Carpal tunnel syndrome affects up to 10% of adults, causing pain, numbness, and tingling in the hand and wrist. While surgery is sometimes necessary, many cases respond well to conservative treatment including physiotherapy, splinting, and ergonomic modifications.
Understanding Carpal Tunnel Syndrome
What is Carpal Tunnel Syndrome?
The carpal tunnel is a narrow passageway in the wrist formed by bones and ligament. Through this tunnel passes the median nerve and nine tendons. Carpal tunnel syndrome (CTS) occurs when the median nerve becomes compressed, typically from swelling or repetitive movements.
The Median Nerve Controls:
- Sensation in thumb, index, middle, and half of ring finger
- Thumb opposition (ability to touch thumb to fingers)
- Fine motor control of hand
Symptoms
Early Symptoms:
- Tingling or numbness in thumb, index, middle, and half of ring finger
- Symptoms worse at night
- Need to shake hands out for relief
- Intermittent discomfort
Progressive Symptoms:
- Constant numbness
- Weakness in grip strength
- Difficulty with fine motor tasks (buttoning, typing)
- Dropping objects
- Thumb muscle wasting (advanced cases)
Red Flag: Little finger is NOT typically affected. If it is, the problem likely isn't carpal tunnel syndrome.
Causes and Risk Factors
Occupational:
- Repetitive hand and wrist movements
- Prolonged computer use
- Assembly line work
- Use of vibrating tools
- Awkward wrist positions
Medical Conditions:
- Diabetes
- Hypothyroidism
- Rheumatoid arthritis
- Pregnancy
- Obesity
- Kidney failure
Anatomical Factors:
- Smaller carpal tunnel (genetic)
- Previous wrist fracture
- Wrist arthritis
Diagnosis
Clinical Tests
Phalen's Test:
- Press backs of hands together
- Hold 60 seconds
- Positive if symptoms reproduced
Tinel's Sign:
- Tap over median nerve at wrist
- Positive if tingles shoot into fingers
Carpal Compression Test:
- Direct pressure on carpal tunnel
- Positive if symptoms reproduced in 30 seconds
Diagnostic Studies
Nerve Conduction Studies (NCS):
- Measures nerve signal speed
- Gold standard for diagnosis
- Determines severity
- Guides treatment decisions
Electromyography (EMG):
- Tests muscle electrical activity
- Assesses muscle damage
- Rules out other conditions
Ultrasound:
- Visualizes median nerve
- Shows nerve swelling
- Non-invasive option
- Increasing popularity
Conservative Treatment Approaches
1. Splinting
Night Splints (Most Important):
- Maintains neutral wrist position
- Prevents flexion during sleep
- Wear every night for 6-12 weeks
- 80% experience improvement
Daytime Splinting:
- During aggravating activities
- Maintains neutral wrist
- Allows some movement
- Use as needed
Key Points:
- Wrist in neutral (not bent up or down)
- Thumb free to move
- Comfortable enough to wear consistently
- Custom or over-the-counter options
2. Activity Modification
Work Adjustments:
- Frequent breaks (every 30 minutes)
- Vary tasks
- Reduce force and repetition
- Use larger muscles for tasks
- Voice-to-text software
Ergonomic Changes:
- Neutral wrist position
- Keyboard at proper height
- Wrists not resting on hard edges
- Ergonomic mouse
- Document holder at eye level
Home Modifications:
- Tools with larger handles
- Avoid prolonged gripping
- Alternate hands for tasks
- Electric tools vs. manual
3. Physiotherapy Exercises
Nerve Gliding Exercises:
Median Nerve Glide:
- Start with arm at side, fist closed
- Extend wrist back
- Open hand and spread fingers
- Extend arm out to side
- Turn palm up
- Gently tilt head away
Perform slowly, 5-10 repetitions, 3 times daily
Tendon Gliding Exercises:
- Straight position (fingers extended)
- Hook position (knuckles bent, fingers straight)
- Fist position
- Straight fist (fingers bent, thumb out)
- Full fist (thumb wrapped)
Hold each 3 seconds, 10 repetitions, 3-5 times daily
Strengthening Exercises:
Thumb Opposition:
- Touch thumb to each fingertip
- 10 repetitions, 3 times daily
Grip Strengthening:
- Squeeze soft ball or putty
- Hold 5 seconds
- 10-15 repetitions
Wrist Extension:
- Light resistance band
- Extend wrist upward
- 10-15 repetitions
4. Manual Therapy
Techniques:
- Soft tissue massage (forearm)
- Carpal bone mobilization
- Nerve mobilization
- Myofascial release
Benefits:
- Reduces muscle tension
- Improves tissue mobility
- Decreases swelling
- Pain relief
5. Modalities
Ultrasound Therapy:
- Reduces inflammation
- Promotes healing
- 6-8 sessions typically
- Moderate evidence
Laser Therapy:
- Low-level laser
- Reduces pain and inflammation
- Non-invasive
- Growing evidence
Iontophoresis:
- Medication delivered through skin
- Anti-inflammatory effect
- Non-invasive alternative to injection
6. Corticosteroid Injection
Considerations:
- Provides temporary relief (weeks to months)
- Allows participation in therapy
- May avoid surgery in some cases
- 1-2 injections maximum
Success Rates:
- 80% initial improvement
- 50% still improved at 1 year
- Best for mild to moderate cases
Advanced Treatment
Surgical Release
When Considered:
- Failed conservative treatment (3-6 months)
- Severe symptoms
- Muscle wasting
- Constant numbness
- Nerve damage on testing
Procedure:
- Open or endoscopic approach
- Cuts transverse carpal ligament
- Releases pressure on nerve
- Outpatient surgery
Recovery:
- Immediate: Dressing and elevation
- Week 1-2: Gentle finger movement
- Week 2-4: Light activities
- Month 2-3: Progressive strengthening
- Full recovery: 2-6 months
Success Rates:
- 80-90% excellent outcomes
- Symptom relief often immediate
- Numbness may take longer to resolve
- Early treatment = better results
Prevention Strategies
Workplace Prevention
Ergonomic Setup:
- Keyboard at elbow height
- Mouse close to keyboard
- Wrists in neutral position
- Forearms supported
- Take regular breaks
Work Techniques:
- Light touch typing
- Avoid resting wrists on hard surfaces
- Use keyboard shortcuts
- Voice recognition software
- Alternate tasks
General Prevention
Risk Reduction:
- Maintain healthy weight
- Exercise regularly
- Don't smoke
- Manage underlying conditions
- Stay hydrated
Hand Care:
- Keep hands warm
- Stretch regularly
- Avoid prolonged gripping
- Use proper tools
- Listen to early warnings
Treatment Timeline
Mild to Moderate CTS
Week 1-2:
- Begin night splinting
- Start exercises
- Modify activities
- Expect: Slight improvement, especially nighttime symptoms
Week 3-8:
- Continue splinting nightly
- Progress exercises
- Ergonomic modifications in place
- Expect: 30-50% improvement
Week 9-12:
- May reduce splinting frequency
- Maintain exercises
- Ongoing activity modification
- Expect: 60-80% improvement
Month 4-6:
- Wean from splinting if improved
- Maintenance exercises
- Continue preventive strategies
- Expect: Significant improvement or resolution
Success Factors
Good Prognosis:
- Early treatment
- Mild to moderate severity
- No muscle wasting
- Intermittent symptoms
- Good compliance
Poorer Prognosis:
- Constant symptoms
- Severe compression on testing
- Muscle atrophy
- Long symptom duration
- Poor compliance
Special Populations
Pregnancy-Related CTS
Characteristics:
- Common in 3rd trimester
- Due to fluid retention
- Often bilateral
- Usually resolves postpartum
Treatment:
- Night splinting essential
- Activity modification
- Avoid injections if possible
- Most resolve within 3 months postpartum
Diabetes and CTS
Considerations:
- Higher risk of CTS
- May have multiple nerve issues
- Slower healing
- Good blood sugar control important
- Regular monitoring crucial
When to Seek Immediate Care
Warning Signs:
- Sudden severe weakness
- Hand becoming claw-like
- Severe pain unrelieved by medication
- Signs of infection after injection/surgery
- Rapid progression of symptoms
Myths and Facts
Myth: Carpal tunnel only affects computer users Fact: Many causes exist; genetics play a role
Myth: Surgery is the only effective treatment Fact: 60-80% improve with conservative treatment
Myth: Wrist exercises prevent carpal tunnel Fact: Proper ergonomics and breaks more important
Myth: It's just part of getting older Fact: Treatable condition at any age
Living with Carpal Tunnel
Daily Management
Morning Routine:
- Stretch before starting work
- Apply heat if stiff
- Wear splint at night
During Day:
- Regular breaks
- Stretching exercises
- Maintain neutral wrist
- Ice if inflamed
Evening:
- Review day's activities
- Identify aggravators
- Apply splint before bed
- Elevation if swollen
Long-Term Outlook
With Treatment:
- Most improve significantly
- Can remain active
- May need ongoing modifications
- Occasional flare-ups normal
Prevention of Recurrence:
- Maintain good ergonomics
- Continue exercises
- Address early symptoms
- Regular follow-up
Take Action Early
Carpal tunnel syndrome is highly treatable, especially when caught early. Don't ignore tingling or numbness—these are warning signs that intervention is needed.
Experiencing carpal tunnel symptoms? Our hand therapy specialists at M.O. Therapy provide comprehensive assessment and treatment for carpal tunnel syndrome. We'll determine the severity of your condition and create a personalized treatment plan to get you back to pain-free function.
Book your assessment today. The sooner you address carpal tunnel syndrome, the better your outcome. Most patients see significant improvement with our conservative treatment approach, avoiding the need for surgery.