Carpal Tunnel Syndrome
Carpal tunnel syndrome occurs when the median nerve is compressed as it passes through the wrist. Our physiotherapists provide comprehensive treatment to relieve symptoms and address contributing factors for lasting relief.
Understanding Carpal Tunnel
Anatomy
- Carpal Tunnel: Narrow passageway in wrist
- Median Nerve: Provides sensation to thumb, index, middle, and half ring finger
- Flexor Tendons: Nine tendons share the space
- Transverse Ligament: Roof of tunnel
Causes of Compression
- Repetitive hand use
- Wrist position extremes
- Pregnancy-related swelling
- Inflammatory conditions
- Trauma or injury
- Anatomical variations
Symptoms
Classic Presentation
- Numbness/tingling in median nerve distribution
- Night symptoms common
- Shaking hands provides relief
- Dropping objects
- Difficulty with fine motor tasks
Progression
- Mild: Intermittent symptoms
- Moderate: Frequent symptoms, some weakness
- Severe: Constant symptoms, muscle wasting
Assessment
Clinical Tests
- Phalen’s Test: Wrist flexion reproduction
- Tinel’s Sign: Tapping over nerve
- Carpal Compression: Direct pressure test
- Sensory Testing: Two-point discrimination
- Strength Testing: Thumb opposition
Differential Diagnosis
- Cervical radiculopathy
- Thoracic outlet syndrome
- Pronator syndrome
- Peripheral neuropathy
- Arthritis
Conservative Treatment
Manual Therapy
- Carpal bone mobilization
- Soft tissue release
- Nerve mobilization
- Tendon gliding
- Fascial techniques
Nerve Gliding Exercises
- Median nerve mobilization
- Tendon gliding exercises
- Progressive stretching
- Neural tension techniques
- Daily program essential
Splinting
- Night splinting most effective
- Neutral wrist position
- 6-8 weeks typical use
- Daytime use if needed
- Proper fit crucial
Activity Modification
- Ergonomic assessment
- Tool modifications
- Technique changes
- Regular breaks
- Position awareness
Exercise Program
Tendon Gliding
- Straight fingers
- Hook fist
- Full fist
- Tabletop position
- Straight fist
Nerve Gliding
- Wrist neutral, fingers extended
- Wrist extension
- Thumb stretch
- Wrist flexion
- Cervical side bend
Strengthening
- Grip strengthening (when appropriate)
- Thumb opposition
- Finger exercises
- Forearm strengthening
- Postural exercises
Workplace Ergonomics
Computer Users
- Keyboard height optimization
- Mouse positioning
- Wrist support use
- Regular breaks
- Stretching routine
Manual Workers
- Tool handle size
- Vibration reduction
- Force minimization
- Task rotation
- Protective equipment
Contributing Factors
Systemic Conditions
- Diabetes
- Thyroid disorders
- Rheumatoid arthritis
- Pregnancy
- Obesity
Biomechanical Factors
- Poor posture
- Neck/shoulder issues
- Forearm tightness
- Previous injury
- Joint hypermobility
Treatment Phases
Phase 1: Symptom Relief
- Splinting
- Activity modification
- Gentle exercises
- Manual therapy
- Education
Phase 2: Mobility
- Nerve gliding progression
- Range of motion
- Soft tissue work
- Gradual loading
- Ergonomic implementation
Phase 3: Strengthening
- Progressive resistance
- Functional exercises
- Work simulation
- Endurance training
- Prevention strategies
When to Consider Surgery
Indications
- Failed conservative treatment (3-6 months)
- Severe symptoms
- Muscle wasting
- Constant numbness
- Significant functional limitation
Post-Surgical Rehabilitation
- Early mobilization
- Scar management
- Nerve gliding
- Progressive strengthening
- Return to work program
Prevention Strategies
Primary Prevention
- Ergonomic setup
- Regular stretching
- Proper technique
- Rest breaks
- General fitness
Secondary Prevention
- Early treatment
- Risk factor modification
- Ongoing exercises
- Regular monitoring
- Lifestyle changes
Special Populations
Pregnancy-Related
- Usually resolves postpartum
- Conservative management
- Night splinting helpful
- Gentle exercises
- Position modifications
Diabetic Patients
- Higher risk
- Slower recovery
- Blood sugar control important
- Comprehensive management
- Regular monitoring
Expected Outcomes
Conservative Treatment
- 60-70% improve significantly
- Early treatment better outcomes
- Night symptoms improve first
- Full recovery possible
- Surgery avoided in many
Prognostic Factors
- Duration of symptoms
- Severity at presentation
- Associated conditions
- Treatment compliance
- Occupational factors
Red Flags
Seek medical attention for:
- Rapid progression
- Severe muscle wasting
- Bilateral symptoms
- Associated systemic symptoms
- No improvement with treatment
