PT Perspective

with Jason Lau, Doctor of Physical Therapy

Question:

I have had a tingling and numbness type of feeling in my right hand for the past three weeks. I don’t remember doing anything to provoke the symptoms. The numbness seems to be worst at night when I’m trying to sleep and when I wake up in the morning. Sometimes it takes a few minutes before the hand feels normal again after getting out of bed in the morning. I was diagnosed by my doctor with carpal tunnel. What should I do?

Answer:

First a summary of what the carpal tunnel is. The carpal tunnel is a narrow passageway made of the wrist (or carpal) bones on the palm side of the wrist that contains the tendons of the fingers and the median nerve. Since the carpal tunnel is a tight fitting space, inflammation in any of the structures in the carpal tunnel can lead to a compression force on the median nerve which causes the symptoms of numbness, tingling, and sometimes weakness. 

There are other complicating factors in carpal tunnel syndrome that need to be ruled out before proper treatment can be administered, especially if considering surgery. Since we know that the median nerve is involved, we also need to look into other possible sites of compression of the nerve pathway. If there is compression on the nerve in the neck or arm then there is a higher chance that there can be compression in the carpal tunnel because the median nerve has already been compromised and is not as healthy. Think of the nerve like a vine in a garden… if you pinch the vine closer to the root where the vine comes out of the ground, then the rest of the vine is lacking in proper nutrients and is not as healthy. It is sad but not uncommon to hear patients who have had carpal tunnel surgery come out of the surgery with no positive results, only to find out that the source of their issue was more in their neck than in their wrist.

Being that carpal tunnel syndrome symptoms all stem from irritation of the median nerve, the key to treatment is protection of the median nerve. First off, discontinue activities that contribute to the symptoms. Irritating activities often include using the keyboard, over using the hand and wrists, and remaining in a bent wrist position. A wrist brace that limits the bending of the wrist can help by limiting the bending of already irritated structures in the carpal tunnel. Decreasing overall hand and wrist activities will reduce blood flow to inflamed structures in the carpal tunnel. Secondly, after we limit the cause, we want to treat the damage that has been done; often that will be through working on the inflammation with ice and anti inflammatory medications. Physical therapy including stretches and proper exercises can help as well. 

The greatest challenge to overcoming carpal tunnel syndrome is discontinuation of the aggravating activities. This can be difficulty because the aggravating activity is often related to one’s work. However if you are starting to have numbness and tingling in your hands that is not going away and seems to get worse with more work related activities, ask yourself “Am I willing to risk a wrist surgery next year and all the complications that come with surgery so that I can keep up my pace at work?”.

When addressed early, carpal tunnel syndrome is definitely a condition that can be addressed without surgery. If you are having hand numbness/tingling or pain, let your trainer know or set up a physical therapy consultation. 

Submit your questions for future PT Perspective columns to Jason Lau, Doctor of Physical Therapy at jasonlaudpt@gmail.com