Therapy is critical for treating carpal tunnel syndrome prior to and after surgery if surgery is deemed necessary. One in five people have carpal syndrome and have symptoms of pain, numbness, and tingling. Carpal tunnel can affect functioning at home, work, and during recreational activities. Learn ways to manage carpal tunnel syndrome with proper exercise, splinting, and education in modification of day-to-day activities.
Occupational therapy can be provided without and after surgery. It is usually provided on an outpatient basis by an occupational therapist (OT) who specializes in hand therapy.
Exercise is very important in the management of carpal tunnel syndrome. This helps reduce the pressure on the median nerve at the wrist and helps relieve symptoms. Some individuals may benefit from particular exercises that assist the median nerve to move more freely within the carpal tunnel. Also, exercises assist tendons to glide through the carpal tunnel, which can increase range of motion and functioning of the hand.
A typical exercise program for carpal tunnel lasts about three to four weeks and is continued at home on a maintenance basis. The individual should not feel any pain during any exercise, an increase in pain that does not improve or numbness that worsens. In these cases the patient should call their therapist.
Here are some of the exercises:
Wrist extension stretch
Keep your arm straight while bending your wrist back with your fingers pointing to the sky. The opposing hand is used to apply mild pressure across the palm until a gentle stretch is felt in the forearm. Hold the stretch for 15 seconds. After completing 15 repetitions complete the exercise on the opposite arm.
Wrist flexion stretch
Repeat the same exercise above but with the palm facing down and your fingers pointing to the ground. The two above exercises are warmups and should be done regularly throughout the day. Complete five repetitions, four times per day.
Before doing the three exercises below apply heat to the hand for 15 minutes and once finished apply a bag of crushed ice for 20 minutes. A bag of frozen peas is a good substitute.
Median nerve glides
Make a fist with the thumb on the outside. Move your wrist backwards with straight fingers and the thumb close to the fingers. Gently stretch the thumb outward. Do ten to 15 repetitions daily.
The wrist and fingers should be straight. Bend the last knuckle of the fingers into a hook position. Make a tight fist with the thumb over the fingers.
The wrist and fingers should be straight. Make a tabletop bending at the second knuckle. Keep the second knuckle straight and attempt to touch the palm. Hold the position in the above two exercises for three seconds, completing ten to fifteen repetitions progressing towards daily as tolerated.
The occupational therapist may also introduce exercises after carpal tunnel decompression to control swelling with range of motion and ultrasound and a paraffin bath to control pain. The OT may also work on scar management especially if they become sensitive and limit use of the affected hand.
The active range of motion exercises for the hand, fingers, wrist, and forearm also reduce edema without causing damage to the stitches or incision site. Hand strengthening exercises will become more robust as the incision heals. Squeezing and stretching therapeutic putty will be helpful, too.
The occupational therapist may create a splint to wear at night or during the day to keep the wrist in a proper position. With mild to moderate carpal tunnel syndrome a splint is worn at night to hold the wrist in a neutral position. This way the median nerve cannot be compressed.
Many people are prone to bend their wrists at night while sleeping and a splint prevents this from happening. These splints appear like fingerless gloves, which keep the wrist in a neutral, straight position. Splints ensure proper healing without the risk of injury following carpal tunnel decompression. Sometimes they are referred to as braces.
OTs focus on teaching their patient about activities that cause or aggravate carpal tunnel syndrome. They may work with patients who present with carpal tunnel syndrome or have had carpal tunnel decompression surgery.
Patients are taught to not overstretch or overuse their wrists as this can worsen symptoms. Activities that are repetitive put a strain on your wrist or that require extended grip all contribute to carpal tunnel syndrome and its symptoms. So, do activities that require strong pulling, pushing, tugging or twisting movements.
Recreational activities and carpal tunnel syndrome
Recreational activities like typing, knitting, crocheting and painting can all stress the wrist joint and potentially cause carpal tunnel syndrome or further aggravate it if you have it. Even holding your phone tightly as you type or read messages can lead to inflammation. Taking frequent breaks is critical. Stretching during activity is also important.
Poor posture with slumped shoulders can shorten the muscles in the shoulders and neck compressing nerves and further inflaming the wrists. It is important to take frequent rest breaks or build up the handle of the tool you are using to prevent a forceful grip. This can apply to a pen, a gardening trowel, even cutlery if it is a bad case of carpal tunnel.
According to the Fitzmaurice Hand Institute, many jobs have the potential to cause carpal tunnel syndrome.
The following are taken from that list.
Factory and assembly workers:
- Grasping or handling objects on conveyor belts
- Assembling small objects
- Using air-powered hand tools
- Hand weeding
- Using spray guns
- Pressing tools into hand
- Using spray guns
- Wearing poorly-fit gloves
- Using air-powered hand tools
- Using a bow to play stringed instruments such as a violin, viola or cello
Cashiers, receipt processors:
- Using laser scanner at checkout
- Pounding safety lever or stamping machine
Homemakers, tailors, garment workers:
- Grasping and tugging fabric
Locksmiths, electronics workers:
- Assembling small items
- Turning keys
These jobs need an individual, on-site ergonomic evaluation by an occupational therapist to assess specific problems that need to be addressed.
Carpal tunnel syndrome is very common, affecting 20% of the population. It tends to affect some jobs more than others. It causes tingling, numbness, and pain. These symptoms can become so intense that they affect a person’s ability to perform self-care, home management, recreation and work. Occupational therapists can assist a client to minimize or eliminate these symptoms or manage carpal tunnel post-surgery.
Occupational therapy is critical for treating carpal tunnel syndrome and it can minimize and even eliminate symptoms.
It is also necessary after carpal tunnel decompression if surgery is deemed necessary.
Carpal tunnel can affect how a person can function at home and work and during recreational activities.
There are many jobs that can cause carpal tunnel syndrome.
Carpal tunnel syndrome can be treated with proper exercise, splinting and education in modification of day-to-day activities.
Mayo Clinic. Carpal Tunnel Syndrome: Why go to Occupational Therapy.
Orthopaedic and Spine Center of the Rockies. How Occupational Therapy Can Help After Carpel Tunnel Surgery.
Motus Rehabilitation. Occupational Therapy for Carpal Tunnel.
Atroshi, I., Gummesson, C., Johnsson, R., et. al. (1999). Prevalence of Carpal Tunnel Syndrome in a General Population. JAMA.
InformedHealth.org. Carpel tunnel syndrome: Wrist splints and hand exercises.
Fitzmaurice Hand Institute. Which Jobs and Activities Increase Your Risk for Carpal Tunnel Syndrome?