will include education on care for your scar, decreasing swelling, decreasing sensitivity to light touch, tendon/nerve gliding exercises, and range of motion exercises for the forearm, wrist, and fingers. A common complaint after carpal tunnel surgery is pain along the base of the palm. A physical therapist can educate you about activities to avoid that increase this pain including weight bearing through the palm and gripping activities. As your healing progresses, your physical therapist will also teach you strengthening exercises to allow you to return back to normal daily and work activities. We typically recommend strengthening with something that is easily collapsible in your hand such as putty. Squeezing a stress ball is not something we would recommend. With return to work, some important points to keep in mind are to be cautious with repetitive use of the wrist and working with tools that cause a lot of vibration. Anti-vibration gloves might be helpful. Increasing the diameter of hand tools to 1.5- 2 inches in diameter is recommended. If you work in an office it is important to make some changes to your work station. These changes might include changing the position of your office chair, computer keyboard, monitor and mouse. If you believe you have carpal tunnel, seek treatment. Your physical therapist can evaluate you and determine the best course of treatment for your individual symptoms. He or she will also guide you about when you may need to consider surgery to prevent a permanent loss of sensation and strength.
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