Treatment Options for Carpal Tunnel Syndrome

By: Dr. Rebecca Van Heuklon, DPT, FAFS, FMR

You've started having pain, numbness and tingling in your hand and fingers that wakes you up at night or bothers you when you are driving.  Maybe you’ve even started noticing weakness with gripping and squeezing, and you find you are dropping things.  You've visited your doctor and are told that you have carpal tunnel syndrome (CTS) and need to have surgery.

CTS occurs when the median nerve is compressed and irritated as it travels through the thick ligament on the inside of the wrist.  So, what other options do you have if surgery isn’t the direction you want to go?  Some of the most common conservative treatments for CTS include getting a steroid injection, using a wrist brace, doing nerve mobility exercises, and having manual therapy performed by a physical therapist.  Which is the most effective option that provides the best relief?  Is it treating conservatively or moving forward with surgery?  Won’t I just end up having surgery anyways?  These are all questions that are likely flooding through your mind when faced with a decision like this.

Well, there is good news for you!  A new, randomized control study was just published in Physical Therapy comparing the long-term results of manual therapy performed by a physical therapist versus surgery on women with CTS.  The manual therapy techniques consisted of soft tissue work in areas from the neck down into the arm where the nerve can commonly get trapped, as well as mobility work at the neck.  Both the surgical group and the conservative group were also taught how to perform tendon and nerve gliding exercises that increase nerve mobility in the wrist as part of a home exercise program.  Amazingly, the study found that there were no significant differences in intensity of hand pain, function, or the rate of needing future surgery between the conservative group and the surgical group at 1- and 4-year follow-ups.  In addition, of those participants in the conservative group, only 15% ended up needing surgery in the 4 years following treatment.  These promising results demonstrate that a manual therapy approach in physical therapy should be the first-line of defense in the treatment of CTS before considering surgery.

It is important to note that the most effective conservative treatment supported in research for CTS uses manual therapy techniques that target mobility restrictions at the neck and throughout the entire arm.  This approach is more successful at alleviating pain and symptoms than treating only locally at the wrist.  The Doctors of Physical Therapy at MotionWorks Physical Therapy have experience in treating carpal tunnel syndrome with an emphasis on education, nerve gliding, and manual therapy techniques that target both the neck and entire upper extremity to help you avoid the need for a carpal tunnel release surgery.  Contact MotionWorks Physical Therapy at 920-215-2050 to schedule an evaluation today!