How to Diagnose and the Best Carpal Tunnel Syndrome Treatment

Physical therapists are well trained to assess and evaluate people with carpal tunnel syndrome. Although some patients (anywhere from 28% to 62%) recover without carpal tunnel syndrome treatment, others (from 32% to 58%) get worse. 

A recent patient of mine from Santa Clara has had pain in their wrist and hand for over 6 months. She reported having low grade pain in her wrist, which she felt while working at Nvidia, but also while biking down Lawrence Expressway. She hoped it would go away because she was busy with a newboarn at home. Unfortunately, the pain only got worse.

This is a familiar story for many with carpal tunnel pain, as many people hope it will spontaneously improve.

Why risk the injury and hope it just goes away on its own. In our current medical system, it is necessary to be proactive with your health, as we currently have a “sick insurance” not “health insurance”.

5 Self Tests to Determine if you have carpal tunnel syndrome

If you are having pain or symptoms in your hand, there is a set of tests you can perform to see if your symptoms of carpal tunnel syndrome is serious.

In those with suspected carpal tunnel syndrome (CTS), here are 5 tests you can perform to see if you have carpal tunnel syndrome.

  1. Patient age (older than 45 years): A simple “test” is age. Age is never easy on the body and CTS is no exception, research suggests if you are >45 years old, you are at a higher risk of CTS.
  2. Shaking their hands relieves their symptoms: When you shake the hand of someone, it will contract the muscles at and around the wrist. Then can increase space for the median nerve (the nerve injured in CTS).
  3. Sensory loss in the thumb: Sensation is one of the first things which diminish when a nerve is injured (followed by strength). If you are having sensory loss, for example, you can’t feel an object brush against your thumb, you are at a higher risk of CTS. If you are unsure of how to test this, you may need to seek a physical therapist.
  4. Wrist ratio index (greater than 0.67): Wrist ratio index, as described by Johnson et al, is measured by using a pair of sliding calipers to measure the anteroposterior (AP) wrist width and the mediolateral (ML) wrist width at the distal wrist crease. Wrist ratio index is then calculated by dividing the AP wrist width by the ML wrist width in centimeters. Ratios greater than .70 were found to be a predisposing factor for carpal tunnel syndrome. 
  5. Boston Carpal Tunnel Questionnaire: Scores from the Boston Carpal Tunnel Questionnaire symptom severity scale (CTQ-SSS) greater than 1.9 are another risk factor for carpal tunnel syndrome.

The presence of more than 3 of these clinical findings has shown acceptable diagnostic accuracy for carpal tunnel syndrome. If you said yes on 3 of these tests, you should see a physical therapist for carpal tunnel syndrome treatment.

4 Effective Carpal Tunnel Syndrome Treatments

There are numerous carpal tunnel syndrome treatments. However, only 4 have shown to be effective in the literature. Remember, a lack of evidence doesn’t mean a treatment can’t be done. It may show it isn’t effective for the majority of people or it hasn’t been researched fully.

  1. Biomechanical Modification: The computer station is the most common issue for carpal tunnel syndrome and effective carpal tunnel syndrome treatment should assess this. Particularly the position of the mouse, as pressure on the wrist from the mouse pad can increase CTS symptoms.  Trying keyboards with reduced strike force for patients with CTS who report pain with keyboard use.
  2. Manual Therapy: Massage, instrument assisted work, cupping, or other manual therapy directly on the wrist or on the neck, shoulder, or forearm may benefit patients with moderate carpal tunnel syndrome. Manual physical therapy, including desensitization maneuvers of the central nervous system, has been found to be equally effective but less costly (ie, more cost-effective) than surgery for women with CTS. From a cost-benefit perspective, the proposed CTS manual physical therapy intervention should be considered.
  3. Orthotics:  An orthotic or brace on the wrist can keep the wrist in the proper position, limiting stress on the median nerve (the injured nerve in most carpal tunnel syndrome cases).  Specifically, a neutral-positioned wrist orthosis worn at night for short-term symptom relief and functional improvemen. Physical therapists may suggest adjusting wear time to include daytime, symptomatic, or full-time use when night-only use is ineffective at controlling symptoms in individuals with mild to moderate CTS. If the standard brace isn’t beneficial, a metacarpophalangeal joint immobilization or modifyig the wrist joint position for individuals with CTS who fail to experience relief. An orthosis is also recommended for women experiencing CTS during pregnancy and should provide a postpartum follow-up evaluation to examine the resolution of symptoms.
  4. Heat: For some patients, superficial heat may be a beneficial carpal tunnel syndrome treatment. A physical therapist may recommend a trial of superficial heat for short-term symptom relief for individuals with CTS.

Two Possibly Effective Treatments for CTS

  1. Neurodynamics: Gently gliding the nerves through the forearm and the wrist may be a beneficial carpal tunnel syndrome treatment. However, there is conflicting evidence on the use of neurodynamic mobilizations in the management of mild to moderate CTS.
  2. Strengthening: Despite popular belief, strengthening doesn’t have adequate research to fully support it in proper carpal tunnel syndrome treatment. However, most physical therapists and rehabilitation specialists would argue strengthening the neck, shoulders, and forearm is necessary for a full recovery.

4 Unlikely Treatments for CTS

A recent literature review by Erickson (2019) found no consistent benefit for CTS for the following treatment:

  1. Low-level laser therapy
  2. Thermal ultrasound
  3. Iontophoresis
  4. Magnets

What if You don’t improve?

If nonsurgical carpal tunnel syndrome treatment does not help, you may need surgery. Your physical therapist can help guide your recovery, decreasing your symptoms in most cases, but in severe, long-standing cases, surgery may be necessary. However, as mentioned earlier, manual therapy is more cost-effective than surgery for the majority of carpal tunnel syndrome cases.

Certainly, pain in the hand and wrist is an issue with many tasks during the day, especially in our technologically advanced World. This makes it even more crucial to start physical therapy at the intial signs of symptoms.

If you are having pain in the wrist region, we do advocate scheduling a physical therapist evaluation. If you are not sure, we are offering a complimentary success session for those who refer to this article (a $100 value). Click on the link below to schedule.

Reference

  1. Erickson M, Lawrence M, Jansen CWS, Coker D, Amadio P, Cleary C. Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome. J Orthop Sports Phys Ther. 2019 May;49(5):CPG1-CPG85. doi: 10.2519/jospt.2019.0301.