Physiotherapy In CTS-Carpaltunnel syndrome

Having wrist pain? and your doctor is prescribing you Carpal tunnel syndrome? well, let's talk about this Condition.

Carpal tunnel syndrome (CTS) is a common condition of the wrist and hand that can affect the use of the whole arm. It is caused by pressure on the nerve at the base of the palm (median nerve). Symptoms include numbness, pins and needles, and pain (particularly at night).

Anything that causes swelling inside the wrist can cause carpal tunnel syndrome, including repetitive hand movements, pregnancy, and arthritis.

The following health conditions can also lead to CTS:

1. Inflammation and swelling of the tendons of the wrist
2. Injuries like strain, sprain, dislocation, and fracture to the wrist
3. excessive fluid retention. mostly in pregnancy and during some medication like steroids
4. Diabetes, Hormone and Metabolic changes.
5. Degenerative and rheumatoid arthritis.
6. Obesity or sedentary lifestyle

Signs and Symptoms

When the nerve is compressed 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 it is because of Inflammatory reaction. Hanging your hand out of bed or 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, housework, difficulty to open jar, etc, can bring symptoms back.

What is a carpal tunnel in Wrist?

The carpal tunnel (CT) is formed by a non-extendable osteofibrous wall surrounding its content. The wall of the tunnel consists of carpal bones, joint capsule, carpal ligaments, flexor carpi radialis tendon, and the flexor retinaculum. Carpal bones from an arch-like base for the tunnel. Flexor retinaculum spanning from the pisiform bone and the hamulus of the hamate bone to the scaphoid and the trapezium complete and close the tunnel.

The carpal tunnel (CT) allows the passage of multiple structures between the hand and proximal segments of the body. There are eight small bones within your wrist which are known as the carpal bones. These naturally form a small space (tunnel) at the wrist joint for the median nerve and all of the forearm tendons to pass through.

How Is It Diagnosed?

Physical therapists work closely with other health care professionals to accurately diagnose and treat Carpal tunnel syndrome. Symptoms of Carpal tunnel syndrome are typical, and it is often possible to diagnose it without extensive testing.  Physical therapists are experts in the movement and function of the body and will conduct an evaluation to determine all of the factors.

These are several tests that may be used to help diagnose Carpal tunnel syndrome, but it can vary patient to patient:

1. Grip strength of fingers and thumb.

2. Sensory tests.

3. Wrist and hand range-of-motion.

4. Wrist flexion (Phalen) test: Your physical therapist will have you push the backs of your hands together for 1 minute.  Tingling or numbness in your fingers that occurs within 60 seconds may be an indication of Carpal tunnel syndrome.

5. Tinel's Sign: Your physical therapist will use a reflex hammer or finger to tap over the median nerve at your wrist. Tingling in the thumb and index and middle fingers may indicate Carpal tunnel syndrome.

6. Electrical studies (electromyogram/EMG) and nerve conduction velocity (NCV): These tests determine the transmission of the nerve and the severity of the Carpal tunnel syndrome.

7. X-rays: When trauma has occurred or if there is a reason to suspect anatomical abnormality, x-rays may be ordered.

Cervical radiculopathy or radiating pain,

How Can a Physical Therapist Help? What Is the Role Of PT in Carpal tunnel syndrome?

After proper evaluation, your Physical therapist will make a plan with exercise, but it depends on the severity of CTS.

Conservative Care For Early Stages

Physical therapy treatment can be effective in reducing your symptoms and getting you back to performing normal activities.
Depending upon the causes of your CTS, your Physical therapy program may include:

  • Reapproach to, wrist positions
  • neck and upper back posture 
  • stretching exercises to improve the flexibility  
  • Exercises to increase the strength

  • Use of a night splint to reduce discomfort
  • Covering or stabilizing gloves for hand
The goals of physical therapy are to reduce your symptoms without the need for surgery, to enable you to be as active and functional as possible, and to help you resume your normal work, home, and leisure activities.

if CTS is severe, Surgical treatment is done followed by PHYSICAL THERAPY.
it may include,
  • Scar management 
  • Exercises
  • Stretching
  • reeducation of wrist, forearm, arm work
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