BACKGROUND INFO: Carpel Tunnel Syndrome (CTS) is a peripheral nerve entrapment issue, most commonly the median nerve. CTS is often due to overuse of the wrist flexors, which causes inflammation in a band of tissue that surrounds the wrist called the flexor retinaculum. It is most common in middle to late aged females (age >45). Most commonly people will report numbness, tingling, pins and needles, or a burning sensation in the palmar side of the hand from the thumb up to the ring finger. Other symptoms include pain in the wrist at night/morning or even weakness of the hand/wrist - this may result in a complaint of clumsiness and loss of grip and pinch strength or dropping things. People with CTS may notice aggravation of symptoms with static gripping. WHAT TO CHECK: There is a chance you have CTS if you have pain with performing the Phalen’s Test demonstrated in the video. With this test, you want to hold the position for 1-2 minutes. This will typically aggravate CTS symptoms (pain/numbness and tingling in the wrist/hand/fingers). If you have no issues with this, there is a chance of CTS not being the issue. If the Phalen's test does not bother your wrists, you can try the Reverse Phalen's Test. If both are negative, you can feel more confident with CTS not being the issue. You can also perform the flick sign - people with CTS will report an improvement of symptoms following shaking or flicking of their hand. It is also worthwhile checking for diminished sensation in the top-side of the thumb compared to the base of the thenar eminence (palm side skin at the base of the thumb and palm region.) WHAT TO AVOID: Maintaining a flexed or extended wrist position, especially with pressure on the wrist, for long periods of time may aggravate this issue as it increases pressure in the carpal tunnel. Working on maintaining a relaxed and supported neutral wrist position may help. When it comes to phone use, try holding the phone with a neutral wrist or rest your hand on a supported surface. You can also try 45˚ of forearm pronation with a neutral wrist with forearms supported as this can be an alleviating position as well. Take breaks for nerve and tendon gliding (see resource videos) and avoid full pronation for extended periods of time when you can (thumb side of hand rotated in with palm and palm side of forearm parallel to the ground). WHAT TO EXPECT: People with CTS have better outcomes if they have been dealing with symptoms for less than 1 year and have minimal night time paresthesias (numbness and tingling). If this program provides no help after 12 dedicated weeks, it may be worthwhile following up with a hand & wrist specialist. RESOURCE 1. Michlovitz SL. Conservative interventions for carpal tunnel syndrome. The Journal of Orthopaedic and Sports Physical Therapy 2004;34(10):589–600.
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