In today’s digital era, countless individuals spend hours typing on keyboards, scrolling through smartphones, or doing repetitive hand movements at work. One common health issue arising from such habits is Carpal Tunnel Syndrome (CTS). This condition affects the median nerve as it travels through the wrist, often leading to pain, tingling, numbness, and weakness in the hand.
Carpal Tunnel Syndrome can significantly disrupt daily activities—from writing and gripping objects to sleeping comfortably. Early detection and proper management, especially through physiotherapy, can help avoid the need for surgical intervention and restore normal function.
In this in-depth article, we will explore the anatomy, symptoms, risk factors, diagnosis, treatment options, and the essential role of physiotherapy in managing Carpal Tunnel Syndrome.
What is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome is a compression neuropathy of the median nerve as it passes through the carpal tunnel in the wrist. The carpal tunnel is a narrow, rigid passageway made up of bones and ligaments at the base of the hand.
When this tunnel becomes narrowed due to inflammation, swelling, or structural changes, it puts pressure on the median nerve, resulting in characteristic symptoms.
Anatomy of the Carpal Tunnel
- The carpal tunnel is located on the palm side of your wrist.
- It contains:
- Median nerve
- Nine flexor tendons (from the forearm to the fingers)
- The transverse carpal ligament forms the roof of the tunnel.
- Compression of the median nerve inside this tunnel leads to Carpal Tunnel Syndrome.
Common Symptoms of Carpal Tunnel Syndrome
The symptoms often begin gradually and may come and go initially, worsening over time. Common signs include:
- Numbness or tingling in the thumb, index, middle, and half of the ring finger
- Burning sensation in the palm or fingers
- Pain radiating up the forearm
- Weakness in hand grip
- Difficulty in holding objects, writing, or using a phone
- Symptoms worsen at night or upon waking up
Causes and Risk Factors
CTS can result from a combination of anatomical, medical, and occupational factors.
Medical Causes
- Diabetes mellitus
- Thyroid disorders (hypothyroidism)
- Pregnancy (due to fluid retention)
- Rheumatoid arthritis
- Obesity
- Kidney failure or dialysis
Occupational Risks
- Repetitive hand use (typing, sewing, carpentry, assembly line work)
- Poor wrist posture while using a keyboard or mouse
- Prolonged use of vibrating tools
Anatomical Factors
- Fractures or dislocations of the wrist
- Congenitally smaller carpal tunnel
How is Carpal Tunnel Syndrome Diagnosed?
Diagnosis is based on clinical symptoms, physical tests, and diagnostic studies.
Clinical Evaluation
- History of symptoms
- Location of numbness or weakness
Special Tests
- Phalen’s Test: Wrist is flexed for 30–60 seconds. Tingling or numbness indicates CTS.
- Tinel’s Sign: Tapping over the carpal tunnel causes tingling in the fingers.
- Durkan’s Compression Test: Direct pressure over the median nerve elicits symptoms.
Diagnostic Tests
- Nerve conduction studies (NCS)
- Electromyography (EMG)
- Ultrasound or MRI (in rare cases)
Treatment Options for Carpal Tunnel Syndrome
Treatment depends on the severity of symptoms and ranges from conservative care to surgery.
Non-Surgical Management
- Wrist splints (especially worn at night)
- Activity modification
- Physiotherapy
- NSAIDs for pain/inflammation
- Corticosteroid injections
Surgical Option
If conservative treatment fails or if there’s severe nerve damage, carpal tunnel release surgery may be performed to relieve pressure.
Role of Physiotherapy in CTS Management
Physiotherapy is a highly effective, non-invasive treatment approach for Carpal Tunnel Syndrome, especially in mild to moderate cases. It focuses on relieving symptoms, correcting biomechanical issues, and preventing further progression.
Physiotherapy Goals
- Decrease pain and inflammation
- Improve nerve mobility
- Increase wrist and hand strength
- Correct postural alignment
- Educate on ergonomics and self-care
- Delay or eliminate the need for surgery
Effective Physiotherapy Techniques
1. Nerve Gliding Exercises
These exercises help the median nerve glide smoothly through the carpal tunnel without being compressed.
Example: Median Nerve Glide
- Start with the wrist in neutral, fingers curled
- Slowly straighten fingers, then wrist
- Extend thumb and gently tilt head away
- Hold for 5 seconds and repeat 10 times
2. Wrist and Finger Stretching
Gentle stretches of the wrist flexors and extensors improve mobility and reduce tightness.
- Wrist Flexor Stretch: Extend arm, palm up, and gently pull fingers back
- Wrist Extensor Stretch: Palm down, gently pull back fingers
Hold each stretch for 20–30 seconds, 3–5 repetitions daily.
3. Strengthening Exercises
After pain decreases, strengthening the hand and wrist improves endurance.
- Theraputty squeezing
- Finger spring resistance
- Wrist curls with light dumbbells
4. Manual Therapy
A trained physiotherapist may apply:
- Soft tissue mobilization around the wrist and forearm
- Joint mobilization to improve carpal alignment
- Myofascial release techniques to reduce tension
5. Ultrasound Therapy
Therapeutic ultrasound reduces inflammation and promotes tissue healing.
6. TENS (Transcutaneous Electrical Nerve Stimulation)
Used for pain management, especially in acute flare-ups.
Ergonomics and Lifestyle Modification
A major part of CTS management is modifying hand use and improving work posture.
Workplace Ergonomic Tips
- Keep wrists in a neutral position while typing
- Use a keyboard with wrist support
- Take regular breaks every 30–40 minutes
- Adjust chair and screen height for correct posture
Nighttime Care
- Wear a neutral wrist splint while sleeping
- Avoid sleeping with your hand tucked under the pillow
Daily Habits
- Limit mobile phone usage if symptoms worsen
- Avoid prolonged gripping or squeezing tasks
Stages of Physiotherapy Treatment Plan
| Stage | Focus | Duration |
|---|---|---|
| Acute (0–2 weeks) | Pain control, splinting, rest | 1–2 sessions/week |
| Subacute (2–6 weeks) | Nerve glides, stretching | 2–3 sessions/week |
| Strengthening (6–12 weeks) | Resistance training | 2 sessions/week |
| Maintenance (>12 weeks) | Ergonomics, activity resumption | Home program |
When to Consider Surgery?
Surgical intervention is considered when:
- Symptoms persist for more than 6 months despite therapy
- Severe nerve conduction delay is detected
- Muscle wasting or hand function loss occurs
Post-surgical physiotherapy is also essential for full recovery.
Prevention of Carpal Tunnel Syndrome
- Practice wrist mobility and strengthening exercises regularly
- Maintain proper ergonomics at work
- Stretch hands and fingers throughout the day
- Avoid prolonged forceful gripping
- Manage chronic conditions like diabetes or thyroid problems
Final Thoughts
Carpal Tunnel Syndrome may seem like a small issue at first, but if left unmanaged, it can lead to chronic pain and permanent nerve damage. Early recognition, proper ergonomics, and a structured physiotherapy program can prevent complications and restore full function.
At The PhysioFix, we offer personalised treatment plans for CTS based on your symptoms, occupation, and lifestyle. With a combination of manual therapy, exercises, and ergonomic education, we aim to help you recover faster and avoid surgery.
