Carpal Tunnel Syndrome (CTS) is a common condition resulting from the compression of the median nerve within the wrist. This nerve travels through a narrow passage called the carpal tunnel. Physical therapy (PT) offers a non-invasive, conservative approach to managing CTS symptoms. The primary goal of physical therapy is to relieve pressure on the median nerve, restore function, and improve the quality of life for those affected. This approach is often considered a first-line treatment before more invasive options are explored.
What is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome is caused by increased pressure on the median nerve as it passes through the carpal tunnel, a confined space at the base of the hand. The tunnel is formed by the carpal bones and the transverse carpal ligament, which acts as the roof. Inside this narrow passageway, the median nerve shares space with nine flexor tendons responsible for bending the fingers and thumb. Pressure can increase due to factors like inflammation of the tendon sheaths, fluid retention, and repetitive stress from certain occupations.
Symptoms typically begin gradually, including numbness, pain, and tingling, often affecting the thumb, index, middle, and half of the ring finger. This discomfort frequently wakes individuals during the night and may radiate up the forearm. If untreated, the condition can progress to weakness, clumsiness, and visible wasting of the thumb-side muscles (thenar atrophy).
How Physical Therapy Addresses CTS Symptoms
Physical therapy intervenes by using a combination of targeted techniques designed to decompress the median nerve and reduce inflammation within the carpal tunnel. A foundational component of PT involves specific exercises aimed at improving the mobility of both the nerve and the flexor tendons. These exercises are particularly effective in the early stages of the disease.
Nerve and Tendon Gliding
Nerve gliding exercises, also called median nerve mobilization, involve carefully guided movements of the hand, wrist, and arm to gently slide the nerve. This movement prevents the median nerve from adhering to surrounding tissues and promotes blood flow. Tendon gliding exercises are concurrently used to ensure the flexor tendons move smoothly within their sheaths, reducing the friction and swelling that contribute to nerve compression. These exercises, along with manual soft tissue mobilization performed by the therapist, aim to restore the normal biomechanics of the wrist and hand.
Supportive Care and Education
The therapist also provides supportive care, often including the use of a custom wrist splint. The splint is typically worn at night to keep the wrist in a neutral position, avoiding the flexed posture that increases pressure on the median nerve while sleeping. Modalities like heat or cold treatments may be used to manage pain and inflammation in the short term. A significant part of the treatment involves education on proper posture and workplace ergonomics to reduce repetitive strain, ensuring long-term symptom management.
When Physical Therapy is the Right Choice
Physical therapy is supported by research as an effective treatment, especially for individuals with mild to moderate Carpal Tunnel Syndrome. Studies indicate that a dedicated course of manual therapy and exercise can be as successful as surgery in improving function and reducing symptoms. Patients undergoing PT may also experience faster initial improvements in function.
The decision to pursue physical therapy is based on the patient’s symptom severity, the duration of the condition, and their commitment to the prescribed exercise regimen. PT is the preferred initial choice because it is a non-invasive, lower-risk intervention that can significantly reduce the need for surgery. Treatment typically involves multiple sessions over several weeks, focusing on strengthening the hand, wrist, and forearm muscles once initial symptoms have decreased.
If symptoms are severe, include muscle wasting, or fail to respond after a dedicated period of conservative management, surgical consultation may become necessary. The goal of carpal tunnel release surgery is to physically cut the transverse carpal ligament to permanently relieve pressure on the median nerve. For most patients with early or moderate symptoms, physical therapy provides a proven, first-line approach to recovery.