Physical therapy treatment of Carpal Tunnel Syndrome ( CTS )

Carpal tunnel syndrome is a neurological condition of wrist and hand caused by compression of the median nerve. 

Differentiating Carpal Tunnel Syndrome from Cervical Radiculopathy and Pronator Teres Syndrome

CTS cause numbness in first, second, third hand first half of fourth digit while cervical radiculopathy causes pain in respective area. Motor function is diminished in biceps, brachioradialis, triceps and wrist and finger extensors.

Pronator Teres Syndrome occurs due to compression of median nerve at elbow. Pain occurs when arm is pronated and supinated repeatedly or against resistance.

 

Clinical presentation of Carpal Tunnel Syndrome

Clinical presentation helps in proper diagnosis of patient’s problem and nerve root involved. Symptoms are presented as following:

• Tingling or numbness
• Activity of daily living ( ADL) are affected example grasping onto an object
• Weakness of muscle in thenar eminence
• Symptoms may improve by jerking/flicking of the hand

 

Causes of Carpal Tunnel Syndrome

Repetitive Movements – such as continuous use of vibrating tools, typing, assembly line work, or using a computer mouse

• Diabetes
• Hypothyroidism
• Rheumatoid Arthritis
• Obesity
• Pregnancy
• Trauma or Injury - such as fractures, dislocations, or sprains
• Hormonal Changes
• Genetic Predisposition - such as a naturally smaller carpal tunnel

Diagnostic Test for Carpal Tunnel Syndrome

Phalen's test

It is a provocative test in which symptoms appear when the patient makes the following position as shown below

Tinel Sign

A Tinel sign test is a simple procedure in which therapist taps your skin above the nerve. The patient then describes the feeling or sensation..

OK Sign 

Done for anterior interosseous nerve which is branch of median nerve. Patient is unable to make a proper OK.

 

Physiotherapy Treatment for Carpal Tunnel Syndrome

Physiotherapy can be an effective component of the management of carpal tunnel syndrome (CTS), particularly in mild to moderate cases or as part of a comprehensive treatment plan alongside other interventions such as splinting or medication. Here are some common physiotherapy approaches for managing carpal tunnel syndrome:

Pain Management Techniques for Carpal Tunnel Syndrome

Transcutaneous Electrical Nerve Stimulation (TENS)

It is used to excite sensory nerves thus improving nerve conduction. It can be applied for 15-20 minutes twice a day.

Therapeutic Ultrasound

Therapeutic Ultrasound reduces inflammation and promotes healing of injured tissue through fibrinolytic, anti-inflammatory, and anti-irritant activity. The preferable intensity is 0.8 to 1.0 W/cm2 with duration of six minutes.

Laser Therapy

It reduces pain and burning sensation in patients with CTS. The use of both low- and high intensity laser beams is considered.

Paraffin Wax Therapy

It is used to induce analgesia, reduction of paresthesia, along with reduction in stiffness. It is applied at a temperature of about 50 °C for 15-20 minutes on the anatomical projection of the carpal canal and the palm

Iontophoresis

Is the transfer of ions through the skin using a mild electrical current. potassium iodide is used for the procedure. The duration of the procedure is 20 minutes

Edema Control in Carpal Tunnel Syndrome

• Cryotherapy
• Elevation of affected part
• Compression
• Interferential current (0-100 Hz)
• Russian current
• Traction
• Prolonged stretching

 

Exercise for Carpal Tunnel Syndrome

• Stretching of wrist extensors

• Median nerve glide

• Tendon glide

Mobilization (wrist extension)

Mobilization is usually done in grade I and II. The proximal bone is convex while distal radioulnar joint is concave so when moving with the convex joint partner we will have to roll and glide in two opposite directions. Force is applied in palmar direction.

Carpal Tunnel Syndrome Splint

Splint or Cast is used to reduce pressure on median nerve or for corrective purpose. It is recommended to use cast during night. The wrist is kept in neutral position. The most preferred method in the treatment of CTS is volar-assisted neutral splints and it is typically applied in the first stage.

Kinesio taping (KT) for Carpal Tunnel Syndrome

It is relieve nerve compression along with improve blood circulation to affected area, reduces muscle spasms, facilitates the movement of tendons and fascia, and reduces pain through neurological suppression . Application direction, duration, frequency and degree of tension are important for kinesiotaping. It is applied in such a manner that it lengthen the transverse carpal ligament.

Acupuncture

Acupuncture reduces pain intensity by providing anesthetic effect.