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Health & Exercise Forum

Carpal Tunnel Syndrome

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May 7, 2009

Dr. Paul MackareyGuest Columnist: Nancy N. Wesolowski, OT, MS, CHT

My colleague, Nancy Wesolowski is an occupational therapist specializing in rehabilitation of the hand and upper extremity. We have been working together for many years and I am always amazed by the variety of hand problems she encounters. I asked her to discuss the most common problem she treats in our office. This problem affects the carpenter, typist, truck driver, jackhammer operator, violinist, pianist and court stenographer. They all ask the same question, “Do you think I have carpal tunnel syndrome?” Over the past 10-15 years, carpal tunnel syndrome has moved to the forefront in medicine and has become water cooler conversation. So what is carpal tunnel syndrome and how is it treated?

Carpal tunnel syndrome (CTS) is a nerve disorder caused by compression of the median nerve at the wrist. The median nerve is one of three main nerves that provide sensation to the hand. This nerve specifically supplies sensation to the thumb, index, middle, and half of the ring finger. In CTS, compression on the median nerve occurs as it travels through a narrow passage in the wrist called the carpal tunnel. The carpal tunnel is formed by eight bones in the wrist (the floor of the tunnel) and the transverse carpal ligament, a strong ligament traveling across the roof of the tunnel. Within the tunnel there are nine tendons, which are a bit smaller than a pencil. These tendons share this space with the median nerve. In the case where there is swelling on the structures in the carpal tunnel, a person can experience pins and needles, numbness, and aching in the hand.

Causes of Carpal Tunnel Syndrome

  • Repetitive motion of the fingers/wrist
  • Vibration from machinery/equipment
  • Wrist trauma such as fractures and crush injuries
  • Naturally narrow carpal tunnel
  • Hormone related conditions including pregnancy and menopause
  • Arthritis
  • Diabetes
  • Medications (i.e. birth control pills and some high blood pressure drugs)

Risk factors for Carpal Tunnel Syndrome

  • Gender (more common in females)
  • Aging
  • Obesity
  • Smoking
  • Repetitive motion type jobs and activities (i.e. sewing, playing instruments)

Symptoms of Carpal Tunnel Syndrome

  • Tingling, numbness, or burning in the thumb, index, and middle fingers
  • Pain or numbness that worsens with use or activity or becomes worse at night
  • Cramping/hand stiffness that is relieved after shaking or upon waking
  • Dropping objects
  • Decreased grip strength


To be properly diagnosed, a physician will discuss your symptoms and medical history, and examine strength and sensation. A nerve conduction study, electromyography (EMG), and x-ray may be ordered to provide information regarding sensation in the median nerve distribution and confirm compression at the carpal tunnel.


Treatment focuses on the causes. Therefore treatment suggestions may include activity modification and postural changes during activities. Other suggestions may include frequent rest periods, elevation, and exercises or stretching. Wrist splints are effective in relieving compression at the carpal tunnel and are typically recommended for night wear. Appropriate fit of the splint is vital. Occupational therapists or certified hand therapists can check the fit of pre-fabricated splints or can fabricate a custom splint. The above mentioned treatments all focus on decreasing inflammation and compression on the median nerve.


Your physician may order pain relievers or anti-inflammatory medication. A cortisone injection into the carpal tunnel may also be recommended to assist with decreasing inflammation near the carpal tunnel.


A referral to an occupational therapist or certified hand therapist may be made. A therapist can provide information regarding the diagnosis, appropriate treatment, and symptom reduction. They can make recommendations to introduce into daily activities to allow appropriate positioning of the upper extremities. A therapist will also instruct individuals on helpful stretching exercises or fabricate a wrist splint. Other treatments include ultrasound, iontophoresis, and massage. The focus of therapy is to introduce changes and interventions that reduce inflammation at the carpal tunnel to assist with symptom relief.


Surgery, referred to as a carpal tunnel release, may be indicated if symptoms are significant and impair functional activity performance.


  • Minimize repetitive hand/wrist motion
  • Alternate activities
  • Avoid prolonged hand use or prolonged positioning
  • Keep wrists straight during use when possible
  • When working on a computer or at a desk, adjust environment for optimal positioning (back straight, feet flat, knees level with or slightly lower than hips, shoulders straight, elbows at a 90 degrees angle, forearms parallel to floor, and wrists straight)
  • Take frequent rests and massage hands
  • Exercise regularly
  • Reduce smoking and caffeine intake

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This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:

Paul J. Mackarey PT, DHSc, OCS is a Doctor  in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliate faculty member at the University of  Scranton, PT Dept.