If you experience numbness, tingling, or “pins and needles” in your hands, chances are that you’ve looked into carpal tunnel syndrome (CTS). This article provides a bit of helpful information about CTS and what the research shows are effective treatment options. We’ll cover the basics and move into treatment options from there.
What is Carpal Tunnel Syndrome?
Let’s start with the basics: What is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome (CTS) is the most commonly diagnosed upper extremity condition. In fact, around 2.7 million doctor visits every year in the United States involve the treatment of CTS [1]. CTS also accounts for a large portion of work-related injuries that require employees to take time off of work [2]. It’s fair to say that CTS is a fairly common syndrome. In fact, check out what the research says about CTS:
“Carpal tunnel syndrome (CTS) is the most commonly diagnosed disabling condition of the upper extremities. It is the most commonly known and prevalent type of peripheral entrapment neuropathy that accounts for about 90% of all entrapment neuropathies. ” [1]
Patients who are diagnosed with Carpal Tunnel syndrome experience significant interference in their daily life. Common symptoms of CTS include: decreased grip strength, pain when completing tasks that involve gripping or bending the wrist, sleep interruption, and decreased finger dexterity [3]. CTS can affect any activity that involves the use of your hands.
If left untreated Carpal Tunnel Syndrome leads to long-term permanent damage [4]. This is why it is imperative to begin treatment when symptoms first appear. And, as we’ll discuss in the following section, Occupational & Physical Therapy play a key role in conservative and post-surgical treatment of CTS.
What the Research Says About Treatment
As with many conditions and diagnoses, researchers and journals regularly publish articles about CTS. That means that the evidence and our own knowledge about CTS constantly changes and that causes treatment techniques to adjust or change to incorporate what new research tells us. That being said, here is what we currently know about treatment options for CTS.
When it comes to treatment options, most patients must choose between either conservative treatment or invasive treatment options. Conservative treatment options include physical/occupational therapy, stretches, exercises, splints (like a simple wrist cockup splint), non steroidal anti-inflammatory (NSAIDs), and even activity modifications. Invasive treatment options involve surgery and/or injections. Depending on the journal article, sometimes injections get lumped in with conservative treatment, but let’s be honest: getting stabbed with a needle seems pretty invasive to me. For our purposes, we’ll consider conservative treatment to be anything that doesn’t involve surgery or injections.
What does therapy for Carpal Tunnel Syndrome look like?
Conservative interventions are typically considered for more mild to moderate cases of CTS. Treatments can include patient education, work simplification, splinting, nerve glides, manual therapy, and ultrasound therapy [1][2]. Depending on the clinic or clinician, a typical therapy session may involve manual therapy & nerve glides, exercises, and work or activity modification or adaptation.
Surgery is recommended in severe cases, and Occupational & Physical therapy for post operative management is useful. In the event of surgery for carpal tunnel syndrome, therapy treatment typically starts off with wound care, scare management, and edema (swelling) reduction techniques. After the initial few days following surgery, range of motion, gentle stretches, and activity modification takes place.
The eventual goal of therapy following carpal tunnel release surgery is to return to normal activity and functional level. The recovery times vary due to a host of reasons. Everything from overall health, job or work type, and daily routines can affect the recovery time; but most surgeons and therapists expect a patient who has a carpal tunnel release surgery to return to normal activity within 6-12 weeks.
How can Physical Therapy and Occupational Therapy help?
A study involving 490 patients with carpal tunnel syndrome found that non-operative, conservative treatment that includes education, task modification, and wrist splinting is helpful in relieving symptoms. Patients who took part in supportive splinting for 4 weeks showed significant decrease in symptoms [2]. Most current research suggests that conservative treatment methods should be used as a primary treatment approach before considering more invasive treatment like injections or surgery.
Some research also found that a comprehensive education program reduces symptoms in disorders like CTS, and is essential in creating successful outcomes long term [5]. Occupational & Physical therapy plan a key role in successful treatment of CTS to reduce long term disability and improve outcomes.
Summary
There’s a lot to be said about carpal tunnel syndrome and treatment options. The most important thing is to make sure you and your physician have discussed all available options for your specific situation. However, in the event that you choose to try to avoid surgery or injections, seek out a therapy clinic and don’t be afraid to ask questions about treatment techniques, research, and likely outcomes.
And, if you live in the Augusta, GA area and would like to receive treatment here at ProActive, you can book an appointment online here.
References
[1] Ghasemi-rad M, Nosair E, Vegh A, Mohammadi A, Akkad A, Lesha E, Mohammadi MH, Sayed D, Davarian A, Maleki- Miyandoab T, Hasan A. A handy review of carpal tunnel syndrome: From anatomy to diagnosis and treatment. World J Radiol 2014; 6(6): 284-300 [PMID: 24976931 DOI: 10.4329/wjr.v6.i6.284]
[2] Barbara Hall, Hoe C. Lee, Helen Fitzgerald, Brent Byrne, Annette Barton, Andy H. Lee; Investigating the Effectiveness of Full-Time Wrist Splinting and Education in the Treatment of Carpal Tunnel Syndrome: A Randomized Controlled Trial. Am J Occup Ther 2013;67(4):448–459. https://doi.org/10.5014/ajot.2013.006031
[3] Gelfman, R., Melton, L. J., 3rd, Yawn, B. P., Wollan, P. C., Amadio, P. C., & Stevens, J. C. (2009). Long-term trends in carpal tunnel syndrome. Neurology, 72, 33–41. http://dx.doi.org/10.1212/01.wnl.0000338533.88960.b9
[4] Van Doesburg, M.H.M., Yoshii, Y., Villarraga, H.R., Henderson, J., Cha, S.S., An, K.-N. and Amadio, P.C. (2010), Median nerve deformation and displacement in the carpal tunnel during index finger and thumb motion. J. Orthop. Res., 28: 1387-1390. https://doi.org/10.1002/jor.21131
[5] Eversmann, W. W. (1990). Reduction of cumulative trauma disorders by a comprehensive ergonomic program in a major commercial bakery. ASSH News, 9, 1–88.
