Physical Therapy for Carpal Tunnel Syndrome

If you have pain, numbness, tingling, or weakness in your hand or hands, you may have a condition called carpal tunnel syndrome (CTS). This condition occurs when the median nerve in your wrist becomes compressed and irritated.

The problem may become severe and limit your ability to use your hands normally during activities such as gripping and typing on your computer keyboard.

If you have CTS, you may benefit from physical therapy. Physical therapy for CTS can help decrease your pain and abnormal hand sensations, regain strength, and improve overall hand and arm function.

This article will describe carpal tunnel syndrome and the types of therapies that a physical therapist may employ in treating the condition.

What Is Carpal Tunnel Syndrome?

The carpal tunnel is an anatomical structure in your wrists formed by your eight carpal (wrist) bones and the transverse carpal ligament that courses over them. The ligament creates an anatomical “tunnel” where several tendons pass. Your median nerve also passes through the carpal tunnel.

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

When these structures become pinched and inflamed, symptoms of carpal tunnel syndrome may appear and you may have a difficult time with functional tasks involving your hand and arm.

Symptoms of CTS vary from person to person and may include:

• 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

If you have any of these symptoms, check in with your physician to get an accurate diagnosis of your condition. Diagnosis of CTS may involve a clinical examination, X-ray, nerve conduction tests, or magnetic resonance imaging (MRI).

If you have CTS, you may find it challenging to use your hands and wrists, and may have difficulty keeping your hands in various positions for any length of time. Many people with CTS have difficulty working on the computer using the keyboard or mouse. Some people have worsening symptoms as they sleep or when they wake up in the morning.

Common treatments for CTS may include:

• Physical therapy for pain, range of motion, and strengthening
• Anti-inflammation medications
• Splinting of the wrist
• Injections
• Surgery

Most patients diagnosed with CTS benefit from engaging in non-invasive treatments first. Physical therapy, medications, and splinting are good things to try prior to seeking out more invasive treatments like injections or surgery.

Role of Physical Therapy in Treatment

Conservative treatment after a diagnosis of CTS begins with a visit to a physical therapist. Your therapist can assess your condition and make recommendations for proper treatment. 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

Once your physical therapist has evaluated your carpal tunnel syndrome, they can develop a plan of care for you. This may include various treatments like heat or ice, splinting, or exercise to improve mobility and strength.

Exercise

Exercise should be your main treatment for carpal tunnel syndrome. Why? Because there is some scientific evidence that shows exercise may decrease pain and improve function in people with CTS.

One study found that engaging in physical therapy for CTS produced similar results when compared to surgery for CTS. However, there is also some research indicating that mobility and exercise for CTS are not effective.

Having an exercise program that helps improve your mobility and decrease pain for CTS puts you in control of your condition.

Wrist stretches may be prescribed by your physical therapist for carpal tunnel. To stretch your wrists:

1. Sit with one arm in front of you.
2. Bend your wrist up, and grab your wrist, thumb, and fingers with your other hand.
3. Gently pull back, stretching the front of your palm and wrist. You may also feel a stretch in your forearm.
4. Hold the stretch for 15 to 30 seconds, and then release.
5. Repeat three times.

This exercise helps to improve wrist extension mobility and may give the structures in the carpal tunnel more room to exist. However, use with caution as it may increase symptoms in some people.

Carpal tunnel tendon gliding exercises have been shown to decrease pain and improve motion for people with carpal tunnel syndrome. To do these glides, hold one hand up in front of you, and move your fingers into various positions. Positions for tendon glides include, in order:

1. Palm open
2. Fingertips to top of palm
3. Palm open
4. Fist
5. Palm open
6. Fingers in an “L” position
7. Palm open
8. Fingertips to bottom of palm

Move slowly through each position, holding it for a few seconds. This carpal tunnel exercise program helps glide and slide the tendons through the carpal tunnel, allowing them to move and function better.

Your physical therapist may also have you work to improve the gripping strength of your hand. Specific tools like a DigiFlex or therapy putty can be used to improve grip strength.

You can also work on grip strength by rolling up a hand towel and gently gripping it with your hand. Simply grip the towel, hold the grip for five seconds, and release. Repeat 10 times.

Tips for Daily Routine

Many functional activities that we perform every day may exacerbate your symptoms of CTS. You may have to modify some of these activities or your daily routine if you have CTS. 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 using a computer, be sure your workstation is set up properly. Using appropriate ergonomics can ensure you keep your neck, back, arms, and wrists in the best position possible. Your therapist is a good resource to use when setting up your workstation.

Treatment

Your physical therapist may recommend various treatments during your rehab for CTS. These may include:

• Wrist splints: Wearing a wrist splint to gently place your wrist and hand in slight extension may be helpful. The splint keeps your wrist in an optimum position, offering maximal space within the carpal tunnel and keeping pressure off the structures there.
• Anti-inflammatory medication: Some people with CTS benefit from taking anti-inflammatory medication to decrease the pain and swelling that occurs around the median nerve. Be sure to speak with your physician prior to taking any medicine.
• Ultrasound: Some therapists use therapeutic ultrasound to treat CTS. The ultrasonic waves pass through your skin and into the injured area, increasing tissue temperature and circulation. However, ultrasound has not been proven to improve outcomes for people with CTS.
• Paraffin wax: Some therapists use a paraffin wax dip for your wrist and hand prior to stretching or treatment. The hot wax increases circulation and decreases pain, although paraffin use has not been shown to improve outcomes for CTS.
• Electrical stimulation: Electrical stimulation, or e-stim, is occasionally used to decrease pain. Your therapist may use it for your CTS, although the pain relief gained through e-stim is temporary.

Home remedies for CTS may also include the application of heat or ice to your wrists. These may temporarily reduce pain and improve your ability to achieve your daily activities.

When to See a Physical Therapist

For many orthopedic conditions like CTS, the best outcomes from physical therapy are achieved when you start rehab soon after the onset of symptoms.

The longer you wait to begin treatment, the more chronic your condition may become and the less likely you are to have a successful outcome. So, if you are feeling symptoms of CTS, check in with your physician right away and ask to be referred to your local physical therapy clinic.

If you do have severe symptoms of CTS, you should still attempt to get relief with your physical therapist. Some severe cases may respond favorably to conservative treatments like physical therapy. If your severe symptoms do not abate within a few weeks, you may need to seek more invasive treatments like cortisone injections or surgery.

If you have surgery for CTS, you may benefit from a course of rehab after the operation. Surgery for CTS involves a small incision in the palm of your hand and your doctor removing the thickened ligament on top of the carpal tunnel, making room for the structures that reside there.

Post-operative rehab usually starts three to four weeks after surgery and may include:

• Scar tissue massage
• 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.

Frequently Asked Questions

How long should you do physical therapy for carpal tunnel syndrome?

Most physical therapy episodes of care for CTS last about four to six weeks. Your time may be shorter or longer depending on the severity of your condition and on any comorbid factors. Working closely with your therapist can ensure you have a realistic expectation of the length of your specific episode of care.

How much does physical therapy for carpal tunnel syndrome cost?

Most people who attend physical therapy for CTS have health insurance that covers a portion of the cost for physical therapy. Costs for rehab vary depending upon your location and what procedures are performed during physical therapy. If you have insurance, you will likely have a co-payment for therapy ranging from $10 to $50.

If you do not have health insurance, you can expect to pay approximately $100 to $150 per session of physical therapy for your care. This may be higher in some places. Over the course of four to six weeks, this can add up, so be sure to work with your therapist’s billing department to understand your specific requirements for payment for services.

Does heat or ice help with carpal tunnel symptoms?

Heat increases circulation and decreases pain. Ice application decreases circulation, inflammation, and pain. Both may be used as a remedy for mild or moderate CTS symptoms. Research indicates that application of heat or ice does not change the overall long-term outcome for CTS.

Summary

If you have wrist pain or thumb and hand tingling, you may have carpal tunnel syndrome. Physical therapy can be a first-line treatment for CTS. Your physical therapist will assess your condition and may use exercises, activity modifications, splints, and other forms of treatment.

A Word From Verywell

Most cases of mild to moderate CTS respond well to therapy. Sometimes, movement and exercise causes increased pain, so be sure to let your physician or therapist know if things are getting worse.

Starting early treatment and making some minor lifestyle modifications can help you quickly recover and return to your previous level of pain-free function.