Carpal tunnel syndrome - targeted relief, secure grip

What physiotherapy and occupational therapy can do for CTS before and after surgery

Tingling in the fingers at night, a furry feeling in the hand, loss of strength when gripping - carpal tunnel syndrome (CTS) is one of the most common nerve compression syndromes of all. The symptoms are caused by a constriction of the median nerve in the wrist area.

Many complaints can be significantly alleviated with targeted conservative therapy - but even after an operation, follow-up treatment with physiotherapy and occupational therapy plays a key role in fully restoring function, strength and mobility.

What is carpal tunnel syndrome?

The carpal tunnel is a narrow channel between the carpal bones and a fixed ligament (flexor retinaculum) through which tendons and the median nerve run. If there is an increase in pressure - for example due to swelling, overloading or anatomical constrictions - the nerve becomes irritated.

Typical symptoms:

- Tingling, numbness or burning sensation in the thumb, index and middle finger

- Hand falls asleep at night with pulling pain

- Loss of strength, e.g. when gripping, holding or writing

- Weakness in the ball of the thumb muscles (with prolonged course)

Important: CTS is often part of a more complex stress pattern - the neck, shoulder and arm should also be assessed and treated if necessary.

Conservative therapy - relieve and regulate

In many cases, carpal tunnel syndrome can be treated without surgery - especially if the symptoms are mild to moderate or in the early stages.

Aims of conservative treatment:

- Reduce pressure on the nerve

- Improve the gliding ability of the nerves

- Hand function retained

- Correct movement and load patterns

Physiotherapy focal points:

- Neurodynamic mobilization of the median nerve

- Mobilization of the cervical spine, thoracic spine and shoulder girdle

- Treatment of myofascial tension in the arm and hand

- Medical yoga and breathwork for vegetative regulation

Occupational therapy focal points:

- Adaptation of strenuous everyday activities (e.g. typing, lifting, writing)

- Ergonomic advice at the workplace

- Provision of aids (e.g. night splints)

- Functional gripping and hand training

Surgical therapy - when conservative measures are not enough

In advanced cases or if symptoms persist despite conservative treatment, surgery may be necessary. This involves cutting the flexor retinaculum in order to permanently reduce the pressure on the median nerve.

Indications for surgery:

- Persistent or increasing deafness

- Muscle atrophy in the ball of the thumb

- No improvement after 3-6 months of conservative treatment

- Positive electrophysiological findings (e.g. delayed nerve conduction velocity)

The operation is usually minimally invasive, outpatient and has few complications - but requires targeted follow-up treatment for optimal results.

Follow-up treatment after surgery - targeted support for regeneration

After a successful operation, many patients are quickly pain-free - but mobility, strength and sensitivity often have to be rebuilt first. This is where physiotherapy and occupational therapy come in during aftercare.

Physiotherapeutic measures after the operation:

- Scar mobilization to avoid adhesions

- Joint mobilization of wrist and fingers

- Strengthening the hand muscles and coordination training

- Training of a physiological movement sequence in the entire arm-shoulder complex

Occupational therapy measures after the operation:

- Sensitivity training (e.g. for numbness or sensitivity to stimuli)

- Build-up training of fine motor skills and writing function

- Adaptation of work processes and movement behavior

- Instructions for self-treatment in everyday life (e.g. scar care, self-exercises)

The aim of the follow-up treatment is to restore pain-free, powerful hand function that is suitable for everyday use - including a return to work and leisure activities.

Biopsychosocial approach - regulating the nervous system, building trust

At Hockenholz, we do not view CTS in isolation as a "mechanical problem", but as part of a sensitive system of movement, perception, nervous system and everyday stress.

That's why we integrate them into our therapy:

- Modern explanation of pain and nerves

- Conscious movement training for arm, shoulder and neck

- Breathing and mindfulness work for vegetative regulation

- Resource activation and self-efficacy

Conclusion: carpal tunnel syndrome is treatable - with sensitivity and a system

Whether conservative or post-operative: carpal tunnel syndrome requires more than just local treatment. With an individual, functional and holistic approach consisting of physiotherapy and occupational therapy, hand function can be regained, pain relieved and resilience built up - safely, sustainably and close to everyday life.

Are you a therapist and want to expand your knowledge of nerve mobilization, hand therapy and pain regulation?
👉 Discover our training courses at:
www.hockenholz.com/weiterbildungen

Are you affected yourself?
We support you before and after the operation - professionally, empathetically and with a clear goal: back to an active, pain-free everyday life.