American Physical Therapy Association

What You Need To Know About

CARPALTUNNELSYNDROMEA Physical Therapist’s Perspective

What Is Carpal Tunnel Syndrome?

You’ve probably already heard about carpaltunnel syndrome (CTS) and its effect ondifferent occupations, like computer pro-

grammers and assembly line workers. Maybe youeven know someone who has CTS or you your-self are suffering from it. But what exactly is CTS,and how do you keep from getting it?

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©1996 APTA All rights reserved.This brochure is not intended as a substitute for professional health care.

Carpal Tunnel

The carpal tunnel is a narrow tunnel in the wristformed by ligament and bone. The median

nerve, which carries impulses from the brain into thehand, passes through the carpal tunnel, along withthe tendons that enable the hand to close. Whenstressed, the tendons swell inside the tunnel andcompress the median nerve. Besides repeatedmovements, other conditions can lead to compres-sion of the median nerve: arthritis, diabetes, fluidretention, gout and malaligned fractures, or chemi-cal imbalances, emotional stress, and sometimeshormonal changes in women.

Median Nerve

Carpal tunnel syndrome is a condition that maybe caused by repeatedly performing stressfulmotions with your hand or holding your hand inthe same position for long periods of time. CTS isclassified as a cumulative trauma disorder, an ailment that attacks the body’s musculoskeletalsystem.The musculoskeletal system is made upof muscles that pull on tendons and move thebones at joints.The joints are held together by lig-aments. Carpal tunnel syndrome specificallyaffects the sensitive nerves of, and the blood sup-ply that feeds, the hands and wrists.

Carpal tunnel syndrome has been around for along time. Meatpackers began complaining ofpain and loss of hand function in the 1860s. Backthen, these complaints were largely attributed topoor circulation.

But the nature of work has changed over theyears. Today, more jobs are highly specializedand require use of only a small number of mus-cles repeatedly. With the growing numbers ofpeople using computers and keyboards, plus thefocus on better health care for workers, carpaltunnel syndrome is of real concern to bothemployers and the health care professions.

Recent studies have shown that carpal tunnelsyndrome, like all other cumulative trauma disor-ders, is on the rise while other workplace injurieshave leveled off. Many companies are turning tophysical therapists for help in designing andimplementing health promotion and injury preven-tion programs to protect their employees fromCTS.

This booklet explains what carpal tunnel syn-drome is and the role physical therapists play intreating this debilitating disease and in educatingpeople about possible risk factors. It also tells youhow you can avoid CTS both at work and athome.

What Are The Symptoms?

People with CTS usually experience feelingsof numbness, weakness, tingling, and burn-ing in their fingers and hands. If not treated,

the symptoms may escalate into acute, persistentpain. CTS can become so crippling that peoplecan no longer do their work or even perform sim-ple tasks at home. At its most extreme, carpaltunnel syndrome forces people to undergosurgery and miss many days of work, or preventsthem from working at all because their hand func-tions are permanently impaired.

Who’s At Risk?

Carpal tunnel syndrome strikes men andwomen of all ages, and is often found inworkers whose tasks require repeating the

same motion in the fingers and hand for long peri-ods of time.

CTS has surfaced among meatpackers, assem-bly line workers, jackhammer operators, andemployees who spend hours working at a com-puter or typewriter. Carpal tunnel syndromeshows up in athletes as well as homemakers.

The U.S. Department of Labor has cited carpaltunnel syndrome, as well as other cumulativetrauma disorders, as the cause of 48 percent of

Some of the Symptoms of CTS❏ tingling in the fingers ❏ numbness in the fingers❏ aching in the thumb, perhaps moving up

as far as the neck❏ burning pain from the wrist to the fingers❏ change in touch or temperature sensation❏ clumsiness in hands❏ weakness of grip, ability to pinch and other

thumb actions ❏ swelling of hand and forearm❏ change in sweat functions of hand

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all industrial workplace illnesses. The diseaseaffects more than five million Americans.

CTS’s impact on American businesses is devastat-ing. It shows up in the workplace in the form offatigue, poor work performance, discomfort andpain, and poor employer/employee relations. Thehigh cost of treatment for an employee with CTS,plus the lost productivity when that employee isabsent for a long period of time, strains the compa-ny’s ability to operate efficiently and can lead tomorale problems when other employees have totake over the absent workers’ responsibilities.

How Physical Therapists Can Help

Physical therapists with specialized training incumulative trauma disorders have been work-ing in industrial and corporate settings for

many years to meet the health care needs ofAmerica’s workforce. They work closely withemployers to educate employees about CTS—whatcauses it and how to avoid it through proper use ofthe musculoskeletal system. Physical therapists cantarget and correct poor work habits and improper work designs, such as tools, furni-ture,

equipment, and work space. They also can assessthe risk potential of an individual and determine ifthat person is physically unsuited for a particular job.

Among their many responsibilities, physical thera-pists teach health awareness and job safety. A typ-ical education program includes exercises employ-ees can do at work and at home, adjustments tothe overall work environment and individual workstations, plus early detection of symptoms to avoidpainful and costly surgery.

Physical therapists also work with employers andtheir engineering departments to design and modi-fy the work environment, helping to remove thecausal factors of CTS.

If you or anyone you know has symptoms of carpaltunnel syndrome, consult a physical therapist orother qualified health care practitioner for an evalu-ation and individualized treatment.

In the Workplace

Aphysical therapist will begin by observinghow employees work and evaluating theergonomics of the work environment.

Ergonomics is the study and control of the effectsof postures, stresses, motions, and other physicalforces on the human body engaged in work. Forinstance, computer programmers may be sitting in

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Hand Tools in the WorkplaceThese are just a few of the questions a physicaltherapist may ask when evaluating tools used inthe workplace:❏ Are hand tools operable with a straight-

wrist position?❏ Are they well-balanced and easy to hold?❏ Are they designed to eliminate sharp edges

or ridges that might impair circulation or exert pressure on the nerves?

❏ Are they designed to keep vibration to aminimum?

Stand in arelaxed position

with your arms atyour side. Shrugyour shoulders up,then squeeze yourshoulders back,then stretch yourshoulders down,then press themforward. Count toseven as you com-plete one rotation ofyour shoulders.Repeat four times.

a chair that forces them to slouch. Their computerscreen may be too high, causing stress in the neckand shoulders, and the keyboard may be in a posi-tion that forces continued pressure on the wristmuscles. Factory workers standing on their feet allday may have to use tools that are designed forindividuals with a larger grip. Their work stationmay be too high or too low, forcing them into anawkward body position. This action puts addedstrain on the neck, shoulders, and arms.

A physical therapist can show employees how toadjust their work area, handle tools, or performtasks in a way that puts less stress on the body.They may teach employees a number of exercis-es to increase flexibility of their arm/hand regionwhile they are at work. Frequent brief stretchingand relaxation exercises can help reduce injuriesand improve productivity in the workplace.Physical therapists also suggest short rest breaksafter two hours of using the hands.

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W hen using a keyboard or typewriter, move onlythe fingers—always maintain a straight-wrist

position. If your keyboard has a pad at the bottom,use it to rest your wrists during breaks.

If your work includes using a typewriter, computer,or other keyboard, be sure to practice proper bodymechanics.This means good posture—sit with thespine against the back of your chair, shouldersrelaxed, elbows along the sides of the body, wristsstraight, and feet flat on the floor.Typing materialsand monitors should be at eye level so that youdon’t have to bend your neck over your work. It isimportant to maintain good posture at the work siteto assist the circulation and nerve function to thearm/hand region.

Sit upright. Place your righthand on top of your left

shoulder. Hold that shoulderdown as you slowly tip yourhead away to the right. Keepyour face pointed forward, oreven turned slightly toward theright shoulder to stretchall the muscle fibers. Hold this stretch gently for five secondsDo thisonce for each side.

At Home

Many activities outside of work may con-tribute to carpal tunnel syndrome: knit-ting, sewing, or needlepoint; cooking and

housework; TV computer games and home com-puter work; playing sports or cards; and hobbiesor projects like carpentry or using power tools forextended periods of time.

You can do the same exercises at home that youdo at work.You should also take frequent breaksand examine the tools you use at home that couldbe causing strain on your hands. You may needto wear a wrist splint at night, while playingsports, or when working at home. The wrist splintassists in maintaining the wrist in a neutral orstraight position and allows the wrist to rest.

Your physical therapist will help you design anexercise program that allows you to enjoy dailyactivities at home.To begin with, your physicaltherapist will instruct you on exercises to stretchthe forearm muscles to reduce tension on ten-dons that pass through the wrist. After swelling in

the wrist decreases, your physical therapist willgive you some isometric strengthening exercisesthat are correct for your particular injury.

You can do these isometric and stretching exer-cises at work or at home. They’ll strengthen themuscles of your wrists and hands, as well as inyour neck and shoulders, improving the bloodflow to those areas.

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Do you spend a lot oftime cutting or slicing

with a knife? This actionputs a strain on your wristand carpal tunnel.

Be sure to take regularshort breaks when

pursuing activities thatrequire repetitive motionof the hand and wrist.

Make a loose fist, thenrelease, fanning out

fingers. Repeat five times

About APTA

The American Physical Therapy Association(APTA) is a national professional organiza-tion that represents more than 75,000

members throughout the United States.

Physical therapists are vital members of the multi-disciplinary health care team.They provide treat-ment and can refer clients to other health carespecialists. APTA serves its members and thepublic by promoting understanding of the physicaltherapist’s role in the health care system. APTAalso promotes excellence in the field withimprovements in physical therapy practice,research, and education.

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The tendons in the wrist need to glide freely asthe wrist and the fingers move. These are

three different exercises to help the tendons in thewrist glide more easily...

straight fist full fist

Start with the fingers in the straight position andthen move the fingers into the hook fist position.Hold this position for five seconds, then relax.Repeat four more times. Repeat the same seriesfor the straight fist and the full fist positions.

hookstraight

Fist Extension Exercises

Other APTA Brochures❑ Fitness: A Way Of Life❑ Fit Kids❑ Fit Teens❑ For The Young At Heart: Exercise Tips

For Seniors❑ For Women Of All Ages❑ Taking Care Of Your Back❑ Taking Care Of Your Hand, Wrist, And Elbow❑ Taking Care Of Your Knees❑ Taking Care Of Your Shoulder❑ The Secret Of Good Posture❑ What Young People & Their Parents Need To

Know About Scoliosis

Bulk quantities available. Send for the APTAResource Catalog, APTA, 1111 North FairfaxStreet, Alexandria, VA 22314-1488. Or order viathe Internet at www.apta.org

AcknowledgementsThe Section on Hand Rehabilitation, APTA Teri Bielefeld, PT, CHTLauren Andrew Hebert, PTJanna Jacobs, PT, CHTRobert Wiersma, PT

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PR/39/3M/1-96

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1111 North Fairfax StreetAlexandria, VA 22314-1488