Rehab for Wrist and Hand Pain
If you have discomfort, tingling, numbness, or weakness in your hand or arms, you may have carpal tunnel syndrome (CTS). This condition occurs when the flexor median nerve in your wrist is compressed and irritated. The problem could become serious, limiting your capacity to use your hands normally during activities such as gripping and typing on your laptop keyboard.
If you have CTS,physical therapy can help you find relief from pain as well as abnormal hand sensations, regain strength, and improve your overall hand and arm function. Carpal tunnel syndrome therapy is the purpose of either physical rehabilitation or surgical treatment. A physical therapist may also apply rehabilitation modalities such as ultrasound to manage carpal tunnel.
What to Know About Carpal Tunnel Syndrome
The carpal tunnel is an opening in your wrist that is formed by the carpal bones on the bottom of the wrist and the transverse carpal ligament across the top of the wrist. The median nerve provides sensory and motor functions to the thumb and 3 middle fingers.
The main structures within the carpal tunnel include:
- Median nerve
- Tendon of the flexor pollicis longus
- Four tendons of the flexor digitorum superficialis
- Four tendons of the flexor digitorum profundus
If pinching and severe pain occur in these tissues, symptoms of carpal tunnel syndrome may appear, and you may need help with functions of your hand and arms.
CTS goes away for individual people in different ways and can differ in severity.
- Pain in your wrist, thumb, or first two fingers
- Numbness or tingling in your thumb and first three fingers
- Weakness in your hand and thumb muscles
- Noticeable atrophy of your thumb muscle
You should discuss any symptoms you're experiencing with a medical professional for a definitive diagnosis of CTS. An exam,X-rays, nerve conduction tests, or magneticresonance imaging (MRI) may be required.
If you have CTS, you may have a difficult time using the hands or wrists, and require considerable effort to maintain any positions for long durations of time. Many people with CTS find it challenging to use the computer or mouse, and can experience worsening symptoms at night or in the morning.
Common treatments for CTS may include:
- Physical therapy for pain, range of motion, and strengthening
- Anti-inflammatory medications
- Splinting of the wrist
- Injections
- Surgery
Patients diagnosed with carpal tunnel syndrome often obtain the most relief by doing non-invasive treatments first. Physical therapy, medications, and splinting are examples of non-surgical treatments you can try.
What role does physical therapy play in treatment?
After you receive a diagnosis of carpal tunnel syndrome from your therapist, conservative therapy begins with a visit to a physical therapist. Your therapist will be able to assess your condition and make treatment recommendations. Impairments that your physical therapist will likely measure and assess include:
- Pain
- Palpation
- Range of motion of your wrist and fingers
- Postural assessment
- Strength
- Special tests
Your physical therapist will evaluate your carpal tunnel syndrome and devise a plan for treatment. These may include various treatments like heat or ice, splinting, or exercise to elevate your mobility and strength.
Exercise
As your main treatment for carpal tunnel syndrome, exercise is extremely important. Why? Because there is some scientific evidence that demonstrates exercise may decrease pain and improve function in people with carpal tunnel syndrome. One study comparing physical therapy to surgery found similar results for CTS; however, some research also showed mobility exercises and physical therapy are not effective for CTS.
An exercise program designed to minimize discomfort in your CTS condition enables you to take complete control over it. Your physical therapist may prescribe wrist stretches as a treatment for carpal tunnel syndrome. To stretch your wrists:
- Sit with one arm in front of you.
- Bend your wrist up, and grab your wrist, thumb, and fingers with your other hand.
- Gently pull back, stretching the front of your palm and wrist. You may also feel a stretch in your forearm.
- Hold the stretch for 15 to 30 seconds, and then release.
- Repeat three times.
This stretching exercise helps to relieve carpal tunnel symptoms and gently enlarges the structures inside the carpal tunnel. However, exercise it with caution, as it may worsen the symptoms in some people.
Carpal tunnel tendon gliding exercises have been shown to lessen pain and improve mobility for people suffering from carpal tunnel syndrome. To carry out these exercises, hold one hand in front of you, and move your fingers into various positions. Positions for tendon glides include, in order:
- Palm open
- Fingertips to the top of the palm
- Palm open
- Fist
- Palm open
- Fingers in an “L” position
- Palm open
- Fingertips to the bottom of the palm
While gliding and sliding the tendons with a carpal tunnel exercise program, slowly move through each position, holding it for a few seconds. This helps release tension in the tendons, allowing them to function and move much more freely. Your physical therapist may also have you work to improve hand-grip strength. Products like DigiFlex or therapy putty might help you improve hand-grip strength.
You can also work on grip strength by rolling up a hand towel and gently holding your hand with it. Just grab the towel, hold the grip for five seconds, and release. Repeat 10 times.
Tips to Create a Daily Routine That Works for You
Many daily tasks may increase the symptoms of CTS that you may be experiencing. You may need to modify some of the tasks you're currently doing or choose a different approach to carry out your activities if you have CTS. A few tips that your physical therapist may tell you to perform may include championing particular lifestyle changes. Some tips that your physical therapist may advise you to do may include:
- Build-in time for rest
- Take a break to perform your CTS home exercise program
- Use more hands-free options with your phone and devices
- Use a wrist rest for your keyboard and mouse when working at the computer
When setting up a workstation with a computer, be sure to make sure that it's set up ergonomically. Good ergonomic practices can help you stay in good condition. Your physical therapist can play an essential role in setting up your workstation.
What are the options for treating carpal tunnel?
Your therapist may advise various CTS treatments during your rehabilitation. These may include:
Wrist splints: If your wrist and hand require a slight extension, wearing a wrist splint to your benefit can ease the pain. The splint secures your wrist and palm, giving you more clearance within the carpal tunnel, and preventing pressure on any structures or nerves.
Anti-inflammatory medication: People diagnosed with CTS often benefit from taking anti-inflammatory medications to decrease the pain and swelling that occurs around the median nerve. Be sure to consult with your physician prior to taking any related medications.
Ultrasound: Some therapists use high-frequency therapeutic ultrasound to treat CTS. Ultrasound waves traveling through your skin, paired with an increase in tissue temperature and blood flow, have a positive effect on CTS. However, ultrasound has not been proven to produce better results for long-term people with CTS.
Paraffin wax: Some therapists work with a paraffin wax dip for your hand and wrist before a physical therapy session. The wax increases blood flow and reduces discomfort, although it has yet to be proven to actually improve results for CTS.
Electrical stimulation: E-stim is sometimes used to relieve pain. Your therapist may involve it for your CTS, but the pain relief gained from e-stim is only temporary.
Home treatments for carpal tunnel syndrome may involve the use of heat or ice to your wrists. These may temporarily reduce pain and increase your ability to perform daily activities.
When Should I See a Physical Therapist?
Orthopedic conditions such as carpal tunnel syndrome are most effectively treated by physical therapy if you start treatment soon after the start of symptoms. The more time you wait before beginning therapy, the more challenging your symptoms will be to treat and the less likely a positive outcome will be. So, if you experience symptoms of carpal tunnel syndrome, be sure to get in touch with your physician and ask to be referred to your physical therapist at your local clinic.
If you feel that your CTS symptoms do not respond well to conservative treatments, you are encouraged to reach out to your physical therapist for help. Severe cases where conservative treatments are not sufficient may require more invasive procedures, including cortisone injections or surgery.
After CTS surgery, a course of rehabilitation may be recommended to help enhance hand function after the surgery. CTS surgery involves a small incision in the palm of your hand and your doctor removing the thickened ligament on top of the carpal tunnel, opening the door to the structures there.
Post-operative rehab usually starts three to four weeks after surgery and may include:
- Scar tissue massage
- A gentle progressive range of motion exercises
- Progressive strengthening exercises
- Treatments to reduce swelling and pain
Speaking with your physician about your CTS symptoms, whether you had surgery or not, is a good place to start on your road to recovery.
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