Helping hand

Therapist talks treatments for carpal tunnel syndrome

Stephanie Carlson-Ballone, certified hand therapist and doctor of occupational therapy at UP Health System Rehab Services, guides a patient through hand therapy exercises in the UP Health System Rehab Services building along West Washington Street in Marquette. Carlson-Ballone gave a presentation on carpal tunnel syndrome and how hand therapy can help at Peter White Public Library on Wednesday. (Journal photos by Cecilia Brown)

MARQUETTE — Carpal tunnel syndrome, or CTS, is a very common nerve disorder — an estimated 4 to 10 million people in the United States suffer from CTS, which can cause numbness and weakness in the hand.

This common syndrome and its treatment was the topic of a presentation given by UP Health System Rehab Services Certified Hand Therapist Stephanie Carlson-Ballone at the Peter White Public Library on Wednesday as part of the library’s “The Doctor Is In” series.

“Carpal tunnel syndrome is a (nerve) compression syndrome, it’s the most common,” Carlson-Ballone said. “And it’s the compression of what’s called the median nerve and that’s something that passes along the arm and originates in the spinal cord — but where it’s getting compressed is at the wrist level, and so as it passes through the wrist, something is disrupting its ability to send messages.”

Carlson-Ballone explained the anatomy of the wrist’s carpal tunnel, illustrating how the median nerve can become compressed and lead to numbness, tingling and weakness in the hand.

The carpal tunnel, which is located on the wrist’s palm side, is encircled by eight small wrist bones and the transverse carpal ligament — the median nerve, along with nine tendons, must pass through the narrow space of the carpal tunnel and withstand high pressures from forceful wrist movements.

Carlson-Ballone performs stretching exercises on a patient. (Journal photo by Cecilia Brown

“Those tendons and that one nerve have to pass through that space and anatomically, that should happen, but when we start looking at our daily activities and things we do throughout the day, sometimes anatomy doesn’t always match with all the other stuff that’s going on, so some of those tendons, maybe that nerve is going to get irritated,” she said. “The long and short of it is that sometimes the space there does not allow for a lot of changes in that area, and if there’s swelling or other abnormalities, that nerve starts to get pressed.”

Injuries, arthritis and repeated forceful use of the hand and wrist can all lead to median nerve compression, Carlson-Ballone said.

When the nerve is compressed, nerve impulses may be slowed or blocked — because the median nerve sends sensations and muscle impulses to the hand, the compression of the nerve can cause pain, numbness and/or tingling in the thumb, pointer and middle fingers, as well as half of the ring finger; swelling; and hand weakness, she said.

“In addition to other symptoms, people may feel clumsy or they might start dropping objects,” Carlson-Ballone said.

People who have CTS may feel weak in their affected hand, she said.

“Grip strength decreases, but usually people feel like they’re weaker before they actually are … people say ‘I’m so weak,’ but they’re not actually,” she said. “But because they’re clumsy and because they’re not feeling things the way that they normally would, they feel weak right off the bat. In later stages of this condition, weakness does occur.”

There are stages of severity, Carlson-Ballone said, noting that mild CTS usually involves numbness, tingling and clumsiness, waking up at night with swelling, and the “flick sign” — a shake of the whole hand that people do in an attempt to relieve these symptoms.

In moderate-severity CTS, measurable weakness can occur, along with noticeable symptoms throughout the day, in addition to increased numbness, tingling and clumsiness — when carpal tunnel syndrome becomes severe, the large muscle of the thumb may appear flat in the affected hand due to muscle wasting, she said.

“The severe stage is when there is truly wasting of muscle because the messages for movement have not been getting through clearly,” she said.

Carlson-Ballone said if someone suspects they may have CTS, they can start with a visit to their physician — they can direct a patient to the right resources to determine if they have CTS, as other nerve issues can cause similar symptoms.

X-rays, as well as “provocative tests,” can help determine if a person has CTS — once a person has a definitive diagnosis of CTS, a range of treatment options can be pursued, Carlson-Ballone said.

“There can be surgery, there can also be conservative treatment — conservative treatment is usually therapy,” she said. “What determines what the treatment is, starts with the stage.”

The treatment pursued depends on the severity of carpal tunnel, as well as a person’s lifestyle and wishes, she said.

She emphasized that conservative treatments, such as hand therapy, the use of medication in the area, and lifestyle changes, can all be helpful.

“There’s some things that can be done throughout the day to prevent further injury or to prevent injury and that’s something that during the evaluation and treatment in a therapy program we would provide to you,” she said. “So looking at ways to modify daily activities, looking at maybe some things you haven’t thought about throughout your day that are causing these symptoms, showing some exercises, these are all things that would be part of therapy.”

Helpful modifications include taking breaks from activities that involve forceful gripping over a long period of time, such as using a lawnmower, snowblower or powerful tools; wearing protective items such as padded gloves while doing these activities; stretching the area; and applying heat, she said.

However, the surgery — which involves releasing the transverse carpal ligament to reduce the pressure in the carpal tunnel — may be needed in some cases, she said, noting both open and endoscopic procedures offer equivalent relief from CTS.

After surgery, the median nerve should be relieved from compression — while a person’s grip strength may not return to “100 percent,” it is likely to improve, especially if the person receives appropriate supportive post-operative care, Carlson-Ballone said.

“Getting it moving and getting a plan of care after either type of surgery is really necessary,” she said. “I like to see people post-op, even if it’s just once, even if it’s just to set up a program and see where you’re at, I think it’s beneficial.”

For those who suspect they may have carpal tunnel syndrome, Carlson-Ballone said UP Health System Rehab Services offers free injury screens.

Interested parties can call 906-228-2595 for more information or to set up an appointment.

Carlson-Ballone and other hand therapists at UP Healthy System Rehab Services work by physician referral, she said, noting that referrals are needed for services outside of the free injury screens.

Cecilia Brown can be reached at 906-228-2500, ext. 248. Her email address is cbrown@miningjournal.net.