Overview of Carpal Tunnel Syndrome (CTS)/Pinched Median Nerve

Carpal tunnel syndrome or CTS is caused by a pinched nerve in the carpal tunnel. Physical Therapists use various stretches and exercises to help treat and prevent CTS, which is also the most common form of median nerve impingement. The goal for CTS or pinched median nerve exercises is to stretch the (wrist and finger) flexors and strengthen the (wrist and finger) extensors. In this post, I am going to discuss both in detail, which should help alleviate symptoms related to Carpal Tunnel Syndrome.

Exercises for Carpal Tunnel Syndrome (CTS)/Pinched Median Nerve

The majority of the exercises I am going to discuss here can be done almost anywhere. That is the best part of it!! You don’t have to go to the gym or find that extra fifteen minutes in your busy day. You can keep working, talking, or watching TV and do the exercise. Isn’t that accommodating? So, let’s get started…

Wrist Flexion / Extension:

Wrist Flexion/Extension is nothing but moving the wrist up and down in the pain-free range. If you are symptomatic (have pain due to CTS), you may want to wait until your symptoms subside.

The figure below explains how to perform these wrist exercises.

Repetitions: You can do these 10 reps twice a day.

Finger Exercises:

Properly doing the finger exercises are important with CTS, as it can increase the pain if done incorrectly.

Below is a figure that shows how finger exercises should be done to cure and prevent CTS symptoms. This is more like tendon gliding exercise. This also helps to mobilize the nerve (nerve mobilization is a separate exercise but tendon gliding also helps).

You can also perform finger bending – just like making a fist if you want to avoid any fancy exercises. Making a fist and opening it will also help to reduce pain and swelling of the nerve.

Repetitions: You can do these 10 reps twice a day.

Thumb Exercises:

Thumb exercise is important in the case of CTS as all the small muscles of thumb (thenar muscles) are supplied by the median nerve.

The exercises are, moving thumb side to side (Abduction & Adduction), up and down (flexion & Extension), and trying to touch the tip of the thumb to tip of each finger (opposition).

While touching the tip of little finger and ring finger, you will feel a little stretch (pull) – and that is ok. If you feel pain then you should wait for a day or two before you try to do those exercises.

An alternate way to do this exercise is trying to touch the tip of the fingers but still not touch it (so stop at the range when you feel pain or just before that). By doing this, you are still using the same muscles, but in a pain-free range. Gradually, as your symptoms subside and swelling goes down, you will be able to touch the tips of each finger with no pain.

Repetitions: You can do these 10 reps twice a day.

Nerve Stretching:

Stretching is crucial in the case of CTS as it reduces the pressure in the carpal tunnel and thereby decreases the compression of the nerve. The result is less pain and less numbness. Stretching the full nerve under the shoulder is great but you can only stretch at the wrist to reduce the symptoms. Below is how to stretch the nerve at a different level.

The figure above explains how to stretch the pinched median nerve from shoulder (technically, just under the shoulder). The figure above stretches the full median nerve. Sometimes, this stretch is difficult as it demands a near-normal range of motion at shoulder, elbow, and fingers. A person with arthritis or frozen shoulder (and many other pathologies) may not be able to perform that range in order to stretch the nerve.

The alternative method to this is to stretch the pinched nerve at the wrist only. In this process, you keep palm facing upwards (towards the ceiling), fingers straight, and press the fingers downwards with the other hand (as shown in the image below). You should feel pulling at the wrist area.

Repetitions: 3 reparations twice a day with 45 to 60 seconds hold at each reparation. You should only feel pull/ stretch while stretching and not any pain.

Strengthening exercises:

To recover from CTS, strengthening is as important as stretching. The key point is to strengthen the extensors of fingers, wrist, elbow, and shoulder. These are the muscles that bring elbow, wrist, and fingers in a straight position. You can use weights, dumbbells, elastic bands, etc.

Here are some products I recommend to strengthen these muscles:

You can also use a can of soup or beans in initial stages to perform the same exercises. Remember to exercise in a pain-free range. If you decide to use weight, start slowly. I will try 1 lb first, perform 5 to 7 repetitions, and see how you feel. If you feel no pain than perform the same weight for 3 sets of 10 repetitions and gradually increase the weight.

Braces:

Wrist braces help at night to reduce the pain. They also provide extra support to prevent wrist moving/ bending in a painful way.

See this as an example of brace that can be used. You can also use the braces during daytime to support your wrist.

Preventative Measures:

Strengthening exercises shown above will improve muscle functions and strength. This is a good preventative measure for CTS or a pinched nerve.

Few other measures are improving posture and modifying the work environment. This is mainly for those long-time computer/laptop users. Changing or modifying the wrist and hand positions as well as adding some extra support (when and where needed) will eliminate extra pressure and compression on the nerve.

You can find more on posture modifications and ergonomics here.

Here is a picture that has some extra support under the wrist to help with the pain.

There are a variety of support available based on your workstation and your need. You can find some of the modification support here.

Also taking a five-minute break to stretch the muscles and nerve (same stretches shown above) will help prevent re-occurrence.

Here is a quick exercise chart that you can follow routinely.