Carpal Tunnel Symptoms and Treatment Options | Precision Movement

Carpal Tunnel Symptoms and Treatment Options

What Works and What DOESN’T to Treat Carpal Tunnel Syndrome

By Coach E

how to treat carpal tunnel

Are you researching carpal tunnel symptoms and worried that you might have to have surgery? Here’s what you need to know including treatments that may help you avoid the knife.

Carpal Tunnel Symptoms

Carpal tunnel syndrome (CTS) is a wrist injury with significant symptoms that can interrupt your daily life, your work, and your workouts.

The most common carpal tunnel symptoms are uncomfortable feelings in your fingers – usually the index, middle, and ring fingers, plus your thumb. These sensations might present as pain, tingling, burning, weakness, or numbness [1].

carpal tunnel symptoms and how to treat them

You might feel these sensations radiate up your forearm, even reaching your shoulder at times. Or sometimes, the pain may be felt as a sudden shock through your fingers.

Because of these painful and uncomfortable symptoms, people with CTS often feel weak and clumsy when it comes to handling objects with their hand.  It may suddenly feel difficult to type or button your shirt or you may continuously drop items.

Carpal Tunnel Anatomy

So what is causing these unpleasant symptoms?

Your carpal tunnel really is like a tunnel or small passageway in your wrist.

Three sides of the tunnel are formed by wrist bones referred to as your carpals and the top is formed by the transverse carpal ligament. The space created by these structures is about an inch wide [2].

carpal tunnel symptoms median nerve

In this small space run several important structures – your flexor tendons that help flex your fingers and your median nerve, which is the main nerve that provides feeling in those fingers experiencing carpal tunnel syndrome symptoms (basically every finger except your little finger).

If this already narrow tunnel experiences any reduction in space, excess pressure can be placed on your median nerve. This tension leads to the unpleasant symptoms described earlier.

Root Causes of CTS

There are a couple of factors that can reduce the space in your carpal tunnel and cause CTS.

One common root cause is repetitive movements that result in inflammation in your wrist, which in turn put pressure on your median nerve.

These movements repeated over and over with insufficient recovery can cause microtrauma to the muscles and tendons worked, resulting in swelling [3]. It doesn’t take much swelling in an area so small to cause excess pressure on the nerve and symptoms that get on your nerves.

Another common factor is not just repetitive movements in general, but repetitive movements performed with your wrist in a non-neutral position. These activities tend to further decrease the carpal tunnel space and compress your median nerve.

For example, if you have a job that requires you to type all day and you type with your wrist extended, there’s increased pressure on your median nerve, which furthers the likelihood that you’ll develop carpal tunnel syndrome.

carpal tunnel syndrome exercises working

And it’s not just typing that can put you at risk, although this is one obvious example in our modern world.

One study of meat processing workers in Italy found that the more hand activity and the more force used by the hand in general, the higher the likelihood of carpal tunnel syndrome [4].

So don’t think you’re off scot-free if you don’t have a desk job.

Plenty of folks – from massage therapists to mechanics to artists and athletes can all be at risk.

Testing for Carpal Tunnel Syndrome

There is a simple way to test for carpal tunnel syndrome that is pretty effective at pinpointing this condition. It’s called the Phalen’s test and you can easily perform it at home.

Simply take the back of your hands towards each other so that your fingers are pointed down and your forearms are pointing towards each other to form a line across your chest.

Press the knuckle-side of your hands together for about 1 minute. If you start to experience tingling and numbness in your thumb or index, middle and ring fingers during this time, it is likely you have CTS [5].

how to treat carpal tunnel phalen test

What DOESN’T Work Long-Term

There are a ton of methods for treating CTS. While this might seem great at first glance, many of these options only provide short-term symptom relief without addressing the ROOT CAUSE of your pain.

This means that the carpal tunnel symptoms are likely to return and your injury is likely to be prolonged. Let’s examine some of these methods that don’t quite cut it when it comes to long-term recovery. (Then we’ll get to the good stuff!)

Ultrasound

Ultrasound therapy uses soundwaves to treat injuries and encourage healing. It is noninvasive and is usually painless to receive [6].

carpal tunnel symptoms and chiropractic rehab

But unfortunately, when it comes to CTS, thorough reviews of years of research have shown that therapeutic ultrasound is probably no more effective than placebos – either for long-term recovery or just short-term relief [7].

Low Level Laser

Low level laser therapy is a treatment that uses low power lasers on the surface of your skin. The lasers are thought to encourage healing by stimulating cells [8].

The treatment has been shown to be effective… but only within short time frames – i.e., less than 5 weeks [9].

For time periods longer than this, low level lasers haven’t proven to be all too effective at causing lasting recovery.

Corticosteroids

Corticosteroid injections are a treatment method that can provide you with some short-term relief. These injections are aimed at easing the swelling and inflammation in the carpal tunnel. However, the results don’t usually last.

Corticosteroids do ease the symptoms temporarily, but, because they aren’t addressing the root cause of CTS, the pain usually returns.

For example, in one study of 69 folks with CTS, about half the participants received corticosteroid injections, the other half received injections of a saline solution placebo [10].

While the corticosteroid group did see symptom relief in the short term, the results didn’t last. Within a year, half of this group’s carpal tunnel symptoms had returned.

Splinting

Splints or braces for carpal tunnel syndrome are a common DIY treatment method. You can pretty much find these braces in any pharmacy or drugstore.

However, this “easy fix” probably doesn’t provide that much of a fix.

Take, for instance, one comprehensive review of 19 splinting studies that compared different splint designs and a variety of other treatments in over 1,000 participants [11].

The study found some evidence that wearing a splint (specifically, wearing a splint at night – more on that in a minute) was better than no treatment at dealing with short term carpal tunnel symptoms.

However, when compared to other non-surgical treatment methods, splinting was no more effective. And yet again, there is no evidence of long-term effects.

Splinting for Night Pain

There has been some evidence that splinting can help relieve symptoms, however this is only true for a very specific group of patients.

carpal tunnel symptoms while sleeping

Take for example, one study of 40 CTS patients. The patients were divided into two groups – those who only had symptoms during the night and those who only had symptoms during the day [12].

After 3 months of splinting, only the patients who only experienced carpal tunnel symptoms at night saw significant improvements.

So if your CTS symptoms ONLY bother you when you’re trying to get some sleep, then splinting might be worth a shot. But for everyone else, you’re going to need a more effective approach.

Steps to Rehab – What Really Works

We’ve learned what doesn’t work, now let’s learn what does work and how to treat carpal tunnel syndrome effectively.

Get to the Root

The absolute first thing you must do is identify what’s causing really the problem in the first place – think about those common causes of CTS – repetitive movements and non-neutral positioning of your wrist.

Ideally, you’ve got to eliminate the movements that are causing your carpal tunnel symptoms –  otherwise the inflammation compressing the nerve will never get a chance heal.

Now, this may require buy-in from employers and some creative solutions…

Assess the repetitive tasks you do at work and home in a non-neutral wrist position and think about what you can do to reduce the movements OR improve your wrist positioning during the movements.

carpal tunnel symptoms at work

For example, can you change your keyboard or mouse height for computer work? Can you make an effort to change the main hand you use for repetitive tasks like mousing, swiping on on your smartphone, or even brushing your teeth?

Dictation software is one option if you spend a ton of time typing. Or your employer might be willing to supply a workstation with adjustable height that could improve your ergonomics. Maybe a coworker will agree to tag-team some tasks so your wrists can get an extra break…

Another idea if you’re on the computer all day at work is to give yourself a strict no-computer or smartphone browsing rule when you get home.

The bottom line is the more you can let the affected wrist rest, the faster you’ll heal and the faster you can get back to your work and everyday activities.

After you’ve addressed these root causes, tackle these next steps in order – meaning if one approach isn’t working to ease your symptoms, move on to incorporate the next.

Add in Anti-inflammatories

Incorporating anti-inflammatories into your diet is an excellent way to help ease the inflammation and pressure in your wrist. You can try to add these into your diet with food choices, or by taking a supplement.

Omega-3’s are a great option, as is turmeric/curcumin. I suggest liquid fish oils at a dosage of around 3 grams/day of total omega-3’s (if you take capsules it’ll be like 10 caps, which is a lot vs. 1 tbsp of the oil.

And for tumeric, I recommend the PuraThrive supplement.

Apply Ice

This method is simple, tried, and true. If you know you used your hand and wrist a ton that day, apply ice (for a max of 15 minutes at a time) to help quickly ease swelling and inflammation.

Perform Nerve Glides

Nerve glides are simple exercises that aim to improve the movement of specific nerves in the body and reduce the compression that can cause nerve issues [13].carpal tunnel symptoms manual therapy

One key thing to keep in mind with nerve glides is that you never want to excessively stretch the nerve. Many recommended carpal tunnel syndrome exercises and stretches you’ll find online may put you at risk for this, so keep it in mind and take it easy.

Manual Therapy & Mobilizations

Manual, or hands-on, therapy is one approach that has been found to be effective for easing carpal tunnel symptoms. This treatment method is usually performed by a physiotherapist who uses their hands to release and mobilize soft tissues involved in the affected area.

In fact, manual therapy has proven in studies to be effective at easing carpal tunnel symptoms and improving hand function abilities (like grip) as long as a year after the injury [14]. These findings put the short-term effects of methods like low level lasers to shame.

One study followed 100 women with CTS in Spain – half of whom had surgery, half of whom received manual therapy [15]. After 3, 6, and 9 months, the manual therapy groups showed a better recovery from pain, and after a year there were no major differences between the groups.

And the exact form of manual therapy doesn’t seem to play too big of a role.

Another study examined two different types – the Graston technique, in which the clinician uses tools to aid in mobilizing the tissues, and the traditional approach in which they use just their hands [16]. This study found that CTS patients receiving both types of manual therapy improved, and the improvements held 3 months after treatment.

All these studies tell us a few things. One – manual therapy is effective in the long-term at reducing carpal tunnel symptoms. And two, it is often just as effective as surgery – so it’s definitely worth it to give this method a go before going under the knife.

Try Taping

Taping is another conservative method that can offer big results. Unlike bracing, which just creates a false support system, taping can actually be applied in a way that can expand the carpal tunnel space.

One study of 20 females with CTS found that after 4 weeks of taping in this way, there was evidence of reduced pressure in the carpal tunnel [17].

Acupuncture

Acupuncture is another effective and minimally invasive (as long as you don’t have a thing with needles) method for easing these symptoms. This technique works to decrease the cross-sectional area of median nerve so it becomes less compressed in the carpal tunnel space.

treat carpal tunnel symptoms using acupuncture

In one study comparing acupuncture to night splinting found that both groups saw some symptom relief, but only the acupuncture group had a reduced cross-sectional area of the median nerve [18].

Yet again, this points out the difference between short-term results (surface level symptom relief) and treatments that address the deeper issues (reducing chronic compression on the nerve).

PRP Therapy

PRP therapy is a fairly new treatment method that uses injections of platelet-rich plasma (PRP) made from the subject’s own blood. The plasma is thought to encourage healing of the nerve itself.

And, the treatment has been shown to not only be effective in the short-term, but to have lasting results, too. One study of 60 folks with CTS compared PRP therapy to night splinting [19].

After 6 months, the group receiving PRP therapy (and it’s worth noting that they only received 1 dose at the study’s start) had more significant symptom reduction AND reduction of the cross-sectional area of the median nerve than the splinting group.

I don’t know about you, but I’d rather try to knock something out with one shot than try to mask the symptoms by wearing a brace to bed for 6 months…

The Last Resort: Endoscopic Release Surgery

Now we come to our final treatment method. Remember what I said about considering these treatment methods in order – this last method, endoscopic release, really should be your last resort.

If the other, more conservative measures fail, you might need this surgical approach to get rid of your carpal tunnel pain.

This method uses a very small instrument with a camera that is inserted through a tiny incision in your skin [20]. The transverse carpal ligament, the ligament forming the roof of the carpal tunnel is cut in an effort to release pressure on your median nerve.

treat carpal tunnel symptoms using an endoscopic release

The good news is that an endoscopic release is still more conservative than the more traditional open release, which is a more old-school surgical approach, requiring a larger incision down your wrist.

One comprehensive review of over 20 studies comparing endoscopic and open release showed that both methods were about as effective as each other for long-term symptom relief [21].

But, thanks to the less-invasive method of the endoscopic procedures, these cases were found to have less complications and a quicker recovery period.

The Bottom Line

If you find yourself dealing with carpal tunnel symptoms, don’t waste your time with ineffective treatment methods.

Instead, get to the root of the problem by first identifying habits, movements, and activities that are contributing to the issue.

Try to give yourself a rest from these motions and start to work your way through the treatment options that DO work – starting with more conservative treatments and progressing to other options as needed.

You should be able to kick your carpal tunnel symptoms to the curb much quicker and without so much wasted time.

About the Author

Eric is the founder of Precision Movement and has a degree in Kinesiology from the University of Waterloo. He's been a coach since 2005 and spent his early career training combat athletes including multiple UFC fighters and professional boxers. He now dedicates himself to helping active people eliminate pain and improve mobility. He lives in Toronto (Go Leafs Go!) with his wife and two kids and drinks black coffee at work and IPAs at play. Click here to learn more about Eric.