Carpal Tunnel Syndrome (CTS) in Happy Valley

Your carpal tunnel is, as its name implies, a tunnel that connects several structures from the forearm through the wrist and into the hand. The tunnel itself is made of thickened connective tissue with little flexibility available. With prolonged compression from either the outside in, such as, resting your wrist on the edge of a desk, or from the inside out, such as, swelling inside the tunnel trying to press outwardly; loss of nerve function will begin to occur. A lesser known contributor to carpal tunnel syndrome is vibration and gripping. Think – construction power tools, motorcycles, road cycles, and sports that use a racquet or club. Individuals who work in assembly-line style jobs are up to 3x more susceptible to developing this than an average person. Due to a mixture of lifestyle, work, and physical activities, carpal tunnel syndrome is relatively common. It is estimated that 5% of the population is suffering from carpal tunnel syndrome at any given time. 

Additional increased risk factors for developing carpal tunnel syndrome may include –

  • Swelling and inflammation of wrist tendons
  • Fractures, dislocations, and sprains of your wrist
  • Conditions that results in increased fluid retention or joint mobility changes, such as pregnancy
  • Diabetes Mellitus Type 2
  • Long term corticosteroid use
  • Rheumatoid and Osteoarthritis

Common Complaints (Symptoms)

Symptoms are generally described as a gradual onset or progressive worsening. Possible symptoms include:

  • Numbness / Tingling in the hand or wrist
  • Weakness with grip or dropping items
  • Shrinking of the thumb muscle in your palm (deflated look)

These could be experienced at any point in the day but initially are more prevalent or noticeable at night. These symptoms may wake you up from sensations of a painful “dead hand”. Your wrist was likely flexed into an extreme position and/or you were laying on top of your wrist. “Shaking it out” usually helps alleviate symptoms after a few seconds up to a minute.

If the underlying irritant is not identified and corrected, further progression of symptoms is likely. Severity and frequency will increase to become much more noticeable during the day and begin to interfere with daily tasks. The earlier this is identified and treated, the faster and easier it is to fully resolve.

Diagnosing Carpal Tunnel Syndrome (CTS)

Here are a handful of tests that your therapist or other providers will utilize to confirm suspicions of carpal tunnel syndrome pathology:

  • In depth physical examination, including assessment of your neck to screen for pinched nerves
  • Testing of grip strength and comparing to expected normative data
  • Sensation testing of hands and arm
  • Phalen test – Push the backs of hands together to cause end range wrist flexion. A positive finding is noted if you report familiar symptoms in your hands within 1 minute.
  • Tinel’s Sign – An instrument is used to tap on the median nerve at the wrist level. A positive finding is noted if you report familiar symptoms during test.
  • Nerve Conduction Velocity (NCV) test – The speed of electricity through your nerve is measured and compared to normative data to identify disruptions, severity, and likely locations of the problem.

Treatment Strategies for Carpal Tunnel Syndrome

One of our Doctors of Physical Therapy will be able to assess your individual specific needs and subsequent plan of care, but this is a general outline of key features to expect within your plan of care:

  • Education
    • Relieving wrist positioning strategies
    • Temporary compensation strategies to reduce inflammation
    • Temporary activity modifications to avoid ongoing stress to median nerve
  • Prescriptive Resistance Training
    • Increase strength of forearm and hand
  • Targeted Stretching Activities
    • Increase mobility of affected structures to reduce strain
  • Recommendation of orthotics
    • A neutral wrist brace or splint to reduce tension and compression of median nerve
    • Anti-vibration gloves if you operate heavy machinery or long motorcycle rides
  • Ergonomics
    • Training and identification of contributory factors for long term prevention

Treatment After a Carpal Tunnel Release Surgery

Physical Therapy after your surgery is recommended to avoid complications and safely restore your normal motion & strength. While the surgery itself is generally quite helpful to reduce compression and irritation of your median nerve, it sometimes does not completely relieve symptoms. Understanding and identifying underlying irritating factors is critical to complete recovery and prevention of future symptoms. The treatment strategies will be similar to those already listed with some special consideration for infection risk management and prevention of excessive scar tissue formation.

If Carpal Tunnel Syndrome symptoms have been interfering with your life, call us today to get started on a plan of care that works for you. Ascent Physical Therapy is conveniently located off Sunnyside Road in Happy Valley. We also love treating our neighboring communities of Damascus, Gresham, Clackamas, and Sandy at our top rated physical therapy clinic!