Physiotherapy is a crucial component of conservative management for CTS, especially for mild to moderate cases. The goals of physiotherapy are to reduce pressure on the median nerve, alleviate symptoms, improve hand and wrist function, and prevent recurrence.

Activity Modification and Ergonomics

• Identifying aggravating activities: A physiotherapist will help you identify daily activities, work habits, or hobbies that worsen your symptoms.
• Ergonomic adjustments: Recommendations for proper posture, keyboard and mouse placement, and minimizing repetitive wrist movements at work or home to reduce strain on the wrist.

Splinting/Bracing:

• Nighttime splinting: Wearing a wrist splint, especially at night, keeps the wrist in a neutral position, reducing pressure on the median nerve and often alleviating nocturnal symptoms.
• Daytime splinting: In some cases, a splint may be recommended during the day for specific activities that aggravate symptoms.

Therapeutic Exercises:

• Nerve gliding exercises (Median Nerve Glides): These exercises gently move the median nerve to prevent adhesions and improve its mobility within the carpal tunnel. Examples include:
  • Tendon glides: A series of hand positions that involve straightening fingers, making a hook fist, a full fist, and a straight fist.
  • Median nerve glide sequence: Specific movements of the wrist, elbow, and shoulder to glide the nerve.
• Stretching exercises: Stretches for the wrist flexors and extensors to improve flexibility and reduce tension around the carpal tunnel. Examples include wrist bends (forward and backward), wrist flexor stretches (pulling fingers back towards the body with palm facing up), and wrist extensor stretches (pulling fingers forward with palm facing down).
• Strengthening exercises: Once pain subsides, strengthening exercises for the hand and forearm muscles may be introduced to improve grip strength and overall hand function. This can include squeezing a soft ball.

Modalities:

• Cryotherapy (Ice Therapy): Applying ice to the wrist can help reduce inflammation and pain.
• Thermotherapy (Heat Therapy): Warm water immersion can help with muscle relaxation and circulation.
• Ultrasound Therapy: Used to reduce inflammation, break down adhesions, and improve blood circulation.
• Transcutaneous Electrical Nerve Stimulation (TENS): Can be used for pain relief.
• Laser Therapy: May be used to decrease pain and paresthesia.

Manual Therapy:

• Massage therapy: Techniques like compression, cross-fiber friction, and deep tissue work can help reduce pain and improve tissue flexibility.