Chapter 13: Carpal Tunnel Syndrome

Chapter 13: Carpal Tunnel Syndrome

Moving right along to carpal tunnel syndrome! Most people can say they’ve heard of carpal tunnel somehow at one point in their lives. I’m here to explain the anatomy, the causes, and the ways that OTs can help an individual with carpal tunnel.

What is carpal tunnel syndrome?

Carpal tunnel syndrome (CTS) is an upper extremity disorder caused by compression to the median nerve (Walsh & Chee, 2018). The median nerve provides sensory information along the volar aspect (palm side) of the thumb, pointer, and middle fingers, in addition to the medial aspect of the ring finger. The median nerve runs through the carpal tunnel along with multiple tendons that are responsible for flexing the fingers.

CTS is caused when the median nerve becomes compressed due to swelling or a smaller carpal tunnel (Walsh & Chee, 2018). Repetitive or sustained activities in which the wrist is flexed, extended, or ulnar deviated (positioned toward the pinky side of the hand) for long periods of time may cause the compression. Activities or work that involves repetitive forceful gripping or pinching may also cause compression. Lastly, prolonged exposure to vibration, cold, or constriction over the wrists could contribute to the existence of CTS. Pregnancy, rheumatoid arthritis, and congestive heart failure may also be contributing conditions to CTS as increased inflammation exists throughout the body (Walsh & Chee, 2018).

What does carpal tunnel syndrome “look like”?

Individuals with CTS will often report pain/tingling upon waking at night within the median nerve distribution (volar aspect of thumb, pointer, and middle fingers, medial aspect of the ring finger) (Walsh & Chee, 2018). An individual may also report that they frequently drop items. Pain/tingly during repetitive activities that require wrist flexion, extension, or ulnar deviation may also be a sign of CTS.

There are two tests to quickly assess for CTS. Tinel’s test involves tapping along the pathway of the median nerve. If paresthesia (tingling) is felt during the test, there is a possibility that CTS is present. Phalen’s test involves placing the dorsum (top) of both hands together in an upside downish position (very scientific description right?) so that the fingers are pointing towards the floor. The wrists should be flexed in this position. The individual stays in this position for up to 60 seconds. The individual is asked to report if/when tingling is felt within that time frame. If paresthesia (tingling) is felt during the test, there is a possibility that CTS is present.

How do OTs help individuals with CTS?*

There are a few ways that OTs can help individuals with carpal tunnel. Depending on its severity and potential interference with successful completion of daily tasks, an orthosis could be fabricated to help position the wrist in a less stressful way. Nerve glides could be taught to the individual which is a way of giving the nerve space to move. Education regarding safe and stress-free positioning would also be emphasized to relieve symptoms.

If conservative treatment is ineffective, a carpal tunnel release could be performed by a surgeon. The OT would then have a significant role post-surgery to ensure optimal scar healing and to prevent further or repetitive complications. If the release was done in the right wrist, it would be highly beneficial for the individual to learn ways to prevent carpal tunnel from occurring in the left wrist.

I hope you learned something from today’s post! Stay tuned for more!

*Note: These examples of OT involvement are strictly my own. Information on this post was provided through the reference referred to below.

Reference: 

Walsh J.M. & Chee, N. (2018). Hand and upper extremity injuries. In H. Pendleton & W. Schultz-Krohn (Eds.), Pedretti’s occupational therapy practice skills for physical dysfunction (8th ed., pp. 972-1003). St. Louis, MO: Elsevier.

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