What is carpal Tunnel syndrome?

Carpal Tunnel Syndrome: Causes, Symptoms, Diagnosis, and Treatment

carpal tunnel syndrome


Introduction

Carpal Tunnel Syndrome (CTS) is one of the most common entrapment neuropathies affecting the hand and wrist. It occurs when the median nerve, which passes through the carpal tunnel in the wrist, becomes compressed. This condition leads to pain, numbness, tingling, and weakness in the hand, significantly impacting daily activities and occupational performance. CTS is particularly common among individuals who perform repetitive wrist and hand movements such as typing, writing, sewing, or using vibrating tools.

Anatomy of the Carpal Tunnel

The carpal tunnel is a narrow passageway located at the base of the palm, bounded by:

  • Carpal bones (forming the tunnel’s floor and sides)

  • Transverse carpal ligament (flexor retinaculum) (forming the roof)

Within this tunnel run:

  • The median nerve

  • Nine flexor tendons (four flexor digitorum profundus, four flexor digitorum superficialis, and one flexor pollicis longus)

Because the tunnel is rigid and non-expandable, any swelling or thickening of tissues within it can lead to compression of the median nerve.

Causes and Risk Factors

Several factors contribute to the development of Carpal Tunnel Syndrome, including:

  • Repetitive hand and wrist activities (e.g., typing, sewing, assembly line work)

  • Prolonged wrist flexion or extension

  • Medical conditions such as diabetes, hypothyroidism, rheumatoid arthritis, and obesity

  • Hormonal changes during pregnancy or menopause

  • Trauma or injury to the wrist causing swelling or deformity

  • Genetics (some individuals have naturally smaller carpal tunnels)

Signs and Symptoms

Carpal Tunnel Syndrome typically develops gradually, with symptoms worsening over time. Common symptoms include:

  • Numbness and tingling in the thumb, index, middle, and radial half of the ring finger

  • Pain or burning sensation that may radiate to the forearm

  • Night pain, often waking patients from sleep

  • Weakness and reduced grip strength

  • Difficulty with fine motor tasks (buttoning clothes, holding objects)

  • In severe cases, muscle wasting of the thenar eminence

Clinical Diagnosis

Diagnosis of CTS is based on history, symptoms, and clinical tests. Common assessment methods include:

  1. Phalen’s Test – Wrist flexion for 60 seconds reproduces symptoms.

  2. Tinel’s Sign – Tapping over the median nerve at the wrist causes tingling in the fingers.

  3. Durkan’s Test (Carpal Compression Test) – Direct pressure over the carpal tunnel elicits symptoms.

  4. Nerve Conduction Studies (NCS) and Electromyography (EMG) – Confirm median nerve compression and rule out other neuropathies.

Treatment and Management

Conservative Management

  • Activity modification (avoiding repetitive strain, ergonomic adjustments)

  • Wrist splinting (especially at night, to keep the wrist in neutral)

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation

  • Corticosteroid injections into the carpal tunnel for short-term relief

  • Physiotherapy including nerve gliding exercises, stretching, and strengthening

Surgical Management

If conservative measures fail or symptoms are severe, surgery may be considered. The goal is to release pressure on the median nerve by cutting the transverse carpal ligament. Surgical approaches include:

  • Open Carpal Tunnel Release

  • Endoscopic Carpal Tunnel Release

Both procedures generally have good outcomes, though recovery may vary depending on the severity and duration of compression.

Physiotherapy Role

Physiotherapists play a vital role in managing CTS by:

  • Educating patients on ergonomics and activity modification

  • Prescribing nerve and tendon gliding exercises

  • Using manual therapy techniques to reduce stiffness

  • Advising on splint use and functional adaptations

Complications

If left untreated, CTS can lead to:

  • Permanent median nerve damage

  • Thenar muscle atrophy

  • Loss of fine motor skills

  • Chronic pain and disability

Prevention Tips

  • Maintain neutral wrist positions during work and rest

  • Take frequent breaks from repetitive hand movements

  • Use ergonomic keyboards and supportive mouse pads

  • Perform regular stretching and strengthening exercises for wrists and hands

Frequently Asked Questions (FAQs)

1. Can Carpal Tunnel Syndrome heal on its own?
Mild cases may improve with rest, activity modification, and wrist splints, but severe or chronic cases usually require medical intervention.

2. Is surgery always necessary for CTS?
No, surgery is considered only when conservative management fails or when there is significant nerve damage.

3. Can physiotherapy cure CTS?
Physiotherapy can significantly reduce symptoms, improve function, and delay or avoid the need for surgery in many patients.

4. Who is most at risk of developing CTS?
People with repetitive hand movements, office workers, assembly line workers, and individuals with certain medical conditions (e.g., diabetes, arthritis).

References

  1. American Academy of Orthopaedic Surgeons (AAOS). Carpal Tunnel Syndrome.

  2. National Institute of Neurological Disorders and Stroke (NINDS). Carpal Tunnel Fact Sheet.

  3. Atroshi I, Gummesson C, et al. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999.

  4. Aroori S, Spence RA. Carpal tunnel syndrome. Ulster Med J. 2008.


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