In this blog, I’m going to tell you everything you need to know about managing carpal tunnel syndrome.
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What Is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is a condition where symptoms in the hand occur due to the compression or irritation of the median nerve. This nerve is formed around your armpit (from nerves that originate in your neck) and runs down your arm into your hand through a narrow passage in the wrist called the carpal tunnel.
The median nerve provides sensation to your thumb, index finger, middle finger, and thumb side of the ring finger, as well as movement of your thumb and first two fingers.
When this nerve is compressed or irritated, it can cause pain, numbness, tingling, and/or a burning sensation in these areas. You may also find that symptoms worsen at night, causing you to wake up and “shake out” your hand. In more severe cases, it can lead to muscle weakness which may impact hand function, such as your ability to grip objects.
These symptoms can result from various factors, such as repetitive hand movements or prolonged exposure to the end ranges of wrist movement.
For example, if you unknowingly sleep with your wrist flexed or bent, it can further compress the median nerve and may increase symptoms.
It has also been found to be prevalent among pregnant women which may occur due to fluid retention and swelling.
Carpal Tunnel Syndrome Management
For management, there are generally 3 things to consider:
Consideration #1: Behavior & Activity Modifications
First, you want to identify what positions or activities make symptoms worse, implement temporary modifications, and then over time, gradually reintroduce them as tolerated.
For instance, do you have pain during repetitive tasks, such as prolonged computer or mouse use?
In these cases, a popular recommendation is to make adjustments to your workstation. However, based on some limited research, “there is no strong evidence for or against the use of ergonomic keyboards” or other devices such as mice and mouse pads for the treatment of carpal tunnel syndrome.
This doesn’t mean you can’t experiment with different devices, but a more practical recommendation would be to break up these repetitive tasks by incorporating periodic movement breaks. For example, you could set a timer and perform some of the exercises I am about to present every couple of hours, or even do something as simple as going on a few short walks throughout the day.
Do you find that symptoms wake you up at night?
This may happen if your wrist is in a specific position, like end-range flexion, or if pressure is placed on the wrist while sleeping.
If this is the case, it might be helpful to use a night splint and modify your sleeping position. For example:
- If you sleep on your unaffected side, try resting your wrist on top of 1-2 pillows.
- If you sleep on your affected side, try placing a pillow on top of your hand to minimize pressure on your wrist.
- If you sleep on your back, you can try positioning your arm at your side or placing your hand on a pillow on your stomach.
While a 2023 systematic review did find that “there is insufficient evidence to conclude whether splinting benefits people with CTS,” the authors go on to state that “splinting is relatively inexpensive and has no known long-term side effects. Therefore, even small benefits may justify its use…”
In cases where symptoms are interfering with everyday tasks, wearing a splint during the day can also be a consideration.
Just know that a splint is not meant to be permanent but rather can help manage your symptoms in the short term. If you want to try one, simply find an option that is comfortable and keeps your wrist in a relatively neutral or straight position.
Consideration #2: Exercises
The second management consideration is exercise. These can reduce your nerve sensitivity, improve the range of motion of your wrist and surrounding areas, and help break up any repetitive tasks that may be contributing to your symptoms.
Here are 3 exercise categories:
Category 1: Nerve Glides
Start with your arm out to your side, with your elbow bent and wrist flexed. Then, slowly straighten your elbow and extend your wrist, while keeping your fingers relatively straight. Slowly move in and out of this position.
Since the median nerve runs from your neck to your hand, you can also incorporate head movement.
For example, gently side bend your neck toward your hand as you straighten your elbow and extend your wrist. Then, as you bend your elbow and wrist, you will move your head in the opposite direction.
To make it more intense, move your head away from your wrist and your hand as you straighten your elbow and toward your wrist and hand as you bend your elbow.
If you find these nerve glides uncomfortable or too difficult, additional modifications include:
- Decreasing the range of motion at your wrist, elbow, and/or head and neck.
- Lowering the position of your shoulder instead of holding it straight out to your side.
- Performing with a closed fist rather than keeping fingers straight.
- Changing positions, such as performing these while lying on your back.
Category 2: Wrist & Hand Movement
The second category focuses on wrist & hand movement. Here are 2 options to choose from:
Option 1: Tendon Glide.
- Start with your hand and fingers straight
- Move your fingers into a hook position
- Then make a fist
- Straighten into a tabletop position
- Finally, make a straight fist
You will then return to the start and repeat. This can be a challenging sequence to learn, but you should get better with practice and repetition.
Option 2: Wrist Circles – With your elbow bent at your side and your palm facing up, imagine drawing a circle with the tips of your fingers. Complete the motion in one direction before reversing back in the other.
If you find this movement uncomfortable or too difficult you can move through less range of motion and/or perform with a closed fist.
Category 3: Shoulder & Trunk Movement
Lastly, the third category will emphasize movement at your shoulders and trunk. Since the median nerve runs from your neck to your hand, these movements can also reduce nerve sensitivity and improve symptoms.
If you are sitting in a chair, place your arms in front of you, rotate toward the wall behind you, then return to the start. Another option is to lean forward, reach one hand down to the floor, and rotate up to the ceiling.
You can also do this while standing. Place one foot in front of the other in a staggered stance, and rotate over your ‘forward’ leg, back toward the wall behind you.
Exercise Programming
You can perform one, two, or all three of these exercise categories for 30-60 seconds per exercise, 2-4 times a day.
Again, these exercises are a great option for breaking up repetitive tasks. For instance, if your symptoms start a little after 2 hours of computer work, set a reminder to perform these exercises every 2 hours throughout the day.
It is important to start very slowly and build up over time, since these exercises may actually increase your symptoms in the short term or even later in the day. You don’t want to overdo it. More is not necessarily better.
Also, understand that there is not a “one-size fits all” approach for carpal tunnel syndrome. Some of you will find these exercises help reduce symptoms immediately, while for others it may take weeks to months. And as I just mentioned, some may find that these make symptoms worse. Therefore you will likely need to experiment with each exercise, different modifications, and various parameters to find out what works best for you.
Consideration #3: Surgery, Injections, and Other Treatments
The last consideration relates to surgery, injections, and other treatments.
If and when surgery is warranted will depend on factors such as the severity of your symptoms, clinical presentation, personal preference, response to conservative management, etc. Specific concerns about your case and the need for surgery should be discussed with your medical doctor or healthcare provider, as they are outside the scope of this blog.
However, the good news is that in most cases, conservative management is the preferred initial treatment option. This includes the activity modifications, splinting, and exercises mentioned earlier, as well as other non-surgical options such as corticosteroid injections.
A systematic review by Ashworth et al in 2023 concluded that a “local corticosteroid injection is effective for the treatment of mild and moderate CTS with benefits lasting up to six months and a reduced need for surgery up to 12 months.” It’s worth noting that when reported, “serious complications were very low.” Currently, it’s unknown whether these injections are as effective in severe cases.
Finally, you can consider other nonsurgical options if they’re low cost, low risk, and help alleviate symptoms, however, just know that these should not be a replacement or a substitute for the management strategies previously discussed.
Looking for rehab or performance programs? Check out our store here!
Want to learn more? Check out some of our other similar blogs:
Cervical Radiculopathy, Pain With Push Ups, Golfer’s Elbow
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