Carpal Tunnel Syndrome: Symptoms, Causes, Treatment & Physical Therapy and 3 Easy Stretches
Numbness, tingling, or pain in your wrist, thumb, index, and middle fingers can make everyday activities frustrating. Many people immediately assume they'll need surgery, but that's not always the case, physical therapy can help. Understanding what's contributing to your symptoms is the first step toward choosing the right treatment.
What is the Carpal Tunnel?
The carpal tunnel is where the tendons that bend and move your wrist and fingers (red arrow) and their wiring, the median nerve (yellow arrow), pass into the hand. It is a fixed, enclosed space bordered by a very tough band of tissue at the top called the flexor retinaculum (black arrow) and the many small wrist bones on all other sides.
How Does Carpal Tunnel Happen?
An Inside View of the Carpal Tunnel
Carpal tunnel syndrome stems from a repetitive irritation and compression of the median nerve by the the wrist and finger flexors or subluxing of the carpal bones from instability of the wrist. With repetitive wrist bending, gripping and finger movements in a bent position these muscles get bigger, thicker and rub on each other excessively. This can drive inflammation of the tendon sheaths (blue arrow) and scar tissue development further restricting movement and compressing your nerve in a fixed, enclosed space.
What are the symptoms of carpal tunnel syndrome?
Symptoms can include hand and thumb weakness, pain, numbness and tingling in the thumb through middle finger, hand and wrist. Over time, this cycle can make it difficult and painful to do simple things such as cooking, typing, writing, even holding onto a toothbrush to brush your teeth.
Here are some things that can help carpal tunnel syndrome. You can also do these things to help prevent symptoms if you have a job or participate in activities that require repetitive or heavy gripping or repetitive finger motion like typing or crafting.
Mind Your Wrist Posture
Keep your wrist in a neutral (straight) position. Do not keep your wrist in a flexed or extended position when using your hands as it compresses the carpal tunnel. Use a brace to help you if necessary. If your wrist is unstable due to hypermobility use a wrist widget to help keep the small bones at the wrist from slipping. Also do not let your wrist and hands rest on the lap top edge. This places pressure on the median nerve and can irritate it.
Pay attention to your overall posture too.
Typically, patients who have this problem tend to grip too hard because of a weak neck, stiff back , weak back and shoulder blade core muscles. Pay attention to how you do the things that give you pain and be sure to do it with good posture.
Healthy movement throughout the entire upper body helps distribute forces more evenly and reduce unnecessary stress on the wrist.
The wrist is part of a larger movement system. Improving posture, shoulder stability, breathing, and movement quality can reduce unnecessary stress throughout the arm and improve overall function. One of the biggest misconceptions about carpal tunnel syndrome is that it's only a wrist problem. In reality, your wrist is part of a much larger movement system.
The position of your trunk, shoulders, neck, and even the way you breathe all influence how forces are transferred through your arms during everyday activities.
Your wrist doesn't work alone. Neither should your treatment. →
Thoracic Extension and Trunk Stability
A stable trunk provides the foundation for efficient arm movement. When the upper back rounds excessively or the trunk collapses, the shoulders and arms often have to work harder to complete even simple tasks. This increased muscular effort can place additional demands on the forearm muscles and wrist.
Shoulder Stability
Your shoulder acts as the base of support for your entire arm. When the muscles around the shoulder blade and rotator cuff aren't providing adequate stability, the smaller muscles farther down the arm often compensate. Over time, this can increase the workload placed on the forearm and wrist during reaching, lifting, typing, and gripping activities.
Neck Position
The nerves supplying your hand begin in your neck before traveling through the shoulder and arm to the wrist. Poor neck posture, prolonged forward head position, or muscle tension around the neck and shoulders may increase sensitivity of the nervous system or alter how comfortably the nerve moves throughout the arm. While not every case of hand numbness originates from the neck, evaluating the entire nerve pathway is an important part of a comprehensive physical therapy examination.
Breathing and Muscle Tension
Breathing influences much more than oxygen intake. Efficient diaphragmatic breathing helps reduce unnecessary tension throughout the neck, shoulders, and upper chest. When breathing becomes shallow the neck and upper shoulder muscles become overactive, they can contribute to increased muscle tension throughout the upper quarter, making it more difficult for the arm to move efficiently.
Forearm Muscle Capacity
The muscles of your forearm act like the engine that powers your hand. If they're asked to produce more force than they're designed for—or they're repeatedly loaded without adequate recovery—they can become fatigued and irritated. Reduced activation of the shoulder blades abdominals and back stabilizers direct loads and forces more through the wrists and forearms instead of having them evenly distributed through the whole upper body. Building strength in the core and making sure you keep your shoulder blades down and back, chest lifted, tailbone tucked and ribs in helps improve the forearm's ability to tolerate everyday activities without becoming overloaded.
Healthy Movement Reduces Stress Throughout the Chain
The goal of physical therapy isn't simply to treat the wrist—it's to improve how your entire upper body works together. When your posture, breathing, trunk stability, shoulder control, and forearm strength become more efficient, forces are distributed more evenly throughout the arm instead of concentrating at the wrist.
By improving movement quality first, many people are able to reduce unnecessary stress on the wrist, improve function, and return to the activities they enjoy with greater comfort and confidence. Build stronger movement habits →. If you hypermobile? Build the stability in the spine, pelvis and shoulder blades you need to help reduce stress through the wrists contributing to wrist flexor tendonitis (thickening of the wrist and finger tendons compress the nerves) and carpal and wrist bone subluxations. Explore the Hypermobility Program →
What can help in the moment to relieve the symptoms of carpal tunnel syndrome?
Try these three easy interventions to help alleviate wrist, hand and finger pain:
Stretch the muscles and tendons that go all the way down and into your finger tips frequently throughout your day. Try to do them as soon as you notice pain or tension starting to increase to prevent the higher spikes of pain or soreness at the end of the day. Click on the link above to learn all of the stretches you can do.
Brace
Wear it when you are doing things that typically cause you pain. Wear a brace especially at night. People who have carpal tunnel syndrome often sleep with their elbows, wrists and fingers curled up without even realizing it. If you are hypermobile, use a wrist widget during the day, and a brace like this at night.
After doing the stretches, glide the median nerve (yellow arrow), and the finger tendons (red arrow) to prevent or help with irritation, numbness, tingling, sharp zinging pain and the higher spikes of pain.
Stay on top of your symptoms with stretching and gliding and use the brace if you can’t get away from doing things that continually aggravate your pain. Wear it during all waking hours at first. Once you start to feel better, only wear it when you are going to do something that usually hurts the elbow or if you are doing anything above and beyond what you usually do.
Last and definitely not least, get evaluated by a physical therapist. Carpal tunnel symptoms are very similar to symptoms for a pinched nerve in the neck. Your physical therapist will be able to tell the difference in their exam and get you started on the most effective and efficient path to recovery.
