Physical Therapy Advice: Carpal Tunnel Syndrome

Air Date:
Heard On The Larry Meiller Show

Carpal tunnel syndrome occurs when a nerve in the wrist is pinched. Larry Meiller learns how to identify and prevent it, and what treatment options are.

Featured in this Show

  • Carpal Tunnel Syndrome Is A Combination Of Biology, Lifestyle, Experts Say

    Carpal tunnel syndrome can cause pain and weakness in the wrist for people who suffer from it, and can make work and play difficult or impossible.

    In the wrist, there is a tunnel composed of bones and a thick ligament. When the nerve and tendons that pass through it are compressed, pain, tingling and loss of strength can result. Those sensations are felt on the palm side of the wrist.

    Lori Thein Brody, a physical therapist and athletic trainer with the University of Wisconsin Sports Medicine and Spine Center, explained that the structure has a purpose, but can also lead to problems.

    “(That tunnel) creates kind of a pulley for those tendons to work through and increases their ability to leverage. But, it’s also a limited space tunnel. So, if you get any kind of swelling in there due to arthritis, injury or tendonopathy, it can put pressure on that nerve,” Brody said.

    Bill Boissonnault, a professor at the UW School of Medicine and Public Health and senior physical therapist at the Spine Center Physical Therapy Clinic of the UW Hospital and Clinics, said that women more often suffer from carpal tunnel syndrome likely because their wrist structures are smaller.

    Similarly, Boissonnault said women are more at risk during pregnancy and during menopause because of the tendency to retain fluids during both those life stages.

    Boissonnault and Brody said that there isn’t a genetic predisposition to the syndrome, but since body type and therefore skeletal size and structure is passed down, people can “inherit” it in that sense from their parents.

    “If one sibling has it, there is a greater likelihood that the others will have it as well,” Brody added.

    To prevent the onset of carpal tunnel syndrome, Brody said that a good approach is to adjust work and leisure habits to avoid having wrists flexed for long periods. She said that often people will wake up with the symptoms because they have unknowingly slept with their wrists bent.

    Brody said that jobs that require repetitive motion, like using a computer, working as a cashier or on an assembly line, can bring on the condition. She added that motions that also involve gripping will increase the strain.

    “When you grip, it uses those same flexor tendons that pass through that tunnel. And then you’re going to have a tendency to also flex your wrist at the same time. So you’re flexing and using those tendons, and when you use those tendons they’re increasing in diameter,” Brody explained.

    Boissonnault warned that even fun and otherwise healthy hobbies, like gardening, can put people at risk for carpal tunnel syndrome.

    “When you look at all the ways that it can be aggravated, you can understand why so many people are affected,” Boissonnault said.

    Boissonnault said that “conservative care” is the first choice for addressing the symptoms of carpal tunnel syndrome. He said that that approach can be a combination of medication and rehabilitation.

    “We spend a lot of time educating people about their work stations and about their job and how to decrease the pressure within that area anatomically,” Boissonnault said.

    Brody added that splinting the wrist, especially during sleep, can result in a marked improvement and control of symptoms. She added that anti-inflammatory medications can also bring relief.

    While the pain and discomfort is focused in the underside of the wrist, Boissonault said that treatment needs to include shoulders, neck, cervical spine and overall posture as well.

    “Ultimately, to change the mechanics of the wrist and hand, people need to be examined up through the trunk as well,” Boissonnault said.

    One diagnostic note to be aware of is what the nerve that passed through the tunnel is connected to. Boissonnault said that the median nerve that runs through the carpal tunnel affects all of the fingers except the inside of the ring finger and the pinkie. So if there is pain, numbness and tingling in those digits, it’s either something else entirely, or a condition in addition to carpal tunnel.

    For severe cases, carpal tunnel release surgery is an option, and Boissonnault said that it is one of the most common surgeries performed in the United States. He said that it involves cutting through the ligament that forms part of the tunnel’s walls in order to create more space and to relieve pressure.

Episode Credits

  • Larry Meiller Host
  • Judith Siers-Poisson Producer
  • Bill Boissonnault Guest
  • Lori Thein Brody Guest