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Carpal Tunnel Syndrome: Physical and Occupational Therapy in Brooklyn

By Dr. Jack Engelberg, PT, DPT · · 4 min read

Waking up at night with numb, tingling fingers and shaking your hand to "wake it up" is one of the classic signs of carpal tunnel syndrome. It's one of the most common nerve problems in the hand, affecting office workers, new parents, people who use vibrating tools, and many others. Conservative treatment, including therapy, splinting and activity changes, helps many people, especially when started early.

What Is Carpal Tunnel Syndrome?

The carpal tunnel is a narrow passageway on the palm side of the wrist, formed by the wrist bones and a strong band of tissue called the transverse carpal ligament. Nine tendons and the median nerve pass through it. When pressure inside the tunnel increases, the median nerve can become compressed, causing carpal tunnel syndrome.

The median nerve provides sensation to the thumb, index finger, middle finger and part of the ring finger, and powers some of the thumb muscles.

Common Symptoms

  • Numbness, tingling or "pins and needles" in the thumb, index, middle and part of the ring finger
  • Symptoms that are worse at night or first thing in the morning
  • Symptoms during activities like driving, holding a phone or reading
  • Shaking or flicking the hand to relieve symptoms
  • Clumsiness or dropping things
  • Weak pinch or grip, and in advanced cases, wasting of the muscles at the base of the thumb

What Causes Carpal Tunnel Syndrome?

Often there isn't a single cause. Contributing factors include:

  • Repetitive or forceful hand use, especially with bent wrists
  • Vibrating tools
  • Sustained wrist positions, including sleeping with wrists curled
  • Pregnancy, due to fluid retention
  • Health conditions such as diabetes, hypothyroidism and rheumatoid arthritis
  • Wrist fractures or arthritis that change the shape of the tunnel
  • Anatomy — some people simply have a smaller carpal tunnel

How Therapy Helps Carpal Tunnel Syndrome

For mild to moderate carpal tunnel syndrome, conservative care is commonly recommended before considering surgery. Both physical therapists and occupational therapists treat the hand and wrist. Our Boro Park office offers occupational therapy in addition to physical therapy.

Evaluation

Your therapist will check sensation, strength, and wrist and hand movement, and use special tests to see whether the median nerve is irritated at the wrist. They'll also check your neck and elbow, since nerve compression higher up can produce similar symptoms. Your physician may order a nerve conduction study to confirm the diagnosis and gauge severity.

Treatment May Include

  • Night splinting — a neutral wrist splint keeps the wrist straight while you sleep, which is one of the best-supported conservative treatments
  • Nerve and tendon gliding exercises — to help the median nerve and tendons move smoothly through the tunnel
  • Activity and ergonomic modification — keyboard height, mouse and tool selection, and work pacing
  • Strengthening — of the hand, forearm, shoulder and upper back as symptoms allow
  • Manual therapy — for the wrist, forearm and neck when helpful
  • Post-surgical rehabilitation — scar management, swelling control and restoring grip after carpal tunnel release

What You Can Do at Home

  • Keep your wrists straight. Avoid sleeping with your wrists curled under your chin or pillow.
  • Take frequent breaks from repetitive gripping, typing or phone use.
  • Loosen your grip on pens, tools and steering wheels.
  • Warm your hands. Cold hands tend to be stiffer and more symptomatic.
  • Try tendon glides. Gently move your fingers through a series of positions: straight, hook fist, full fist, tabletop, straight fist. Repeat slowly a few times.
  • Adjust your workspace. Keyboard at elbow height, wrists floating rather than resting on a hard edge.

When to See a Therapist or Physician

Book an evaluation if:

  • Numbness or tingling wakes you at night
  • Symptoms are becoming more frequent
  • You're dropping things or having trouble with buttons or writing

See a physician promptly if numbness is constant, if you notice the muscles at the base of your thumb shrinking, or if hand weakness is getting worse. These can indicate more severe nerve compression where earlier intervention matters.

Frequently Asked Questions

Will I need carpal tunnel surgery?

Not necessarily. Mild to moderate cases often improve with splinting, activity changes and therapy. Surgery is generally considered for severe or persistent cases, or when there is muscle weakness or wasting.

Do wrist braces help during the day?

Night splinting is the most commonly recommended use. Wearing a brace during certain activities may help some people, but using it all day can lead to stiffness.

Could my symptoms be coming from my neck?

Yes, it's possible. A pinched nerve in the neck can cause hand numbness. A careful evaluation helps sort it out.

Ready to get started? Call the Refuah office nearest you

Occupational therapy is offered at our Boro Park office, and physical therapy at all three. Call to schedule an evaluation, or book online at refuahpt.com.

Book at refuahpt.com

About the author. Dr. Jack Engelberg, PT, DPT is a Doctor of Physical Therapy and owner of Refuah Physical & Occupational Therapy, with offices in Midwood and Boro Park, Brooklyn, and on Staten Island.

Medical disclaimer: This article is for general education only and is not medical advice, diagnosis or treatment. Everyone’s situation is different. Talk with your physician or a licensed physical therapist about your symptoms. If you think you have a medical emergency, call 911.

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