Massage therapy · Kitchener–WaterlooCarpal Tunnel Syndrome

Some common causes and associated conditions are

• Repetitive and forceful gripping with the hands
• Repetitive bending of the wrist
• Broken or dislocated bones in the wrist, or a previous wrist injury
• Arthritis, especially the rheumatoid type
• Thyroid gland imbalance
• Diabetes
• Hormonal changes associated with menopause
• Pregnancy
• Being overweight
• Having a parent, brother or sister with CTS
• Sports where you grip a lot, like tennis and golf
• Use of vibrating/heavy machines, like drills or lawn mowers

(NHS, 2024; AAOS, n.d.)

Nb. Symptoms are often brought on by holding the wrist bent forwards or backwards for a long time, for example when using a phone, driving or reading (AAOS, n.d.). Keeping the wrist straight (in a neutral position) reduces the pressure on the nerve (NHS, 2024; AAOS, n.d.).

CTS sometimes gets better by itself within a few months, particularly if it is caused by pregnancy (NHS, 2024).

1. Wrist Splints

A wrist splint keeps your wrist straight, which helps to relieve pressure on the nerve. It is worn at night while you sleep, and you can buy one from a pharmacy or online. You may need to wear it for up to 6 weeks before it starts to help (NHS, 2024). The best length of time to wear a splint is not certain (Karjalanen et al., 2022).

2. Pain Relief Medication

The NHS (2024) says painkillers such as paracetamol or ibuprofen may help carpal tunnel pain in the short term, but there is little evidence that they treat the cause of CTS, so it is important not to rely on them. (This medicine information comes from the NHS, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

3. Evaluating Other Medical Conditions

Conditions such as diabetes, rheumatoid arthritis and thyroid gland imbalance are associated with CTS (AAOS, n.d.). Looking at any other medical conditions that may be contributing, with your family doctor or nurse practitioner, can help you decide what changes need to be made.

4. Minimise Certain Activities

Stop or cut down on anything that makes you frequently bend your wrist or grip hard, such as using vibrating tools (NHS, 2024). Take frequent breaks from any repetitive tasks.

5. Yoga

Some people find yoga helpful, but the evidence that it reduces CTS symptoms is limited and of very low quality (Page et al., 2012).

Options outside my scope

• Steroid injection: an injection into the wrist to bring down swelling around the nerve. It is not always a cure, and symptoms can come back after a few months (NHS, 2024).
• Surgery (carpal tunnel release): an operation that cuts the ligament forming the roof of the carpal tunnel, so it no longer presses on the nerve. Surgery usually cures CTS (NHS, 2024; AAOS, n.d.).
• Nerve tests: if the diagnosis is not clear, a nerve conduction test or a scan may be arranged (NHS, 2024).

How I can help (see the My Approach tab)

Ergonomics

Proper seating is important for good ergonomics. The height of your seat and the position of your backrest should be adjustable. The chair should be on wheels so you can move it easily.

Arm rests on the chair, though optional, are often helpful.

Table Height

To adjust the chair properly, look first at the height of the table or desk surface on which your keyboard rests. Taller people will prefer slightly higher tables than shorter people. If you can adjust your table, adjust it so that your elbow makes roughly a 90 degree angle when your hands are on the keyboard.

Wrist Angle

If your keyboard is positioned properly, your wrists should be able to stay straight and rest comfortably in front of it. Some keyboards are very thick or deep and require you to bend your hands uncomfortably upward to reach the keys. If so, it may help to place a raised wrist rest on the table in front of the keyboard. Holding your wrists bent for long periods increases the pressure on the nerve (AAOS, n.d.).

Elbow Angle

With your hands resting comfortably at the keyboard and your upper arms vertical, check the angle between your forearm and your upper arm (the elbow angle). If it is less than 90 degrees, raise the seat of your chair. If the angle is greater than 90 degrees, lower the seat. Try to hold your elbows close to your sides to help minimise sideways bending of the wrist (as when reaching for the "Z" key).

Breaks and Exercises

Working with your hands bent upward at the wrists, or frequently bending your wrists sideways, puts the wrist in the positions that tend to bring on symptoms (AAOS, n.d.). Take regular short breaks from the keyboard. This needn't be a break from productive activities, just a break from typing. Gentle exercises may help, too (NHS, 2024). Try the following, and stop if they make your symptoms worse:

a) Make gentle fists, hold for one second, then stretch your fingers out wide and hold for five seconds. Repeat several times.

b) With arms outstretched in front of you, raise and lower your hands several times. Rotate your hands ten times (make circles in the air with the fingertips).

Variety is the key. If you use a keyboard, structure your workdays to include a mix of activities each hour. For example, instead of typing all morning and filing all afternoon, mix typing and filing throughout the day.

Your hand may feel a little more tingly for a short time after specific work. Work near the armpit is only with your informed consent; work on the chest wall muscles also needs a written consent form.