You have probably heard about ‘carpal tunnel syndrome’ (CTS) or other overuse injuries of the hand from computer, and maybe know someone who has it. But what exactly is carpal tunnel syndrome, and how do you keep from getting it?

Carpal tunnel syndrome is a condition that is caused by compression of the median nerve in the carpal tunnel. The carpal tunnel is a narrow tunnel in the wrist formed by bone and ligament. The median nerve (which carries sensation and muscle power to the thumb), and the tendons that flex the fingers are inside the ‘tunnel’. When stressed, the inflamed tendons swell inside the tunnel and compress the medial nerve causing symptoms. This nerve compression is called carpal tunnel syndrome. Carpal tunnel syndrome (CTS) and other repetitive motion injuries are on the rise (more than 5 million Americans affected). More jobs are highly specialized, and require use of only a small number of muscles in the fingers and hands repeatedly, one of the major risk factors in CTS. Besides repeated movements, other conditions can lead to median nerve compression including diabetes, wrist fractures and fluid retention (including during pregnancy).

Symptoms of CTS include tingling and/or numbness in the fingers (especially the thumb and index fingers), aching in the thumb, burning pain from the wrist to the fingers (possibly moving up to the neck), changes in touch or temperature sensation. Often these symptoms are worse at night due to wrist position, and can be helped with a wrist brace that will keep the wrist straight (neutral). Wrist braces are helpful at times to prevent awkward positioning at work and with other activities, but tend to make the wrist stiffer.

Physical therapy for CTS may include stretching and strengthening exercises, which are taught to the patient so they are able to help reduce stiffness and muscle tension throughout their day, and help them gain sufficient strength to help decreased overstress on their hands/wrists. Modalities (heat/ cold/ electricity/ ultrasound) for pain/swelling reduction, and manual therapy techniques including joint mobilization and myofascial release are used to improve mobility in the wrist and associated muscles for improving pain and flexibility. Patients should also be taught how to avoid prolonged stressful positions for the wrist during daily activities including keyboard work. Bad positions include holding the wrist flexed, extended or bent toward either side, which will decrease the amount of space in the carpal tunnel and tend to compress an irritated nerve. Poor (slouched) neck and back posture (like while at the computer) will additionally put stress on arm positioning, and may add to CTS symptoms. One of the most important things to treat CTS (as well as prevent it) is to frequently change positions/activities to allow some variety in your posture and muscle movement. This can be as easy as taking 30 seconds every 30 minutes to stretch your wrists (flex/extend), stretch arms overhead, then bend your neck and body side to side. This prevents your muscles from cramping from overuse, and will help you from feeling stiff from not moving (which uses muscles to keep you still). Frequent, brief stretching and relaxation exercises can help reduce injuries and improve productivity at work.

For some patients, the conservative approach is not sufficient, and surgery is needed to release the ligament that forms the ‘roof’ of the carpal tunnel to decrease pressure on the nerve. It is a relatively simple procedure, and has a good success rate, but attention must still be paid to using the straight wrist position and stretching exercises after surgery also to avoid additional repetitive motion injuries. If left untreated, symptoms may be crippling and permanent.