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Carpal tunnel syndrome, caused by nerve compression of the median nerve in the wrist, often leads to pain, tingling, and numbness in the hand and fingers. Traditional treatments vary from conservative approaches like physiotherapy and splinting. Another useful way to manage carpal tunnel syndrome symptoms is using the TENS (Transcutaneous Electrical Nerve Stimulation) machine, which alleviates pain by delivering electrical impulses. This guide will provide insight about how using a TENS device can assist with your carpal tunnel syndrome.

 

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is a nerve-related condition that can affect the wrist, hand, and fingers. This condition occurs when the median nerve is compressed as it runs through the wrist into the hand and fingers. Generally, women are up to three times more likely to be affected than men, and this becomes more common among those who are older [1]. There are various severities of carpal tunnel syndrome, which range from mild symptoms to severe symptoms needing surgery.

 

What causes carpal tunnel syndrome?

The main cause of carpal tunnel syndrome is compression and pressure on the median nerve. This is a nerve that helps with sensation and movement in specific areas along the forearm, hand, and digits. As the median nerve travels from the arm to the hand, it enters through the carpal tunnel, which consists of boney borders, ligaments, and tendons. Swelling or expansion of these structures can lead to pressure buildup.

Carpal tunnel syndrome is particularly common in people who experience repetitive movements at their workplace, including forestry, assembly work, and builders [2]. Medical issues and changes to the body can also increase the risk of developing this condition, including [1].

  • Pregnancy
  • Diabetes
  • Obesity
  • Arthritis
  • Hypothyroidism

 

Traditional Therapies for Carpal Tunnel Syndrome

Traditional therapies for carpal tunnel syndrome will vary from person to person. Those with milder symptoms may attempt more conservative therapies, including physiotherapy, massage, acupuncture, wearing therapeutic gloves, using heat or ice packs, performing corrective exercises, and wearing a splint. Your doctor may also recommend medications and/or corticosteroid injections. For persistent or severe presentations, surgery may be required to help with long-term symptom alleviation.

 

What is a TENS machine, and how can it help carpal tunnel syndrome?

TENS stands for Transcutaneous Electrical Nerve Stimulation. This is a portable machine that helps alleviate pain. TENS machines can target specific nerve pathways that can blunt the body’s response to painful symptoms (such as those experienced with carpal tunnel syndrome) [3]. Additionally, research has also shown its capacity to help the body release endogenous opioids [3]. These are your body’s natural proteins that bind to nerve cells to help with pain relief.

 

What's the best way to use a TENS machine for carpal tunnel treatment?

Settings on the TENS machine can be adjusted to help optimise treatment. While there are recommendations about optimal settings, preferences can vary from person to person. When in doubt, speak to a healthcare professional who has experience with TENS machines, such as a physiotherapist.

Here are the best practices for using a TENS unit:

Position of electrode pads for carpal tunnel treatment

There will be gel electrodes that are connected to your TENS unit to help deliver treatment. The placement of these electrodes will determine which area undergoes treatment. For carpal tunnel syndrome, most people’s symptoms exist around the hand and finger regions. At least 2 channels (2 gel electrodes) on your TENS machine are required for carpal tunnel syndrome treatment.

The first common placement of gel electrodes to treat carpal tunnel syndrome is having one channel along the base of the palm and under the wrist line, as illustrated in the picture below.

 

The second common placement includes 1) having one channel along the base of the palm and 2) the second channel under the waistline on the other side of the arm.

 

Conductive garments as an alternative to electrode pads

An alternative to electrode pads are conductive hand glove garments that can be worn like gloves. This allows for an easier setup and a more a more complete treatment. Symptoms of carpal tunnel syndrome can often occur in areas that are difficult to reach with the electrodes (e.g., fingers, knuckles, around the nails, etc.). Wearing a conductive garment allows current to be delivered completely around the wrist and hand for a more complete treatment.

Setting the TENS Mode for Carpal Tunnel Treatment

There are multiple modes on your TENS machine that can be set for specific reasons, including massage, EMS, and TENS. For carpal tunnel syndrome treatment, it is recommended to preset your devices to TENS mode. Afterwards, there may be several settings that can be adjusted in

the TENS mode, including frequency, pulse width, and intensity. The following paragraphs will highlight settings that may assist with the alleviation of carpal tunnel syndrome symptoms.

Setting the Pulse Rate (Frequency) for Carpal Tunnel Treatment

Typically, the pulse width for TENS machine treatment can be separated into low-frequency (less than 10 Hz) and high-frequency (greater than 100 Hz) treatments. Currently, there isn’t enough research to confirm the difference between low- and high-frequency treatment for carpal tunnel syndrome [4]. A higher frequency (>100 Hz) is associated with a more constant sensation and helps reduce the transmission of pain signals to the brain [5]. Typically, this may assist with a faster onset of pain relief. Whereas low frequency (<10 Hz) is associated with a sharper and stronger sensation, Generally, this can help stimulate the release of endogenous opioids, which may lead to prolonged pain relief [5]. These recommendations should be taken in line with your own personal preferences.

Setting the Pulse Width for Carpal Tunnel Treatment

The effectiveness of different pulse widths for carpal tunnel syndrome treatment still remains relatively unknown. Studies have used pulse widths ranging from 50 to 250 µs with varying success [4].

How Often Should You Use Your TENS Machine for Carpal Tunnel Treatment?

Most studies have suggested using the TENS machine for 20–30 minute sessions to help relieve symptoms of carpal tunnel syndrome [6]. For most people, they can safely and effectively be used on a daily basis. However, it may be worthwhile speaking to your GP for further enquiries, especially if you have specific medical conditions or circumstances.

 

Using Caremax TENS machine for CTS Pain Mangement


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Other Home Remedies to Relieve Carpal Tunnel Syndrome

Several home remedies can be used to help ease the symptoms of carpal tunnel syndrome. The effectiveness of these treatments may vary depending on the severity of the condition and your individual characteristics. Examples, include:

  • Stretches and exercises
  • Cold therapy
  • Heat therapy
  • Wearing gloves
  • Temporarily wearing a splint
  • Ointments and lotions
  • Taking over-the-counter medications and supplements
  • Rest

 

Where and when to not use TENS machines

Using transcutaneous electrical nerve stimulation (TENS) machines can alleviate unpleasant or painful sensations, but their use necessitates strict adherence to safety guidelines. Following these precautions is essential for ensuring safe and effective use. Key safety measures to consider include:

Do not apply the TENS machine to:

  • Damaged skin, such as wounds or cuts.
  • Areas with reduced sensation or numbness.
  • Swollen regions.
  • Near tumours or blood clots.
  • Areas treated with radiotherapy or radiation.

Specific situations where TENS machines should not be used or require caution include:

  • Individuals with implanted devices like pacemakers or neurostimulators.
  • Those with cognitive or mental impairments.
  • Individuals are unable to consent to the use of TENS machines.
  • For neuropathic conditions (such as carpal tunnel syndrome) or nerve pain, it is recommended to consult a healthcare professional before use.

Additionally, avoid using the TENS machine if:

  • You have reduced sensation or numbness in the application area.
  • You experience severe pins and needles or tingling.
  • Your symptoms worsen after using the machine.
  • You’re pregnant

If you are unsure, please reach out to your local doctor or physiotherapist who has experience with electrotherapy.

 

Are there any risks of side effects when using a TENS machine?

While TENS is generally safe with normal use, understanding potential side effects is crucial. Typically, common side effects are mild and can be avoided with careful usage. It is important to stop treatment at the first sign of adverse symptoms. Although more severe symptoms are less common, they also require immediate attention and discontinuation at the earliest sign [7].

Common side effects [7]:

  • Skin irritation.
  • Unusual sensations around the treatment area.
  • Sensations that may mimic or worsen neuropathy pain.

If these occur, stop treatment immediately and consult a healthcare professional, such as a physiotherapist.

More severe side effects may result from improper use, high-risk users, or application in unsafe areas. Potential severe side effects include [7]:

  • Increased pain.
  •  
  • Interference with implanted medical devices.
  •  
  • Blood clots.
  • Skin damage.
  •  

If these side effects occur, seek out immediate medical support as necessary, including first aid or seeking prompt support from your GP.

 

References

  1. Wipperman, J., & Goerl, K. (2016). Carpal tunnel syndrome: diagnosis and management. American family physician, 94(12), 993-999.
  2. Hearn, S. L., Jorgensen, S. P., Gabet, J. M., & Carter, G. T. (2024). Occupational nerve injuries. Muscle & Nerve.
  3. Chu, X. L., Song, X. Z., Li, Q., Li, Y. R., He, F., Gu, X. S., & Ming, D. (2022). Basic mechanisms of peripheral nerve injury and treatment via electrical stimulation. Neural regeneration research, 17(10), 2185-2193.
  4. Gibson, W., Wand, B. M., & O'Connell, N. E. (2017). Transcutaneous electrical nerve stimulation (TENS) for neuropathic pain in adults. Cochrane Database of Systematic Reviews, (9).
  5. Watson, T. (n.d.). Transcutaneous electrical nerve stimulation (TENS). Retrieved from https://web.archive.org/web/20170809062344id_/https://www.wwmsi.com/documents/W pdf
  1. Gibson, W., Wand, B. M., & O'Connell, N. E. (2017). Transcutaneous electrical nerve stimulation (TENS) for neuropathic pain in adults. Cochrane Database of Systematic Reviews, (9).
  2. University of Iowa Hospitals and Clinics. (2018). Contraindications and precautions for physical therapy modalities. Retrieved from https://www.healthcare.uiowa.edu/marcom/uihc/pain_medicine/contraindication_precauti pdf