Take Charge of Your Health - Light at the End of the (Carpal) Tunnel
It all comes down to making more room for the nerve...
- Dr. Aaron Daluiski
Carpal Tunnel Syndrome (CTS) is the most common of the nerve entrapment syndromes with approximately 3-5% of U.S. adults over 30 making up approximately 90% of all neuropathy cases. The carpal tunnel is a space created by the natural arch of the wrist bones. The actual size of the tunnel cannot change as the bones and ligaments that form it act like solid walls. In addition to the median nerve, the 9 tendons that bend the fingers all have to pass through this narrow tunnel! Unfortunately, because the tunnel is smaller in females, women are three times more likely to experience carpal tunnel syndrome than their male counterparts.
Generally the cause of CTS is extra pressure being placed on the median nerve. This pressure results in numbness, tingling, and pain in the hand and lower arm, especially in the thumb, index, and middle fingers. CTS can be triggered by activities that flex or extend the wrist such as driving, typing, or holding a telephone (aka all of us!). People who perform repetitive hand movements during daily routines are most at risk. Additionally, sleeping with our wrists flexed or bent pinches the median nerve and can also be a contributing factor in CTS.
In addition to the general causes, there are also certain medical conditions that can precipitate or worsen CTS including:
High blood sugar and diabetes which may damage nerve fibers
Thyroid disease which may cause fluid build up putting pressure on the median nerve
Fluid retention during pregnancy or menopause can also compress the nerve
Obesity doubles the risk of CTS
Tests for CTS include electromyography where a mild electric current measures how well the nerve supplies the electrical signals that cause the muscle to contract, and nerve conduction velocity tests that stimulate the nerve and measure how fast an electrical impulse moves through it.
The goal of CTS treatment is to reduce or remove the cause of the increased nerve pressure resulting in the lessening of pain and discomfort. There are many treatment options for controlling CTS, including:
Activity modification, rest, and ice to quiet down the inflamed nerve and surrounding area
Anti-inflammatory medications and corticosteroid injections to reduce swelling
Splinting or bracing to prevent wrist motion to reduce injury and pain
Rehabilitation through physical therapy to learn ways to avoid the strain that causes pain and injures the nerve
In severe cases surgery can be done to release the pressure on the nerve and alleviate pain
If your activities of daily living sound like they would expose you to the risk of developing CTS, the following are some exercises that have been recommended by WebMD to help stretch out the area:
Wrist Rotations: Rotate your wrists by moving only your hands up, down, left, and right. Repeat up to four times.
Finger Stretch: Stretch your fingers wide and then relax them, repeat up to four times.
Thumb Stretch: Using your opposite hand, push your thumb backward until you feel a gentle stretch. Repeat up to four times.
Prayer Stretch: Put your hands together under your chin in a prayer position. Push your hands down to your waist until you feel a moderate stretch. Hold for up to 30 seconds. Repeat between two and four times.
Wrist Flexor Stretch: Hold your hand out in front of you, with the palm face-up. Bend your hand back towards the floor, stretching the palm side of the wrist. Use your other hand to bend your hand back even more, deepening the stretch. Hold for up to 30 seconds. Repeat on each hand between two and four times.
Wrist Extensor Stretch: Hold your hand out in front of you, with the palm face down. Bend your hand forward towards the floor, stretching the back of the wrist. Use the other hand to bend your hand forward even more, intensifying the stretch, and hold for up to 30 seconds. Repeat on each hand between two and four times.
Medial Nerve Glide: You may want to use mild heat for 15 minutes before this stretch. After, use an ice pack for 20 minutes. This will help prevent swelling. Hold each step of this exercise for between 3 and 7 seconds. Make a fist. Extend your fingers, keeping your thumb close to your fingers. Bend your hand backwards, towards your arm. Keeping your hand in that position, extend your thumb away from your fingers. Turn your forearm so your hand is palm up. Use your other hand to pull your thumb back, deepening the stretch. Repeat 10-15 times per day.
Tendon Glides: #1 -You may want to use mild heat for 15 minutes before this exercise, and ice or cold for 20 minutes after. Hold each of these poses for 3 seconds. Hold your hand up in front of you, straightening all fingers. Curl your fingers with your knuckles pointing up. Your fingers will be in a hook shape. Curl your fingers further, making a tight fist. Do this five to 10 times. Repeat a few times each day.
Tendon Glides: #2 - Use heat on your wrist and hand for 15 minutes before doing this one as well. Ice it for 20 minutes after. Hold each position for 3 seconds. Hold your hand up in front of you, straightening all your fingers. Make your hand into a tabletop by bending your fingers at a 90-degree angle. Continue bending your fingers, bringing your fingertips to the bottom of the palm.
Shake It Out: This simple exercise is especially useful at night, when your symptoms can be worse. If you wake up with pain or numbness, shake your hands out to get some relief.
Fist to Stop Sign: Make a fist. Slide your fingers up until they point toward the ceiling, like you're telling someone to stop. Repeat five to 10 times.
Thumb Touches: One at a time, touch the tip of each finger to the tip of your thumb so they make an O-shape. Repeat a few times.
Basic Wrist Stretches: Sit down at a table. Rest your elbow and arm on the table and let your wrist hang over the side, palm of your hand facing up. Start with your hand in a straight, neutral position. Bend your hand toward you so your fingers point up toward the ceiling. Hold for 5 seconds. Return to a straight, neutral position. Bend your hand away from you so your fingers point down toward the floor. Hold for 5 seconds. Return to a straight, neutral position. Repeat 10 times. Do this up to three times a day.
Wrist Resistance: Sit down at a table. Rest your forearm, wrist, and hand on the table, with your palm facing down. Use the hand and wrist affected by carpal tunnel syndrome. Lay your other hand across the knuckles at a 90-degree angle, so your hands make a plus sign. Lift your bottom hand up but resist with your top one. You'll feel this in the muscles of your forearm. Repeat a few times a day.
Wrist Curls: Sit or stand for this one. Get a 1-pound weight or a can of beans. With your elbows at your side, lift your forearm so your arm makes an L-shape. Your forearm should be parallel to the floor. Start with your wrist straight and neutral, palm with the weight facing down. Bend your wrist up. Return to a straight, neutral position. Repeat 10 times. Do this up to three times a day.
Hand Grip Exercises: Squeeze a pair of balled-up socks or a soft rubber ball. Hold for 5 seconds. Repeat 10 times. Do this up to three times a day.
For your safety a gentle pulling feeling is OK, but you should not feel any sharp pain when performing these exercises. If you feel any sharp pains, stop doing the exercise immediately and contact your doctor or physical therapist.
If you have symptoms of CTS including numbness and tingling, waking up having to shake out your hands, feeling as though your fingers are swollen, noticing decreased ability to hold on to objects, having a weaker pinch, sensing discomfort in your wrist, hand or fingers, talk to your health care provider to see if you have CTS and would benefit from treatment.