PHYSICAL THERAPY AND CARPAL TUNNEL: By Jeffrey Williams PT, Cert. MDT
Carpal tunnel syndrome affects millions of Americans each year. A major risk factor is repetitive stress such as people who work on computers for long periods of time or workers who do secretarial work but can also include machinists or anyone who does the same general movements all day. Carpal tunnel syndrome is not confined to just repetitive movements as anyone can get it. Some people can get it without any relevant history at all. Unfortunately, once you have it, your chances of having it reoccur are higher.
WHAT IS CARPAL TUNNEL SYNDROME?
Carpal tunnel syndrome occurs when the median nerve becomes “squeezed” at the wrist. It is still not completely understood why this happens to some people but not others. Risk factors include Diabetes, Rheumatoid arthritis, Occupational requirements (as mentioned above), and even pregnancy can cause this to occur. Symptoms often start as a numbness or pain that gradually increases. Patients often overlook the early symptoms as “annoying” and something they expect to go away with time. And sometimes it does go away. However, in many cases it persists and eventually demands attention. The symptoms can continue to worsen with sharper pain and more frequent numbness. If left to its own the hand can even become weak and the sufferer will even start dropping things. Carpal tunnel in its worse stages can be a serious issue and greatly affect a person's ability to function normally.
TREATMENT FOR CARPAL TUNNEL
There are many options available for the treatment of carpal tunnel syndrome. Obviously the earlier the intervention the better the outcome usually is. Conservative care should always be utilized first. This would include physical therapy and splinting. If conservative measures fail, then a carpal tunnel “release” may be in order. Surgery involves cutting a ligament in the palmar aspect of the wrist to relieve pressure. Surgery usually is indicated in the most severe of cases, where there is muscle atrophy (wasting) in the hand with severe weakness and pain. Sometimes a nerve conduction test can be done which reveals that the nerve is being severely “squeezed” and possibly being damaged in which surgery would be deemed necessary. Most cases, however, don’t reach this threshold and can be treated with physical therapy and/or splinting with very positive outcomes for most people.
PHYSICAL THERAPY VS. SURGERY
A recent study was done in Spain comparing outcomes of patients who went through physical therapy or surgery. The study used 50 women in each group. Fifty women went through a physical therapy program that included manual treatments and exercises followed by home exercises when discharged from care. The other 50 women underwent a carpal tunnel release surgery. After one month the physical therapy group reported feeling better which is understandable as they did not have surgery. However, after 3, 6, and 12 months both groups were much better and reported similar improvements in function and pain reduction. Both options are valid and improve their patients' condition, but one avoids the pain and hassle of surgery. Not to mention the possible cost of surgery depending on insurance coverage.
WHAT CAN I DO TO LOWER MY RISKS?
If you have had carpal tunnel in the past or think you may have mild symptoms starting, or even if you have a job that may put you at risk of developing it, there are some simple steps you can take to help minimize risk. Some simple exercises that do not require any expensive equipment nor do they require a lot of time can be done, preferably, during the day to help reduce stress to the hands and wrists.
Shake your hands. The nearest simulation would be when people are trying to get nail polish to dry. No more than 5 seconds is necessary.
Stress ball squeeze. You don’t need to crush it! Just comfortable pressure is enough and 2-3 minutes for duration.
Wrist stretch. Hold your arm straight in front of you with the palm down and elbow straight. With your other arm, grab the upper part of your fingers and pull back with the elbow remaining straight until you feel a mild pull, no pain. 5 repetitions should be enough.
Sprinkle these in during the day to relieve tension in your hands and wrists. DO NOT DO THESE IF THEY PRODUCE PAIN. This may indicate that there is already significant damage to tissue and a supervised physical therapy program may be in order. The best way to know for sure is to stop in to Advanced Rehabilitation and have us evaluate you to make a recommendation.