Carpal tunnel syndrome
Information for patients
Occupational Therapy
What causes carpal tunnel syndrome?
Carpal tunnel syndrome is the result of pressure on the median nerve at
the wrist.
The median nerve and the tendons of the flexor muscles that flex the
wrist share a common tunnel (carpal meaning wrist). Any process,
which reduces the space in the tunnel for example swelling of the
tendons, can give rise to pressure on the nerve.
What are the symptoms of carpal tunnel?
Symptoms can include any of the following:
• Pins and needles, burning or tingling sensations in the hand,
thumb and index, middle and half of the ring fingers.
• Pain and discomfort in the palm of the hand, thumb and fingers.
• Swelling in the hand, thumb and fingers.
• Weakness of some muscles in affected fingers and or thumb,
which can cause poor grip.
• Loss of sensation (numbness) in fingers and hand, which may
cause poor awareness of hot and cold temperatures.
• Stiffness and cramping in the hands first thing in the morning.
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Median nerve
Transverse ligament
Carpal bones
Flexor tendons
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What can I do to help reduce the symptoms?
• Don't bend your wrist all the way up or down, try to keep it
straight. You may need a splint to help maintain this position at
night.
• Don't flatten the palm of your hand instead do try and use a
cupped position as this lessens the tension in the tendons.
• Don't grip things too tightly i.e. the steering wheel, the
telephone, when holding a book, carrying bags. Do try to relax
your grip frequently and change activities often.
• Do try to avoid tools that cause vibration for example hand held
electric mixers, power tools. If necessary, try to wear padded
gloves or pad the tool handles to absorb the vibration.
• Do try to avoid repetitive pounding activities for example
hammering, stapling.
• Do try to reduce or avoid activities that require pinching for a
prolonged time such as sewing and writing. Do try to enlarge the
grip using padding, relax the hand frequently and vary activities
throughout the day.
• Do try to hold your hands in the air above your head and open and
close your fingers a few times to reduce any over night swelling.
You can repeat this several times through out the day.
• Do follow the exercise regime that your therapist has shown you.
This will help to keep your tendons moving and should reduce the
pressure on the nerve, as this is what causes your symptoms.
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Your carpal tunnel splint / wrist brace
What does the splint do?
The splint is designed to reduce the symptoms of carpal tunnel
syndrome for example numbness, tingling, pain, pins and needles.
How do I put the splint on?
1. You may find it helpful to rest your arm against your body or on
a table.
2. Make sure the cut out is at the thumb side.
3. The metal bar will have been altered by your therapist to a
straight position and this should always be on the palm side.
4. Bring the two edges of the splint together and fasten the straps
but not too tightly as this can cause swelling. There should not be
any gaps between the splint edges.
5. You should be able to see all your knuckles, the splint should be
below the crease on your palm on the side of your little finger.
When should I wear the splint?
You should wear your splint over night while sleeping. It can also be
worn during rest periods in the day if your symptoms are particularly
bad. It is not suitable for wear during activity.
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How should I look after the splint?
You can hand wash your splint after you have removed the metal bar.
Please let it air dry.
Don't forget to replace the metal bar before you resume wearing it.
Splint fitted by:
Profession:
Contact number:
Date fitted:
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Exercises
Tendon gliding exercises
• Hold each exercise for 7 seconds
• Each exercise should be repeated 5 - 10 times
• Do the exercises 3 - 5 times a day
A
B
D
C
E
A. Wrist is straight, with the fingers and thumb extended.
B. Wrist and knuckles are straight, fingers bent and thumb extended.
C. Wrist is straight, make a fist.
D. Wrist is straight, knuckles are bent, fingers straight.
E. Wrist is straight, knuckles and middle joint of fingers bent, end joint
of fingers straight.
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Median nerve exercises
• Repeat each exercise 5 times
• Hold each exercise for 7 seconds
• Do the exercises 3 - 5 times a day
A
B
C
D
E
F
A. Wrist is straight, with the fingers and thumb flexed.
B. Wrist is straight, with the fingers and thumb extended.
C. Wrist and fingers are extended, with the thumb straight.
D. Wrist, fingers, and thumb are extended.
E. Wrist, fingers, and thumb are extended, with the forearm in
supination (turned up to face the ceiling).
F. Wrist, fingers and thumb are extended, the forearm is in supination,
and the other hand gently stretches the thumb.
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What do I do if the exercises cause me pain?
You may experience some discomfort with the tendon gliding and the
median nerve exercises, this is normal. However if this lasts for more
than 15 minutes after exercising or you have an increase in your
symptoms i.e. tingling, pins and needles or numbness you may want to
reduce the number of repetitions.
If the discomfort continues then it is better to stop and inform your
therapist who will advise you.
Contrast baths
You can also try putting your hands in a basin of warm water for 4
minutes and then a basin of cold for 1 minute.
Repeat this 3 - 5 times.
Strengthening
Your therapist may also instruct you in theraputty exercises to improve
the strength of your hand muscles especially your thumb. These may
have wasted due to the compression of the nerve, which can also affect
your grip strength.
Your therapist will give you a separate instruction booklet for these.
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Issue Date: August 2015. Review Date: August 2017