Carpal tunnel syndrome Patient Information Clinical Support Services Physiotherapy Median nerve Transverse carpal ligament Ulna Radius
What is carpal tunnel syndrome? Carpal tunnel syndrome is a condition in which the median nerve is squeezed or pinched where it passes through the wrist. The reason for this is usually unknown. Possible causes include: swelling of the tendon lining, joint dislocations, fractures, or arthritis. Fluid retention in pregnancy can also cause swelling in the tunnel. The median nerve controls some of the muscles that move the thumb and it carries information back to the brain about sensations in your thumb and fingers. When the nerve is squeezed it can cause pain, aching, tingling or numbness in the affected hand. The symptoms tend to be worse at night and may disturb your sleep, but you may notice it most when you wake up in the morning. Hanging your hand out of bed and shaking it around will often relieve the pain and tingling. You may not notice the problem at all during the day, though certain activities such as writing, typing, DIY or housework can bring on symptoms. Flexor tendons Site of compression on median nerve Branches of median nerve Median nerve Transverse Carpal Ligament Sometimes the condition can be mistaken for something else. For example, pressure on nerves in the neck due to disc problems or arthritis can cause similar symptoms. A nerve conduction test may help if there is any doubt about the diagnosis. (Arthritis Research). Symptoms Tingling of the thumb and fingers (not the little finger) Numbness in the thumb and fingers (not the little finger) Aching in the thumb, perhaps moving up as far as the neck Burning pain from the wrist to the fingers Change in touch or temperature sensation Clumsiness in the hands Weakness of grip, ability to pinch and other thumb actions Swelling of the hand and forearm Change in sweat functions of the hand (American Physical Therapy Association) Physiotherapy You may have been referred to a physiotherapist for your carpal tunnel syndrome. They will provide you with some splints, teach you the following exercises, and educate you about posture. They may refer you onwards for an injection or consideration of surgery, depending on your symptoms. 2 3
For video demonstrations of the detailed exercises please click video link. Alternatively, if you have a hand held device such as a smart phone or tablet, download a free QR code reader app from your app store and scan the QR code. NB Viewing this video may use some of your mobile data allowance. We recommend waiting until you have a wifi connection. Tendon gliding exercises Start with a straight hand (1), move into position (2), hold for 2 seconds, then return to position (1). Repeat 10 times. Repeat the same process for positions (3), (4) and (5). Repeat five times daily. Median nerve exercise Fig A. Fig B. Start with both arms out in front of you Bend the wrists back keeping the fingers as straight as possible Hold for two seconds and then relax Bend all four fingers forwards from the back knuckle forming a flat table top (2) Fig A. Fig B. Position 1 Bend all four fingers forwards at the same time from the little knuckles forming a hook like fist (3) Position 2 Position 3 Position 4 Position 5 Bend all four fingers forwards at the same time to form a fist (4) Bend all four fingers forwards from the back knuckle and then the middle knuckle ensuring that the tips are straight forming a box / square shaped fist fist (5) Form a fist with both hands (A) and push the wrists down (B) Hold for two seconds, relax and repeat this exercise three times, once daily Splints Your physiotherapist may provide you with a wrist splint. This is to be worn at night time only. The splint is designed to keep your wrist straight and prevent the carpal tunnel being squeezed when you are asleep. Your physiotherapist may also ask you to wear the splint for short periods in the day if your symptoms are brought on by particular activities, for example, when typing on a computer. 4 5
Posture It is important to avoid aggravating activities when you have carpal tunnel syndrome. It is also important to take regular rests from repetitive tasks, especially when any tingling, numbness, pain or cramping occurs. Try not to bend your wrist too far backwards when typing, writing, knitting, sewing, playing sports, using tools and cutting with knives, this will reduce the pressure on the carpal tunnel. At home Rest your hands frequently, especially when any tingling, numbness, pain, occurs. If a repetitive job is awkward, try to find a better way to do it. When using vibrating tools, try to reduce the vibration to your hands with gloves, padding, etc. Alternate easy and hard tasks that use your hands. Use your whole hand to grasp objects, not just your thumb and index finger. Give your hand and wrist time to recover after forceful movements. Do not carry heavy objects for long periods. Use carts, trollies, etc. whenever possible. Increase the size of handles of tools and equipment with tape, foam or other materials to help spread the pressure more evenly over the hand. Keep your hands warm to promote circulation. Cut back or discontinue the use of tobacco At the office Try and control your mouse with the lightest possible grip Rest your palms, not your wrist, on a wrist-rest or the desktop When using a keyboard/mouse, your hands should be even or slightly lower than your elbows. An adjustable keyboard tray mounted under the desktop may be necessary. Keep your hands in-line with your forearms as much as possible, not bent in/out or up/down at the wrist. Rest your elbows on your chair s armrests and adjust them so the weight of your arms is supported by the armrests, not supported by your shoulders. Use a foot rest if your feet are not flat on the floor. The top of your monitor should be about eye level so you are not bending your neck up or too far down. Sit upright so your head is above your shoulders. Don t slouch forward. Take frequent breaks and do regular stretching exercises Alter your posture from time to time but keep within the guidelines of correct sitting most of the time. Sit so the natural hollow stays in your lower back. A good adjustable chair should allow this. Position your monitor and keyboard in front of you, not to the side. Use thicker pens (1/2 + width) to make them easier to grasp. Do not wear wrist splints for extended periods during the day. Some muscles may weaken. Do not type with long fingernails. 6 7
Comments, compliments, concerns or complaints South Tees Hospitals NHS Foundation Trust is concerned about the quality of care you receive and strives to maintain high standards of health care. However we do appreciate that there may be an occasion where you, or your family, feel dissatisfied with the standard of service you receive. Please do not hesitate to tell us about your concerns as this helps us to learn from your experience and to improve services for future patients. Patient Advice and Liaison Service (PALS) This service aims to advise and support patients, families and carers and help sort out problems quickly on your behalf. This service is available, and based, at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services. Please ask a member of staff for further information. Author: Physiotherapy Team The James Cook University Hospital Marton Road, Middlesbrough, TS4 3BW. Tel: 01642 850850 Version 2, Issue Date: May 2016, Revision Date: May 2018 MICB4311