Carpal Tunnel Syndrome is one of the most common nerve-related conditions which affects the wrist and hand. It most commonly affects adults who complete repetitive hand and wrist movements during their daily activities or work. If left untreated, carpal tunnel syndrome can significantly reduce your quality of life, making every day tasks difficult. Seeking early assessment and treatment can help relieve symptoms and prevent the condition from worsening.
What is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome (CTS) is the compression of the median nerve as it passes through a narrow tunnel in the wrist which is referred to as the carpal tunnel [1]. The median nerve originates in the shoulder and runs down the inside of the arm, through the elbow and the forearm before entering the hand via the carpal tunnel [2]. The carpal tunnel is made up of the wrist bones and a strong ligament called the transverse carpal ligament. As well as the median nerve, the carpal tunnel is also responsible for the passing of several tendons which are responsible for finger movement.
The median nerve provides sensation to the thumb, index finger, middle finger and half of the ring finger. It facilitates many movements including rotation of the forearm, wrist flexion, bending of the thumb and first three fingers and gripping [3]. And so when the carpal tunnel becomes compressed, dysfunction and symptoms heavily involves the wrist and hand function.
What causes Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome develops when there is an increase in pressure on the carpal tunnel which in hand compresses the medial nerve. If the nerve becomes compressed, communication signals cannot be passed through effectively.
CTS is a multifactorial condition and so there are usually several factors which contribute to the increased pressure in the carpal tunnel. These include: [4,5]
- Repetitive hand and wrist movements – especially prolonged gripping, typing or use of vibrating tools
- Sustained bending of the wrists
- Pregnancy
- Diabetes, rheumatoid arthritis or hypothyroidism
- Obesity
- Genetic factors
Signs and symptoms of Carpal Tunnel Syndrome
Symptoms of CTS develop gradually and can be intermittent at the start. Without the appropriate management, symptoms can worsen and become more frequent affecting activities of daily living, work and hand function.
CTS does not follow a textbook presentation, but common signs and symptoms include [6]:
- Numbness or pins and needles in the thumb, index finger, middle finger and thumb half of the ring finger.
- Reduced grip strength or hand weakness
- Difficulty opening jars, holding objects or completing fine motor tasks such as doing a button up
- Increase in symptoms following prolonged use of hands/wrist
- The need to frequently shake hands to relieve symptoms
How does Physiotherapy help?
Physiotherapy is often the first line of treatment for patients suffering from mild to moderate CTS symptoms to help improve hand function. A thorough assessment will be completed to highlight any risk factors and determine the severity of the condition. There are many different approaches to CTS management but often includes:
- Education and Activity Modification
One of the most important parts to physiotherapy is understanding what activities are worsening symptoms and how much load an area is taking. This allows us to modify these activities such as working and sporting loads to reduce stress placed upon the wrist and median nerve.
Ergonomic advice is provided to patients whose symptoms are heavily linked with work or repetitive activities such as construction and desk based workers. Examples include having your wrists supported in neutral positions when using a keyboard or taking frequent breaks if using power tools. These recommendations optimise the work set up to reduce strain on the wrist.
- Wrist Splinting
Research has shown that splinting can be effective in the initial management phase of CTS. Splints are normally worn at night time to help keep the wrist in a natural position (around 0-10 degrees). This helps to reduce the pressure which is placed upon the carpal tunnel [7].
- Manual Therapy
Hands-on treatment uses a combination of techniques to address any stiffness and muscular tension to the musculature surrounding the wrist. This has been shown to provide symptom relief and improve physical function [8].
- Nerve Gliding Exercises
Specific nerve exercises, most commonly known as nerve glides or flossing, can be completed to improve the mobility of the median nerve which helps to reduce irritation and improve the nerves function [9].
- Strengthening and Rehabilitation
Once symptoms start to settle, targeted strengthening exercises can then be carried out to help improve the hand, wrist and forearm strength which provides a long term management to help reduce recurring symptoms.
Does everyone with Carpal Tunnel Syndrome require surgery?
No. Many people with CTS improve with non surgical management through physiotherapy, splinting and activity modifications when treatment is started early. However in more severe cases, surgery may be required when significant weakness or muscle wasting is present, non-surgical treatment has not been successful or nerve conduction studies have highlighted a substantial nerve compression.
The surgical intervention is known as the carpal tunnel release and involves cutting the ligament which forms the top of the carpal tunnel to reduce pressure placed on the median nerve. After surgery, physiotherapy remains to play an important role in rehabilitation to optimise recovery and restore hand function.
Tips to help prevent Carpal Tunnel Syndrome?
Not all cases of carpal tunnel syndrome can be prevented however there are some strategies which can minimise the risk of developing CTS. Here are some:
- Take regular breaks when completing repetitive activities.
- Avoid prolonged wrist bending and gripping.
- When working at a desk, maintain good posture. This means having the screen level with your arms and your wrists supported in neutral, not hanging off by utilising supportive keyboards [10].
- Complete wrist stretching & mobility exercises frequently.
- Complete strengthening exercises [11].
- Manage underlying medical conditions which have correlation to CTS such as diabetes.
These small adjustments over time can significantly reduce the strain placed upon the wrists and hands, therefore potentially reducing the risk of developing CTS.
Key takeaways
CTS is a common condition which has a massive impact on our quality of life due to the compression of the median nerve. Symptoms such as numbness, pins and needles and weakness in the hand can make simple, every day tasks all of a sudden very difficult. Fortunately, physiotherapy plays an important role in symptom management to help patients experiencing these symptoms and working towards a long-term prevention plan.
If you are experiencing symptoms of CTS, seeking early assessment and treatment can help prevent progression and improve your chance of a full recovery.
Our Barnet, Cockfosters & Enfield Physio’s have tons of experience and are specialists in treating Carpal Tunnel Syndrome. Have confidence that our specialist Physiotherapists will closely assess, diagnose & treat you in the correct & evidence-based way for all injuries. You can book an appointment here.
Blog By: Jess Simmons (Specialist Musculoskeletal Physiotherapist at Crouch Physio).
References
- Omole, A.E. et al. (2023) ‘An integrated review of Carpal Tunnel Syndrome: New insights to an old problem’, Cureus [Preprint]. doi:10.7759/cureus.40145.
- Soubeyrand, M. et al. (2020) ‘Anatomy of the median nerve and its clinical applications’, Hand Surgery and Rehabilitation, 39(1), pp. 2–18. doi:10.1016/j.hansur.2019.10.197.
- Bertelli, J.A. et al. (2016) ‘Reappraisal of clinical deficits following high median nerve injuries’, The Journal of Hand Surgery, 41(1), pp. 13–19. doi:10.1016/j.jhsa.2015.10.022.
- Genova, A. et al. (2020) ‘Carpal tunnel syndrome: A review of literature’, Cureus [Preprint]. doi:10.7759/cureus.7333.
- Osiak, K. et al. (2022) ‘Carpal tunnel syndrome: State-of-the-art review’, Folia Morphologica, 81(4), pp. 851–862. doi:10.5603/fm.a2021.0121.
- Nazari, G. et al. (2017) ‘The impact of sensory, motor and pain impairments on patient- reported and performance based function in carpal tunnel syndrome’, The Open Orthopaedics Journal, 11(1), pp. 1258–1267. doi:10.2174/1874325001711011258.
- Georgiew, F. et al. (2022) ‘The use of orthoses in the treatment of carpal tunnel syndrome. A review of the literature from the last 10 years’, Rheumatology, 60(6), pp. 408–412. doi:10.5114/reum.2022.123681.
- Jiménez-del-Barrio, S. et al. (2021) ‘The effectiveness of manual therapy on pain, physical function, and nerve conduction studies in carpal tunnel syndrome patients: A systematic review and meta-analysis’, International Orthopaedics, 46(2), pp. 301–312. doi:10.1007/s00264-021-05272-2.
- Ballestero-Pérez, R. et al. (2017) ‘Effectiveness of nerve gliding exercises on carpal tunnel syndrome: A systematic review’, Journal of Manipulative and Physiological Therapeutics, 40(1), pp. 50–59. doi:10.1016/j.jmpt.2016.10.004.
- Trillos-Chacón, M.-C. et al. (2021) ‘Strategies for the Prevention of Carpal Tunnel Syndrome in the workplace: A systematic review’, Applied Ergonomics, 93, p. 103353. doi:10.1016/j.apergo.2020.103353.
- Łach, P. and Cygańska, A.K. (2024) ‘Effectiveness of prevention exercises protocol among office workers with symptoms of carpal tunnel syndrome’, International Journal of Occupational Medicine and Environmental Health, 37(1), pp. 45–57. doi:10.13075/ijomeh.1896.02164.
