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Core Knowledge

Injury/Pain

Carpal Tunnel Syndrome 101

Overview

The carpal tunnel is a narrow passageway of ligament and bones at the base of the hand that houses and protects tendons and the median nerve. Carpal tunnel syndrome is an overuse condition in which pressure is put on that nerve, which controls movement and feeling in the thumb and all of the fingers except the little finger. The trauma can also cause the tendons to become inflamed. The condition affects hundreds of thousands of individuals, including many athletes.

How It Happens

Although the exact cause varies from person to person, a combination of factors can increase pressure on the median nerve and tendons.

In some people, the carpal tunnel is smaller than in others, which makes the nerve inside more susceptible to pressure caused by repetitive movements or swelling brought on by a fracture or sprain.

In others, the size of the tunnel is normal, but the same kinds of outside forces—primarily swelling—can put pressure on the nerve, causing a variety of painful and debilitating symptoms. Spending long days at the office typing away at your computer is a common cause. In sports, gripping a tennis racquet, golf club, or baseball bat repeatedly can all result in pain.

Here is a possible scenario for an athlete. At first, the symptoms are noticeable only when you are lying in bed at night or resting after a day of activity. You might wake up with pain and numbness in one of your hands. Hoping that it’s probably because of sleeping in an unusual position, you try to lose the tingling feeling by shaking your hand, putting it under cold water, or letting it hang down by the side of the bed. If the condition gets worse, you'll notice more interruptions of your normal routine, especially during the day.

Activities like holding a racquet, reading a book, or even combing your hair becomes a little more difficult. In advanced cases, the muscles along the base of the thumb get weaker. If not treated, those muscles will lose size and strength.
 

By the Numbers

1-2
Percentage of the general population affected by carpal tunnel syndrome.

500,000
Number of surgical procedures done each year to correct carpal tunnel syndrome.
 

Who’s at Risk

Carpal tunnel syndrome is often associated with workplace activities, but the condition is seen in racquet sports such as tennis, racquetball, skiers, and badminton players, as well as handball players, golfers, bowlers, weight lifters, archers, and baseball players. Women are more susceptible than men, and middle-aged adults are more likely to be affected than those under the age of 31.

Symptoms

  • Pain in hands or wrists.
  • Numbness, tingling, burning sensation, or weakness in your fingers or hand.
  • Occasional pain that radiates down to the palm or up to the arm or shoulder.
  • Loss of grip strength.

Initial Treatment

  • Take aspirin, ibuprofen, acetaminophen, or naproxen for pain.
  • Use an over-the-counter splint or brace at night to immobilize the wrist.
  • Use ice applications on the wrist for 15-20 minutes, 3-4 times a day.
  • Rest the hand and wrist for 1-2 weeks.
  • See a doctor if symptoms persist longer than 1-2 weeks; perhaps early if symptoms are severe.

Comeback Strategy

Everyone recovers from sports injuries at a different rate. Your return depends on how long it takes for your condition to heal, not by the number of days, weeks, or months since you sustained the injury. Returning to sports activity too soon could make recovery time even longer. Some athletes can return to training or competition within a week, but others may need two or three weeks. When surgery is required, recovery may take two months or longer.

“Generally, we advise that you keep your pillar as strong as possible as you recover,” says Athletes’ Performance physical therapist, Steve Smith. In other words, perform stretching and strengthening exercises for your forearm, wrist, and hand. But aside from bolstering your grip, don't lose sight of the fact that you'll need a strong, stable pillar to excel in everything you do.

Prehab
 

Following are some prehab exercises used to make the best use of your recovery time.

  1. Pillar Bridge - Front
  2. Lateral Pillar Bridge
  3. Glute Bridge
  4. Physioball Ys (for pillar strength and grip strength)
  5. Physioball Ts (for pillar strength and grip strength)
  6. Physioball Ws (for pillar strength and grip strength)
  7. ½ Kneeling Cable Chop
  8. ½ Kneeling Cable Lift
  9. Standing 5 Way Hip Series With Cable - Abduction, Adduction, Crossover, Extension and Flexion (these exercises will not  only work your trunk, but also your shoulder blades and grip strength)

How to Avoid It

  • Avoid or minimize the repetitive movements that put pressure on the median nerve.
  • Take breaks in sports that allow it.
  • Wear gloves (without fingers) to keep your hands warm and flexible.
  • Wear a splint that keeps the wrist straight.
  • Relax your grip (between points in tennis, between pitches when at bat in baseball, between shots in golf)

 Jim Brown, Ph.D. has written 14 books on health, medicine, and sports. His articles have appeared in the Washington Post, New York Post, Sports Illustrated for Women and Better Homes & Gardens. He also writes for the Duke School of Medicine, UCLA School of Medicine, Cleveland Clinic and Steadman-Hawkins Research Foundation.


Tags: Hand, Wrist Pain, Injury Prevention, Regeneration, Injury, Prehab, Rehabilitation

References

  1. Steve Smith, PT, DPT, SCS, CSCS, Manager, Performance Physical Therapy Services Athletes’ Performance in Florida
  2. Journal of the American Academy of Orthopaedic Surgeons
  3. Journal of the American Medical Association
  4. MayoClinic.com
  5. National Institute of Neurological Disorders and Stroke
  6. National Institutes of Health (Medline Plus)
  7. University of Pittsburgh Medical Center Sports Medicine

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