Carpal Tunnel Syndrome can lead to debilitating pain, weakness, numbness, and tingling in the hand and wrist areas. As a physical therapist, I see these symptoms present most often in people who work on a computer most of the day, and I feel fortunate that I can teach them the proper Carpal Tunnel exercises to treat and relieve their hand pain. However, understanding how to prevent Carpal Tunnel Syndrome in the first place is most ideal.
Over the past few years, we have had many people suddenly shifting their workplaces to their homes instead of at a traditional office. Most homes did not have proper ergonomic desk set-ups established forcing people to work at their dining room table or on their lap. These positions are far from ideal and can result in unforeseen hand and wrist symptoms. Today, I will discuss how to intervene with the best Carpal Tunnel exercises to relieve hand pain, numbness, and tingling symptoms.
Table of Contents
What is the Carpal Tunnel?
The Carpal Tunnel is a tunnel space that is located on the palmar side of the hand near the base. It contains a major nerve called the Median Nerve that runs through it as well as some additional tendons that flex the fingers. Since it sits on the palm side of the hand, it is susceptible to compression when we rest our hands onto firm surfaces.
Median Nerve compression most commonly occurs when resting the hands on a desk while typing and using a mouse. Over time the compression on the nerve begins to irritate it. Eventually, you will begin to notice symptoms in the hand and wrist. Carpal Tunnel Syndrome is the most common peripheral nerve compression issue worldwide.
Symptoms of Carpal Tunnel Syndrome
The first sign of Carpal Tunnel Syndrome is the onset of a dull, ache-type pain towards the base of the hand and wrist on the palm side. This pain is usually described as a dull, ache in the beginning stages. As the compression on the nerve continues over days, weeks, and maybe months, the person will begin to feel numbness, tingling, and burning that refers to the thumb, index, and middle fingers.
If the nerve compression is not treated, muscle wasting (decreased muscle size) will begin to occur as the nerve is no longer able to control the muscle to the extent that it was able to prior to the onset of compression. Typically, people notice difficulty gripping objects, writing, etc. The weakness in the hand becomes overwhelming and dexterity suffers.
How to Diagnose Carpal Tunnel Syndrome?
There are a couple of clinical tests that I perform in order to further support my hypothesis when I think a patient of mine has Carpal Tunnel Syndrome. The first test is to place firm pressure with your thumb on the Carpal Tunnel itself. In this test, you are purposefully trying to place pressure upon the Median nerve within the tunnel. Hold this thumb pressure for approximately 30 seconds and assess if it makes your hand pain, numbness, or tingling worse. If it does make it worse, then you can reasonably suspect that your pain is originating from the Carpal Tunnel.
Additionally, there is another test that can be performed to further support the findings from the first one. Place the back of both hands upon each other in front of you as seen in the picture. Press both hands together and hold for 30 seconds to assess if the hand/wrist pain is increased. A positive test is the replication of your hand pain with this test as well.
Nerve Conduction Velocity Test (NCV):
A nerve conduction velocity test measures the speed of electrical impulses as they pass through a nerve. This test will locate the site of compression and damage on a nerve. It is typically ordered by a medical doctor when a patient has been experiencing chronic Carpal Tunnel symptoms, or if the person begins to experience a gradual progression of weakness in the hand with gripping activities. Depending on the severity of nerve compression (slowed electrical impulses), surgical decompression of the Median nerve within the Carpal Tunnel may be recommended.
Other Potential Causes of Hand Pain
There are other wrist and hand injuries that can also create hand pain that may be mistaken for Carpal Tunnel Syndrome. These include:
Ulnar Nerve Compression at Guyon’s Canal
- The Ulnar nerve does NOT travel inside the Carpal Tunnel, rather it lies just outside of it towards the outside of the hand. Compression of this nerve can also occur when resting the wrist on hard surfaces, though this causes numbness, tingling, and pain along the outside of the palm into the 4th and 5th fingers.
Ulnar nerve compression can cause symptoms at the 4th and 5th fingers
- The Ulnar nerve does NOT travel inside the Carpal Tunnel, rather it lies just outside of it towards the outside of the hand. Compression of this nerve can also occur when resting the wrist on hard surfaces, though this causes numbness, tingling, and pain along the outside of the palm into the 4th and 5th fingers.
Wrist Flexor Tendon Strain
- The wrist flexor tendons run through the carpal tunnel, however, any strain of a muscle or tendon typically occurs suddenly. Additionally, a strain will NOT produce numbness and tingling as it does not affect a nerve.
Identify the Cause of the Carpal Tunnel Compression
The first treatment that I provide in physical therapy when a patient comes to me with Carpal Tunnel Syndrome signs and symptoms is education. In order to quickly address this issue, first and foremost, it is absolutely critical that we identify the source activity of the compression on the Median nerve as it runs through the Carpal Tunnel.
The most common cause of Median nerve compression includes spending long hours typing on a computer or using a mouse while resting the base of the wrists on a firm desk.
I’ve also seen Carpal Tunnel Syndrome caused by writing with a pen/pencil in a significantly flexed (bent) wrist position.
Also, spending several hours typing and swiping on your phone can cause hand pain, numbness, and tingling symptoms.
Conservative Carpal Tunnel Syndrome Treatment Options
Once we can successfully identify the source of the nerve compression, then the next step is to modify the aggravating activity.
Carpal Tunnel Syndrome treatment options include:
Activity Modification
- Reduce the duration, modify the position, or stop performing the aggravating activity altogether.
Cock-Up Wrist Brace
- I almost always recommend that my patients begin wearing a cock-up wrist brace throughout the day, but especially when performing aggravating activities (i.e. typing, writing). This particular type of wrist brace helps keep the wrist in a neutral position that allows maximal opening of the Carpal Tunnel. In addition, it helps to protect the Carpal Tunnel when resting the wrists on a desk or other hard surfaces. My favorite wrist brace is from Copper Compression as it is fairly minimal in size, yet it provides support in all of the right places.
9.5- DECREASES NERVE COMPRESSION
- PROMOTES NERVE PAIN RELIEF
- SIZED & SHAPED FOR BOTH HANDS
- FULLY ADJUSTABLE FOR MAXIMUM SUPPORT
- COPPER INFUSED NYLON
Keyboard Palm Wrest
- You can purchase a stand-alone palm wrest such as the Logitech MX Palm Wrest, which I am using as we speak. This will help to pad the base of the wrists as they rest on your desk. This will help reduce nerve compression in the hand.
9.5- PERFORMANCE FOR LONG HOURS
- FIRM WRIST SUPPORT
- DECREASES NERVE COMPRESSION
- RELAXED WRIST POSITION
- DESIGNED FOR THIN KEYBOARDS
Ergonomic Keyboard
- Change out your keyboard with a proper ergonomic one such as the Logitech Ergo K860 (compatible with both Windows and Apple Macs), which is specifically designed to allow your wrists to rest in a position that naturally reduces pressure on the Carpal Tunnel.
9.6- COMPATIBLE WITH BOTH WINDOWS & MAC
- WIRELESS ERGONOMIC KEYBOARD
- IMPROVED TYPING POSTURE
- PILLOWED WRIST SUPPORT
- ERGONOMIST APPROVED
The BEST Carpal Tunnel Exercises for Hand Pain Relief!
There are several physical therapy Carpal Tunnel exercises that can help to reduce wrist and hand pain. These exercises primarily target muscle/tendon flexibility and are meant to optimize the mobility of the structures that run through the Carpal Tunnel.
Wrist Flexors Stretch with Elbow Straight
- Elbow must be held fully straight
- Perform: 3 reps x 30 seconds holds (3-4x/day)
Wrist Flexors Stretch with Elbow Bent
- Elbow bent to your side
- Perform: 3 reps x 30 seconds holds (3-4x/day)
Wrist Extensors Stretch with Elbow Straight
- DO NOT perform this stretch if you feel an increase in hand pain, numbness, tingling when performing it
- Elbow must be fully straight
- Perform: 3 reps x 30 seconds holds (3-4x/day)
Hand Shake Exercise
- For short-term hand and wrist pain relief. Perform as needed throughout the day
- Perform: 20-30 seconds
Carpal Tunnel Stretch
- Perform massage type stretch from the center of the base of the wrist and glide outwards
- It would be easier if you have someone else doing the massage as you can do both directions simultaneously (as seen in the picture)
- Perform: Massage for 2-3 mins. 1x/day
Wrist Tendon Gliding Exercises
- Follow the sequence of hand positions to promote improved tendon gliding within the Carpal Tunnel.
- Form each position of the hand and pause for 2 seconds.
- Perform: 5 rounds (2x/day)
Carpal Tunnel Release Surgery
As with most physical therapists, I almost always recommend that a patient attempt a trial of physical therapy prior to jumping into surgery for a Carpal Tunnel Release. If someone is having mild to moderate hand symptoms and he or she shows some positive relief with these Carpal Tunnel Syndrome exercises and stretches, then it is reasonable to hold off on surgery and see if good compliance to this home exercise program can help them fully recover from the Carpal Tunnel Syndrome symptoms.
However, if this person is having significant pain, numbness, and tingling symptoms and it has been going on for several months. Or if he or she has noticeable muscle atrophy (decreasing muscle size in the hand) resulting in difficulty gripping objects, then I would recommend that he or she schedule a surgical consult with a hand specialist to discuss a Carpal Tunnel release procedure.
During this procedure, the Carpal Tunnel ligament will be cut to release the increased pressure that has built up within the Carpal Tunnel. Luckily though, recovery from a Carpal Tunnel release procedure is relatively quick with the expectation of 4-6 weeks.
