Hand Therapy for Carpal Tunnel Syndrome (CTS)

Carpal tunnel syndrome (CTS) is a painful condition that, when left untreated, could lead to permanent disability in the hands. It is usually caused by repetitive motion, such as typing and working with tools. Unfortunately, many of these repetitive motions are required to perform a job successfully, so it is hard to avoid these activities entirely.

Carpal tunnel syndrome (CTS) can be treated with anti-inflammatory drugs, and in severe cases, surgery. The potential side effects of drugs and pain and recovery time of surgery have sparked interest in alternative methods of treating CTS. Current evidence demonstrates a significant benefit from hand therapy techniques, such as splinting for stabilization, and exercises for people with carpal tunnel syndrome. People who undergo hand therapy often see benefits of the therapy for three months after treatment.

How Can Hand Therapy Help with Carpel Tunnel Syndrome (CTS)?

People with repetitive stress injuries (RSIs), like CTS, often visit a hand therapist. Hand therapy can also benefit other patients who suffer from conditions like arthritis and some neurological conditions, because it helps, at the minimum, to decrease pain and improve movement.

Some of the techniques hand therapists use to improve function of the hand and wrist include:

• Braces and splinting: Provide support and rest to joints. Wearing wrist splints at night may relieve symptoms that interfere with sleep.
• Massage: Increases circulation, relaxes muscles, and provides a sense of well-being.
• Exercises: Stretch and strengthen tendons.
• Hot packs and cold packs: Provide pain relief. Ice and cold packs can reduce swelling and inflammation.
• Paraffin dips and contrast baths: Increases circulation and decreases pain and swelling.

Self-Treatment for Carpal Tunnel Syndrome (CTS)

A contrast bath isan inexpensive and effective way to manage pain associated with carpal tunnel syndrome (CTS). Contrast baths help to reduce inflammation by constricting and dilating the blood vessels. Fill a sink or basin with warm water (about 96 degrees). Fill another basin with cool water (about 66 degrees). Soak in the cool water for one minute and then transfer to the warm water for two minutes. Go back to the cool water and soak for one minute and then transfer to the warm again for two minutes. Repeat 4 to 5 times. Always start and end with cool water.

An inexpensive, reusable cold pack for hand therapy can be made at home. Use a good leak-proof freezer bag to freeze 3 parts water to 1 part alcohol (any type of alcohol will do). The alcohol prevents the water from freezing completely, making a cold slush that can be wrapped around the painful area.

What is Hand Therapy?

Hand therapy provides preventive and conservative treatment of shoulder, elbow, wrist, and hand injuries. Hand therapy is performed by an occupational therapist or a physical therapist with advanced training. Hand therapists teach exercises and create custom splints to help the hand heal and protect it from additional injury. The goal of hand therapy is to help regain maximum use of the hand.

Some evaluations performed by a hand therapist include:

• Measurement of joint range of motion (called “goniometry”)
• Strength testing—grip, pinch, and manual muscle testing
• Sensory testing—determines deficits in nerve function
• Coordination/fine motor skills assessment
• Splinting/bracing needs assessment
• Activities of daily living assessment

Special Considerations

A qualified hand therapist or a doctor should prescribe your hand brace or splint. Further injury can result from using an improper or ill-fitting brace.

Always use a pillowcase or thin towel between your skin and any ice pack. After using cold therapy, allow 20 minutes before performing exercises or intense activity because cold decreases flexibility. In order to prevent damage to skin, avoid using heat and cold treatments if sensation or circulation is impaired.

What is Carpal Tunnel Syndrome (CTS)?

Carpal tunnel syndrome (CTS) is a type of injury known as a repetitive stress injury. Repetitive stress injuries, or RSIs, occur when a person performs the same action over and over again. During the repeated motion, muscles are kept tensed, causing pain over time. Carpal tunnel syndrome involves the compression of the median nerve connecting the hand with the wrist, which results in weakness, numbness and tingling in the hand. The carpal tunnel itself is actually a group of eight bones in the wrist which form a “tunnel” through which this median nerve runs. The tendons in the carpal tunnel swell to pinch the median nerve when repetitive tasks are performed. Some tasks that cause CTS include prolonged typing, repetitive factory work, or other repetitive work involving hand tools.

Since carpal tunnel syndrome is a condition that worsens with swelling in the wrist area, other conditions that cause swelling will increase the risk for developing CTS. These conditions include pregnancy, diabetes, injuries to the arm and wrist, obesity, thyroid conditions and other pituitary abnormalities.

Warning signs that you may have Carpal tunnel syndrome (CTS) include:

• Pain that shoots from the hand up the arm as far as the shoulder
• Tingling in the hands during the day or at night, that disrupts sleep and limits the ability to grasp objects with the hands
• Weak feeling in the hands, and the inability to pick up small objects
• The feeling that the hands are swollen, even if they do not appear to be so
• Burning and tingling sensation in the thumb and first three fingers
• Weakness in the muscle at the base of the thumb, near the palm

Hand therapy is a practical, conservative intervention for carpal tunnel syndrome, although additional research is needed for some techniques. Insurance carriers may not fully cover the costs of some hand therapies.

Additional Resources

American Society of Hand Therapists

Online Support Group for Carpal Tunnel Syndrome

“Effectiveness of hand therapy interventions in primary management of carpal tunnel syndrome: a systematic review.” Journal of Hand Therapy, 2004 Apr–Jun;17(2):210–28.

“A systematic review of conservative treatment of Carpal Tunnel Syndrome.” Clinical Rehabilitation, 2007 Apr. 21(4):299–314.