Carpal tunnel syndrome - South Tees Hospitals NHS Foundation Trust

Carpal tunnel syndrome
Patient Information
Clinical Support
Services
Physiotherapy
Median nerve
Ulna
Transverse carpal
ligament
Radius
What is carpal tunnel syndrome?
Carpal tunnel syndrome is a condition in which the median
nerve is squeezed or pinched where it passes through the
wrist. The reason for this is usually unknown. Possible causes
include: swelling of the tendon lining, joint dislocations,
fractures, or arthritis. Fluid retention in pregnancy can also
cause swelling in the tunnel. The median nerve controls some
of the muscles that move the thumb and it carries information
back to the brain about sensations in your thumb and fingers.
When the nerve is squeezed 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. Hanging your hand
out of bed and shaking it around
will often relieve the pain and
Branches of
tingling.
median nerve
You may not notice the
problem at all during the
day, though certain
activities – such as
writing, typing, DIY or
housework – can
bring on
symptoms.
Flexor
tendons
Median
nerve
Site of
compression
Transverse
on median
Carpal
nerve
Ligament
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Sometimes the condition can be mistaken for something else.
For example, pressure on nerves in the neck due to disc
problems or arthritis can cause similar symptoms. A nerve
conduction test may help if there is any doubt about the
diagnosis. (Arthritis Research).
Symptoms
• Tingling of the thumb and fingers (not the little finger)
• Numbness in the thumb and fingers (not the little finger)
• Aching in the thumb, perhaps moving up as far as the neck
• Burning pain from the wrist to the fingers
• Change in touch or temperature sensation
• Clumsiness in the hands
• Weakness of grip, ability to pinch and other thumb actions
• Swelling of the hand and forearm
• Change in sweat functions of the hand (American Physical
Therapy Association)
Physiotherapy
You may have been referred to a physiotherapist for your
carpal tunnel syndrome. They will provide you with some
splints, teach you the following exercises, and educate you
about posture. They may refer you onwards for an injection or
consideration of surgery, depending on your symptoms.
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For video demonstrations of the detailed
exercises please click ‘video link’. Alternatively,
if you have a hand held device such as a smart
phone or tablet, download a free ‘QR code
reader’ app from your app store and scan the
‘QR code’.
NB Viewing this video may use some of your mobile data
allowance. We recommend waiting until you have a wifi
connection.
Tendon gliding exercises
Median nerve exercise
Fig A.
Fig B.
Start with both arms out in front of you
Bend the wrists back keeping the fingers as straight as possible
Hold for two seconds and then relax
Start with a straight hand (1), move into position (2), hold for
2 seconds, then return to position (1). Repeat 10 times.
Repeat the same process for positions (3), (4) and (5). Repeat
five times daily.
Bend all four fingers forwards from the back knuckle
forming a flat table top (2)
Fig A.
Fig B.
Form a fist with both hands (A) and push the wrists down (B)
Hold for two seconds, relax and repeat this exercise three times,
once daily
Position 1
Position 2
Bend all four fingers
forwards at the same
time from the little
knuckles forming a
‘hook’ like fist (3)
Position 3
Bend all four
fingers forwards
at the same time
to form a fist (4)
4
Position 4
Position 5
Bend all four fingers
forwards from the back
knuckle and then the
middle knuckle ensuring
that the tips are straight
forming a ‘box’/‘square’
shaped fist fist (5)
Splints
Your physiotherapist may provide you with a wrist splint. This
is to be worn at night time only. The splint is designed to keep
your wrist straight and prevent the carpal tunnel being
squeezed when you are asleep. Your physiotherapist may also
ask you to wear the splint for short periods in the day if your
symptoms are brought on by particular activities, for example,
when typing on a computer.
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Posture
At the office
It is important to avoid aggravating activities when you have
carpal tunnel syndrome. It is also important to take regular
rests from repetitive tasks, especially when any tingling,
numbness, pain or cramping occurs. Try not to bend your wrist
too far backwards when typing, writing, knitting, sewing,
playing sports, using tools and cutting with knives, this will
reduce the pressure on the carpal tunnel.
• Try and control your mouse with the lightest possible grip
• Rest your palms, not your wrist, on a wrist-rest or the
desktop
• When using a keyboard/mouse, your hands should be even
or slightly lower than your elbows. An adjustable keyboard
tray mounted under the desktop may be necessary.
• Keep your hands in-line with your forearms as much as
possible, not bent in/out or up/down at the wrist.
• Rest your elbows on your chair’s armrests and adjust them
so the weight of your arms is supported by the armrests,
not supported by your shoulders.
At home
• Rest your hands frequently, especially when any tingling,
numbness, pain, occurs.
• If a repetitive job is awkward, try to find a better way to do
it.
• When using vibrating tools, try to reduce the vibration to
your hands with gloves, padding, etc.
• Alternate easy and hard tasks that use your hands.
• Use your whole hand to grasp objects, not just your thumb
and index finger.
• Give your hand and wrist time to recover after forceful
movements.
• Do not carry heavy objects for long periods. Use carts,
trollies, etc. whenever possible.
• Increase the size of handles of tools and equipment with
tape, foam or other materials to help spread the pressure
more evenly over the hand.
• Use a foot rest if your feet are not flat on the floor.
• The top of your monitor should be about eye level so you
are not bending your neck up or too far down.
• Sit upright so your head is above your shoulders. Don’t
slouch forward.
• Take frequent breaks and do regular stretching exercises
• Alter your posture from time to time but keep within the
guidelines of correct sitting most of the time.
• Sit so the natural hollow stays in your lower back. A good
adjustable chair should allow this.
• Position your monitor and keyboard in front of you, not to
the side.
• Use thicker pens (1/2”+ width) to make them easier to grasp.
• Keep your hands warm to promote circulation.
• Do not wear wrist splints for extended periods during the
day. Some muscles may weaken.
• Cut back or discontinue the use of tobacco
• Do not type with long fingernails.
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Comments, compliments, Patient Advice and
concerns or complaints
Liaison Service (PALS)
South Tees Hospitals NHS Foundation
Trust is concerned about the quality
of care you receive and strives to
maintain high standards of health care.
This service aims to advise and
support patients, families and carers
and help sort out problems quickly
on your behalf.
However we do appreciate that
there may be an occasion where you,
or your family, feel dissatisfied with
the standard of service you receive.
Please do not hesitate to tell us
about your concerns as this helps us
to learn from your experience and to
improve services for future patients.
This service is available, and based,
at The James Cook University
Hospital but also covers the Friarage
Hospital in Northallerton, our
community hospitals and community
health services. Please ask a member
of staff for further information.
The James Cook University Hospital
Marton Road, Middlesbrough, TS4 3BW. Tel: 01642 850850
Version 2, Issue Date: July 2014, Revision Date: July 2015
MICB4311
Author: Physiotherapy Team