Carpal tunnel syndrome

CARPAL TUNNEL SYNDROME

Carpal tunnel syndrome (CTS) is one of the most common upper-limb conditions and is caused by compression of the median nerve as it passes through the narrow carpal tunnel at the wrist. It typically leads to numbness, tingling, pain or burning in the thumb, index, middle and half of the ring finger, and in more advanced cases may cause weakness, clumsiness and dropping objects. Symptoms often worsen at night or when holding objects such as a phone, steering wheel or book, and many people wake up needing to shake or move their hand to relieve discomfort.

CTS is more common in women and in middle age and is associated with repetitive wrist movements, use of vibrating tools, obesity, pregnancy, fluid retention, diabetes, thyroid disorders, inflammatory arthritis and previous wrist injury. In mild to moderate stages, symptoms can often improve with conservative management, whereas more severe or progressive cases may require surgical decompression of the median nerve, based on medical assessment and shared decision-making.

What happens to the median nerve

The carpal tunnel is a narrow passageway on the palmar side of the wrist, formed by the carpal bones and the transverse carpal ligament. The median nerve and the flexor tendons of the fingers run through this confined space. When pressure within the tunnel rises – due to thickening of surrounding tissues, fluid retention, anatomical factors or repetitive loading – the median nerve becomes compressed, leading to the typical CTS symptoms. People frequently report numbness, tingling or burning in the thumb, index, middle and part of the ring finger, a sensation of swelling in the hand, pain that may radiate up the forearm and difficulty with fine tasks such as fastening buttons or handling small objects.

Diagnosis is based on the pattern of symptoms, physical examination (including provocation tests that reproduce symptoms with wrist flexion, extension or direct pressure over the tunnel) and, when indicated, electrodiagnostic testing to confirm CTS and gauge its severity. Mild, classic cases can often be monitored and managed conservatively, whereas electrodiagnostics are particularly useful when symptoms are moderate to severe, atypical or progressive, to help guide decisions about potential surgical release.

Splints, ergonomics and exercise in carpal tunnel syndrome

Conservative management of carpal tunnel syndrome aims to reduce pressure on the median nerve and support comfortable, effective hand use in daily life. For mild to moderate cases, night splinting in a neutral wrist position is commonly recommended to prevent extreme flexion or extension during sleep and to ease nocturnal symptoms. At the same time, workplace and activity ergonomics are reviewed: keyboard and mouse position, desk height, tool design and task pacing, with the goal of reducing repetitive and sustained strain on the wrist.

Physiotherapy programmes may incorporate gentle joint and soft-tissue techniques, nerve and tendon gliding exercises and graded strengthening and coordination work for the upper limb, all within a symptom-tolerable range. Education is central: patients are supported to identify aggravating patterns, plan rest breaks and adopt small but meaningful changes to how they use their hands (for example, alternating hands, avoiding prolonged end-range positions, scheduling micro-pauses). When symptoms remain severe or progressive despite conservative care, the treating physician may consider options such as corticosteroid injections or surgical release, and physiotherapy can then assist in pre- and postoperative rehabilitation, helping restore strength, mobility and confidence in hand use.

Frequently Asked Questions

In simple terms, what is carpal tunnel syndrome?
It is pressure on the median nerve inside a narrow passage in the wrist, causing numbness, tingling and pain in the hand.
Which fingers are usually affected?
Typically the thumb, index, middle and half of the ring finger the little finger is usually spared in carpal tunnel syndrome.
Why do symptoms often get worse at night?
At night the wrist often bends into positions that raise pressure in the tunnel, so numbness and pain become more noticeable.
Who is more at risk of developing CTS?
People who are overweight, pregnant, have arthritis, diabetes or thyroid problems, use vibrating tools or do repetitive wrist tasks and those with a family history.
Can carpal tunnel syndrome go away on its own?
Mild cases, particularly when linked to pregnancy or reversible factors, may improve over time with appropriate self-care and load reduction.
How does a night splint help?
It holds the wrist in a neutral position, limiting end-range postures that raise nerve pressure and helping reduce night-time symptoms.
What workplace changes can ease my symptoms?
Regular micro-breaks, ergonomic setup, neutral wrist position when typing or using a mouse and alternating hands where possible can all reduce strain.
Are there specific exercises for CTS?
Yes, nerve and tendon gliding exercises and gentle mobility work are commonly used, tailored to your symptoms by your physiotherapist.
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