Carpal Tunnel Syndrome (CTS) is relatively prevalent, especially in New York City, where many jobs require typing away at a laptop for hours every day. Professional physical therapy can help you avoid thousands of dollars on surgery to combat CTS. Certified physical therapists can provide exercises and techniques to prevent and reduce wrist pain. Schedule an appointment at a physical therapy clinic in NYC and UWS for Carpal Tunnel Syndrome.

Have you or anyone you know ever had pain, weakness and/or numbness in your wrist or hand? If the answer is yes, it is not surprising given that CTS affects 3-6% of the general U.S. population. There are between 500,000 and 600,000 surgeries costing an estimated $2 Billion annually.

We have compiled this handy wrist guide covering: wrist pain, relief and recovery.

Anatomy of the Forearm and Carpal Tunnel

The carpal tunnel is formed by bones and ligaments that act as a narrow passageway to the palm side of the wrist. This tunnel provides space and protection for an important nerve to your hand, the median nerve, as well as all of the tendons that attach to and control movement and sensations in your fingers. Carpal Tunnel Syndrome (CTS) occurs when the median nerve becomes entrapped by a compression narrowing or inflammation in the tunnel itself.

While CTS is a common work injury here in New York, an important thing to consider is that the median nerve can also be entrapped by a muscle in the forearm known as the Pronator Teres. The pronator teres is responsible for rotating the forearm and can become very fibrotic and stuck to adjacent muscles through overuse, especially when leading an active lifestyle. When this happens, it is often diagnosed as Pronator Teres Syndrome (PTS).

Symptoms: CTS and PTS

Carpal Tunnel Syndrome (CTS)

• Pain, weakness and/or numbing in first 3.5 fingers.

• Symptoms may arise while sleeping

• Symptoms primarily in wrist and hand

• Symptoms with wrist and hand movements

To confirm an accurate CTS diagnosis, it is very important to undergo a nerve conduction test in addition to a physical exam to confirm the diagnosis.

Pronator Teres Syndrome (PTS)

• Tenderness or pain in upper portion of the forearm

• Pain increases with grabbing, forearm rotation and elbow flexion

• Pain, weakness and/or numbing in first 3.5 fingers.

• Rarely night pain

• Symptoms in wrist, hand and/or forearm and possibly shoulder

It is important also to note that similar symptoms can arise as a result of compression of the brachial nerve near the shoulder joint, known as Thoracic Outlet Syndrome (TOS) or a Pinched Nerve at the neck. Treatments for CTS, PTS, TOS and pinched neck nerves are significantly different. Therefore, accurate diagnosis by a Physician is vital to successful treatment and recovery.

Got a wrist or hand pain? read our injury therapy guide for solutions.

Risk Factors:

Carpal Tunnel Syndrome

In many CTS diagnoses, a single cause is not identified but rather a combination of risk factors is often at play. Despite desk jobs being common occupations in which employees experience symptoms, according to the Mayo Clinic, “There has not been enough quality and consistent evidence to support extensive computer use as a risk factor for carpal tunnel syndrome, although it may cause a different form of hand pain”. Many other studies and institutions have made similar conclusions based on the available evidence.

With this in mind, here are some of the CTS risk factors:

• Structural factors: fractures, dislocations, carpal tunnel shape, bone spurs

• Women 3 x more likely than men for many reasons

• Obesity and lack of fitness

• Specific diseases such as Diabetes and Rheumatoid Arthritis

• Age: risk increases with age

• Occupations requiring forceful and repetitive manual labor

Pronator Teres Syndrome

• Pain with repetitive elbow, wrist and hand movements

• Pain with forceful grasping of the hands and twisting at the wrists

• Sports: Racquet sports, rowing and weight lifting are most common

• Women 4 x more likely than men

Most Effective Treatments

The most effective treatment options for CTS and PTS are different in important ways, highlighting the necessity of an accurate diagnosis.

Treatment for Carpal Tunnel Syndrome (CTS):

• Activity modification – decrease or complete rest of contributing activities

• Ergonomic keyboards

• Wrist splints

• Anti-inflammatory medications (short-term relief)

• Steroid Injections

• Ultrasound and Electromagnetic Field Therapy

• Physical and Manual Therapies

• Surgery – 3 basic surgical options with varying success rates

The scientific data and research is conflicted on the comparative effectiveness of different treatments for Carpal Tunnel Syndrome. A large study in Madrid, Spain, found that manual therapies are equally effective as surgery for CTS.

For clear cases of Carpel Tunnel Syndrome, physical therapy, medical massage, Active Release Techniques, activity modification and other conservative treatments should be used first.

"A new client called me the day after his first treatment to say that his “carpel tunnel” symptoms were entirely gone. One session! That’s all it took." - Mark

When unresponsive to these treatments and therapies, surgery can be the solution.

If surgery is indeed needed after all for CTS, studies show that patients with moderate (as opposed to mild or severe) cases respond best to surgery. It is crucial to emphasize that surgery for a misdiagnosis of CTS will not only fail to resolve the symptoms but could create an entirely new and more complicated problem. So be proactive and persistent with these injuries because they can persist and worsen with time making treatment more difficult

Treatment for Pronator Teres Syndrome (PTS):

When properly labeled and treated, symptoms caused by pronator teres entrapment can be effectively rehabilitated through:

• Active Release and Sports Massage

• Physical Therapy

• Acupuncture

• Forearm stretches

• Targeted strength and muscle activation exercises

• Rest (temporary)

• Modification or cessation of activities that contribute to the problem.

Active Release therapy is especially helpful in resolving Pronator Teres Syndrome because it is a straightforward soft tissue condition, which Active Release therapy is specifically designed to treat. By breaking up scar tissue in the muscle, restoring proper muscle length and helping the muscle to move better and slide seamlessly in relation to adjacent muscles that may be adhered (stuck) together, ART can effectively help resolve this condition in less than 5 sessions.

It has also been my experience and the experience of many colleagues that strengthening and stabilizing the shoulder joint, scapular and thoracic muscles can take stress off the forearm musculature and thus help prevent and treat PTS.

In summary, the key to optimal treatment and injury recovery for both Carpal Tunnel Syndrome and Pronator Teres Syndrome is to get an accurate diagnosis, a second opinion and then proactively use the many conservative treatment options available to you.

For more on Active Release Techniques, view our Sports Injuries Article here.

Not sure if you suffer from one or more of these injuries? Come in for a free health consultation.

References

1. American Family Physician

2. Journal of Hand Surgery (American Volume): Incidence of Carpal Tunnel Syndrome Requiring Surgical Decompression: A 10.5-Year Review of 2,309 Patients. 2015.

3. CBS News: “A surprisingly common office injury that is often misdiagnosed”. 2011

4. Essentials of Physical Medicine and Rehabilitation. (p.121-123). 2015.

5. National Institute of Health: Carpal Tunnel Syndrome.

6. Mayo Clinic: Carpal Tunnel Syndrome.

7. Occupational and Environmental Medicine: Diagnostic strategies using physical examination are minimally useful in defining carpal tunnel syndrome in population-based studies”. 2009.

8. American Journal of Industrial Medicine: “Physical examination has a low yield in screening for carpal tunnel syndrome”. 2010.

9. Massage Today: Pronator Teres Syndrome.

10. Sports Injury Clinic: Pronator Teres Syndrome.

11. Journal of Manual and Manipulative Therapy: “Thoracic Outlet Syndrome”. 2013.

12. New York Times: “Carpal Tunnel Syndrome”. 2013.

13. New York Times: “The latest thinking on computer-related pain”. 2008.

14. Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands: “ Carpal Tunnel Syndrome. Part I: Effectiveness of Nonsurgical Treatments-A Systematic Review” 2010Carpaltunnel.net –

15. “Surgical Procedures

16. Journal of Pain: “Manual Physical Therapy Versus Surgery for Carpal Tunnel Syndrome: A Randomized Parallel-Group Trial”. 2015.

17. Carpal-Tunnel.net

18. Essentials of Physical Medicine and Rehabilitation. (p.121-123). 2015.

19. Active Release Techniques: Soft tissue management system for the upper extremity”. – 2nd edition. 2008.