wrist ROM after epsom soaks 2-3x per day
strengthening exercises: for the wrist, once pain subsided, like squeezing ball, wrist flexion and extension with small weights, etc.
yoga: In a randomized, single-blind, controlled trial involving forty-two individuals with carpal tunnel syndrome subjects participated in a program consisting of 11 yoga postures designed for strengthening, stretching, and balancing each joint in the upper body along with relaxation given twice weekly for 8 weeks. Controls were offered a wrist splint to supplement their current treatment. Subjects in the yoga groups demonstrated significant improvement in grip strength and significantly more improvement in Phalen sign. (Garfinkel MS, et al. JAMA 1998 Nov 11;280(18):1601-1603.)
hydrotherapy
hot epsom soaks
manipulation
spine and extremities: check and align upper thoracics, cervicals, navicular, lunate; C-1 may be particularly significant
cock-up splint: with hand in neutral position, to relieve hand pressure
massage: ligament after soaks
avoid repetitive motions!
electrical and oscillating
ultrasound: over ligament; pulsed; turn up to 1 W/cm slowly; also over C5-T2 nerve root
high voltage Galvanic: (-) pole to stim. nerve
footnotes
Garfinkel MS, Singhal A, Katz WA, Allan DA, Reshetar R, Schumacher HR Jr. Yoga-based intervention for carpal tunnel syndrome: a randomized trial. JAMA 1998 Nov 11;280(18):1601-1603.
Abstract: CONTEXT: Carpal tunnel syndrome is a common complication of repetitive activities and causes significant morbidity. OBJECTIVE: To determine the effectiveness of a yoga-based regimen for relieving symptoms of carpal tunnel syndrome. DESIGN: Randomized, single-blind, controlled trial. SETTING: A geriatric center and an industrial site in 1994-1995. PATIENTS: Forty-two employed or retired individuals with carpal tunnel syndrome (median age, 52 years; range, 24-77 years). INTERVENTION: Subjects assigned to the yoga group received a yoga-based intervention consisting of 11 yoga postures designed for strengthening, stretching, and balancing each joint in the upper body along with relaxation given twice weekly for 8 weeks. Patients in the control group were offered a wrist splint to supplement their current treatment. MAIN OUTCOME MEASURES: Changes from baseline to 8 weeks in grip strength, pain intensity, sleep disturbance, Phalen sign, and Tinel sign, and in median nerve motor and sensory conduction time. RESULTS: Subjects in the yoga groups had significant improvement in grip strength (increased from 162 to 187 mm Hg; P = .009) and pain reduction (decreased from 5.0 to 2.9 mm; P = .02), but changes in grip strength and pain were not significant for control subjects. The yoga group had significantly more improvement in Phalen sign (12 improved vs 2 in control group; P = .008), but no significant differences were found in sleep disturbance, Tinel sign, and median nerve motor and sensory conduction time. CONCLUSION: In this preliminary study, a yoga-based regimen was more effective than wrist splinting or no treatment in relieving some symptoms and signs of carpal tunnel syndrome.