Carpal tunnel syndrome (CTS) is a common but potentially debilitating condition of the wrist and hand. It can detrimentally impact the use of the entire arm, as well as the shoulder.

Carpal Tunnel Treatment

Excessive demands on the hands and wrists make this a very common issue. In fact, 1 out of every 20 people in the United States has Carpal Tunnel.

While surgery is often performed to correct the issue, it is not necessary.

Physical therapy and similar treatments have been found to be effective in alleviating the symptoms associated with the condition.

In this comprehensive guide, you will learn about carpal tunnel syndrome. If you have shoulder pain, limited use of your arm, or complications with your wrists and/or hands, continue to learn more.

The pain you feel today will be the strength that you feel tomorrow…”Unknown

The home medical library (1907) (14781739771)
source: wikimedia

Carpal Tunnel Syndrome Explained

Carpal tunnel syndrome is a direct result of pressure on the nerve that is located at the base of the palm of the hand.  This is medically termed the “median” nerve.

The carpal tunnel is a narrow region located in the wrist, on the side of the palm. It is an area that aids in the protection of the tendons that are responsible for bending the fingers, as well as the median nerve.

If pressure builds in this area, it can result in the development of weakness and pain in the wrist and the hand. It may also result in a numbness or tingling sensation in one or more fingers.

The overall functionality of the arm may be detrimentally impacted. Additionally, many individuals experience extreme bouts of shoulder pain with carpal tunnel syndrome.

Health Issues That May Cause Carpal Tunnel Problems

There are several unique health conditions that may lead to the onset of problems with the carpal tunnel region. These are as follows:

  • Those that experience issues with the tendons in the wrist, such as swelling, inflammation, and other types of irritation are at high risk for developing carpal tunnel problems.
  • Changes in hormones or the unique metabolic balance of the body – such as pregnancy and/or issues with the thyroid – could result in CTS.
  • Injuries that directly impact the wrist like sprains, dislocations, and even fractures may place immense pressure on the carpal tunnel and cause hand, arm, and shoulder problems.
  • Retaining fluid in the body due to other conditions, such as pregnancy, diabetes, and issues with the endocrine system may increase the pressure in the carpal tunnel.
  • Arthritis and/or degenerative disorders in the body are known to cause carpal tunnel problems.
  • In addition to the health issues that may lead to CTS, certain types of medications – such as steroids – may also result in severe pressure in the carpal tunnel in the wrist.

Carpal Tunnel Syndrome and Professions

There are several professions that could leave you prone to carpal tunnel and the hand, wrist, arm, and shoulder problems that stem from it. These include, but, are not limited to:

  • Assembly-Line Responsibilities
  • Packing Jobs
  • Heavy Machinery Operation
  • Landscaping Jobs
  • Data Entry Work
  • Dental Positions
  • Sewing
  • Professional Sports
  • Music Industry Jobs That Require the Playing of an Instrument
  • Construction Jobs
  • Mechanics
  • Gardening
815 The Carpal Tunnel
source: wikipedia

Carpal Tunnel Anatomy

In order to truly understand the effects of carpal tunnel syndrome, it is important to have a solid understanding of carpal tunnel anatomy.

The “tunnel” identified in this syndrome consists of various tendons, an assortment of tissues, and various bones that make up the wrists and hands.

Visualize the bones from the hand through the arm as a roadway. The overpass of this roadway consists of the flexor retinaculum and the palmar carpal ligament. The flexor tendons and the median nerve flow underneath this figurative overpass.

The Median Nerve.
This nerve holds the highest level of importance. It is part of a network of nerves called the “brachial plexus”. This network is located in the shoulder and upper region of the arm. It is directly responsible for providing touch and feeling sensations to the palm,  the side of the thumb, the middle, index, and the ring finger.

It provides sensations to the flexor tendons that are part of the carpal tunnel anatomy. Furthermore, it provides functionality to the muscles that are located at the base area of the thumb.

Risk Factors

In reviewing carpal tunnel test results and confirmed cases of the condition, there are several risk factors associated with the condition. These include the following:

  • The health issues previously mentioned may place a person at risk for developing CTS.
  • Working in the professions previously outlined or in a profession that involves the use of tools that vibrate or place large amounts of weight on the hands or wrists.
  • Individuals that have the genetic predisposition for a small carpal tunnel may experience higher levels of pressure than those that have normal sizing in this area.
  • Females are known to have a threefold risk of developing problems with carpal tunnel.
  • Individuals that are between the ages of 40 and 70 are at higher risk for a diagnosis of this condition.
  • Excessive exposure to cold temperatures and vibrations are more likely to experience issues with this syndrome.
  • Repetitive motions will enhance the probability of developing carpal tunnel health complications.
carpal tunnel symptom of wrist pain

Carpal Tunnel Symptoms

Carpal tunnel syndrome causes many uncomfortable symptoms. While many are directly related to the hands and/or the wrists, there are other symptoms that impact the arms and shoulders.

Examples of symptoms that may be experienced based on carpal tunnel test patients that have been diagnosed with the condition include – but, are not at all limited to – the following:

  • In the initial stages of the condition, one may experience tingling sensations that are often described as “pins and needles”.
  • Numbness may develop in the palm area of the hand and in the fingers. The fingers that are most commonly impacted include the index finger, middle finger, and the ring finger. Additionally, the thumb may also suffer.
  • It is common for individuals to suffer from sensations that resemble that which would occur with a mild electrical shock.
  • Pain is likely to occur in the arm and the shoulder. Many people do not relate shoulder pain and arm pain with carpal tunnel, but doctors have established that carpal tunnel syndrome is one of the most common culprits of pain and discomfort in these areas of the body.
  • Weakness is likely to develop in CTS. This often results in a sense of clumsiness that may make it difficult to perform tasks such as buttoning and zipping clothes, holding eating utensils, carrying cups or plates, and activities that are similar in nature.
  • Many people with CTS develop a condition called “proprioception”. This is where an awareness of where the hand is located is simply lost. When this happens, it is not at all unusual for a patient to drop items or to bump their hand into objects in their environment and sustain injuries.
  • It is common for people to find that they experience issues in sleeping. This is mostly due to the natural tendency to bend or move around the wrist while sleeping.
  • Cramping commonly occurs in the hand.
  • Most will find that the strength associated with their grip is drastically diminished.
  • Limited mobility in the shoulder and arm may be experienced.

Carpal Tunnel Test Process

Many medical professionals work together in the carpal tunnel test process. Primary care physicians, physical therapists, ortho specialists, and others. The carpal tunnel test process is often comprehensive because it’s important that it’s diagnosed accurately to ensure proper treatment. Here are the steps included in the carpal tunnel test process. In some instances, only a few of these steps are performed. In others, all may be performed:

  • A Thorough Neck and Back Examination
  • Grip Strength Tests for Fingers and Hands
  • Blood Tests
  • Wrist Tests
  • Range of Motion Tests
  • Test for Wrist Flexion
  • Tinel’s Sign Carpal Tunnel Test
  • Sensory Tests
  • Electromyogram/EMG Testing
  • Nerve Conduction Tests
  • Phalen’s Maneuver
  • Reflex Tests
  • Ultrasound
  • MRI Scans
  • X-rays

It is quite likely that you are experiencing shoulder pain that you believe could be caused by carpal tunnel syndrome. Is it carpal tunnel or is it a shoulder issue?

The truth of the matter is, it is probably both – stemming from reversed median nerve pain resulting from compression. If you have shoulder pain, it is likely that you are suffering from carpal tunnel syndrome.

In years past, most doctors would not make this correlation. In today’s medical landscape, it’s been found in approximately 75% of all cases of shoulder pain. The root cause is carpal tunnel syndrome. This is especially true among high-risk groups.

Woman with Shoulder Pain.

How Can I Tell if My Shoulder Pain is Median Nerve Pain?

Nerve pain – especially that associated with carpal tunnel syndrome – affects each person in a distinct manner. It often starts with numbness and sensitivity in the fingers and hand.

Then, there are some that start to feel burning sensations or tingling sensations. Many may feel the impact of median nerve pain from their fingertips all the way back into the back.

The truth of the matter is, median nerve pain is felt in many ways and it is not the same for two people.

Each form of compression is unique and is based on a number of factors. These include age, risk factors, the general level of health, and the manner in which the median nerve is compressed.

The GOOD News

While carpal tunnel syndrome is a challenging issue that causes many complications, it is a medical condition that can be treated.

Many throughout history have opted for surgery. While surgical intervention is a viable option, it is not the only option.

There are several other – less invasive – methods for treating carpal tunnel syndrome and shoulder pain caused by CTS that will aid in alleviating symptoms. These include hand and wrist exercises, a range of mobility techniques, and more.

physical therapy shoulder treatment

Non-Operative Treatments

While surgery is often considered to be a viable option for the treatment of carpal tunnel syndrome, there are many non-operative treatment techniques that have proven highly effective. This is especially true for those that suffer from whole-arm pain and shoulder pain as a result of the presence of the condition.

The following outlines these techniques and provides a brief explanation of each:

  1. Starting Treatment – In many instances, a patient will first be encouraged to take over-the-counter medications that are designed to provide symptomatic relief from swelling and pain. Examples of these medications include ibuprofen, acetaminophen, and analgesics. Furthermore, most patients are encouraged to wear a splint and restrict activities that result in the onset of symptoms. These may include – but, are not at all limited to – repetitive motions of the wrist and gripping in a forceful manner.
  2. Education – Many of us have found that when we educate patients on their condition and they develop a solid understanding of what is happening to their body, they are better able to manage their symptoms. We educate on self-management, provide information on proper posturing, give general information on heat therapy, and even detail exercises that may be performed to help in reducing symptoms.
  3. Vitamin B6 – Many researchers have concluded that the use of Vitamin B6 is highly productive in eliminating the symptoms of carpal tunnel syndrome. If blood tests indicate a deficiency of this vitamin or another internal deficiency, a treatment will be encouraged that will correct the deficiency.
  4. Steroid Usage – Most physical therapists do not encourage the use of any type of steroids for carpal tunnel syndrome; however, there are many medical doctors that encourage this. If visiting us at Back to Motion, it is not likely that you will be administered steroids due to the potential adverse effects; however, your doctor may encourage this.
  5. Splinting – Many individuals that suffer from carpal tunnel syndrome have been found to benefit from splinting for the purpose and intent of immobilization. The goal is to support the wrist in a position that is neutral. While daytime splints may prove to be helpful, a nighttime splinting of a period of anywhere from 4 weeks to 6 weeks is likely to be more productive.
  6. Nerve Gliding – These are specially-designed exercises that are meant to work the tissues associated with the peripheral nervous system. These areas are designed to move. By encouraging nerve gliding, it is believed that the area impacted by carpal tunnel syndrome will experience vascular flow that will reduce uncomfortable symptoms.
  7. Manual Therapy – Many physical therapists will manually manipulate the spine in order to help a patient overcome the symptoms associated with carpal tunnel syndrome.
  8. Ultrasound – Ultrasounds may help in optimizing the conduction of nerves in cases of carpal tunnel syndrome. According to studies, the use of ultrasounds is most beneficial when using it with splinting and in modifying activities. Ideally, a patient would receive 12 sessions over a period of about 6 weeks.

Standard Conservative Treatments Offered by Physical Therapists

Now that you have learned about the non-operative techniques used to treat carpal tunnel syndrome among those that experience the symptom of shoulder pain, it is time to learn about the standard conservative treatments that most physical therapists engage in.

We specialize on natural techniques that will eliminate pain, optimize your range of motion, and improve your general level of physical health without compromising other aspects of your health or encouraging you to participate in invasive procedures.

The following outlines one of the most productive strategies for helping our patients overcome carpal tunnel syndrome with shoulder pain:

  1. First, we will provide you with comprehensive information on the condition, the positions of the wrist, hand, arm, and shoulder, and proper posturing. Then, we will encourage you to take stretch breaks throughout the day in order to alleviate the symptoms that you experience with the syndrome.
  2. We will educate you on exercises that you may perform that will help in building the strength of the muscles in the areas of the body that are impacted by carpal tunnel syndrome. These include the fingers, the hand, the wrist, the arm, and the shoulder. In some instances, you will also be instructed on how to perform exercises that work the muscles in the back, as well as the trunk of the body.
  3. Stretching is very important when it comes to recovering from carpal tunnel syndrome. This is especially true if you experience shoulder pain with the condition. Stretching not only optimizes the process of nerve gliding, but, it helps to optimize the flexibility and the overall range of motion associated with the hand, wrist, arm, and back. We here at Back to Motion will work with you closely to ensure that you are provided with the most productive stretching exercises for your needs.
  4. We encourage our patients to use heat and cold therapies, as well as night splints when they are detrimentally impacted by carpal tunnel syndrome. These therapies and tools will help in alleviating pain, pressure, and the presence of inflammation.
  5. We carefully evaluate the activities that you engage in at work and during your leisure time to determine if they are aggravating your carpal tunnel syndrome pain. If so, you will be provided with information on carpal tunnel exercises and carpal tunnel physical therapy activities that will help alleviate discomfort during these activities. For example, you may be asked to wear anti-vibration products and may be encouraged to use cold packs or certain types of sprays and physical therapy kits that benefit the body.

What If I Have Surgery?

While surgery is an option for carpal tunnel syndrome, most physical therapists do not recommend it; however, there are some instances in which a medical professional will deem surgery necessary. If this ends up being the case, you will likely be referred to us following your surgery for rehabilitation therapy. Then, there are very rare cases where we may refer you for surgical consultation.

If surgery is performed, you will have a post-operative physical therapy treatment regimen that includes one or all of the following:

  • First, you will be encouraged to participate in exercises that are designed to improve the overall strength of the muscles located in the hand and wrist area. As the strength of the muscles in this area improves, the functionality of the muscles will also improve.
  • Your physical therapist will encourage you to do carpal tunnel exercises that stretch out the muscles. This aids in optimizing the overall mobility associated with the area, which – in turn – improves function.
  • All surgeries result in some degree of skin scarring. Once you complete the carpal tunnel surgery, you will quickly discover that the skin develops a mark. Carpal tunnel physical therapy includes scar management. This aids in ensuring that the skin remains flexible and is considered to be supple.
  • You will be provided with information regarding how to properly position the wrist and the right posture. This will help in reducing compression and issues, such as shoulder pain.
shoulder cool pad

Minimizing Stress with Carpal Tunnel Syndrome

As a carpal tunnel syndrome sufferer, there are many ways to minimize stress in the hand, wrist, arm, and shoulder. First, you should relax the grip that you have to reduce the amount of force you use when using your hands. By relaxing the grip, you will find that muscle fatigue and strain is avoided.

When using your hands, it is best to take frequent breaks. The wrists should be kept in a neutral position at all times. You may also work to improve your posture.

Additionally, there are many at home tools you can use to ease pain and heal your shoulder. This can aid in healing carpal tunnel syndrome.

Let Us Help

If you suffer from shoulder pain as a result of carpal tunnel syndrome, we here at Back to Motion can help. We offer a comprehensive carpal tunnel physical therapy program that is designed to reduce the strain on your body, eliminate pain, optimize functionality, and improve your range of motion.

Additionally, we offer a multitude of tools, resources, and products that will help you to overcome the symptoms of carpal tunnel syndrome.

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