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Guide to Carpal Tunnel Syndrome

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is the most common nerve entrapment condition that occurs in the hands. It affects females more than males with the peak incident of CTS in adults being 45-60 years old. It is common for this condition to occur in manual workers, new mums and those who spend considerable time behind a desk.

This condition causes pain, pins and needles and numbness in the wrist and hand. Symptoms are often worse in the night, first thing in the morning or after prolonged computer use.

The symptoms of carpal tunnel can be characterised as the following:

  • Ache or pain in your fingers, hand or arm
  • Numbness
  • Feeling of pins and needles
  • Feeling of weak thumb or difficulty gripping
  • Usually affecting the first 3 digits (thumb, index and ring finger)

What causes Carpal Tunnel Syndrome?

Carpal tunnel syndrome is caused as a result of mechanical compression of the median nerve within the carpal tunnel. It is this compression that causes local ischemia that results in sensory and motor deficits in the distribution of the median nerve.

Excessive use of the wrist and the flexor tendons in the carpal tunnel can cause inflammation and swelling of the median nerve. Other possible causes can include diabetes, injury to the wrist, pregnancy, medications and overuse of the wrists.

How is Carpal Tunnel Syndrome diagnosed?

The diagnosis of carpal tunnel syndrome will be based on the presenting symptoms and the completion of a complete physical examination which will include orthopaedic and neurological assessment. There are a few special tests that if positive may indicate the presence of a carpal tunnel.

If required the practitioner may refer you to get an ultrasound scan or MRI which will give great insight as to what is causing the compression and if there is a presence of swelling.

How is Carpal Tunnel Syndrome treated?

If carpal tunnel is left untreated, it may result in permanent neurological damage. Conservative treatment is considered before any surgical alternatives. In the early stages, there are things that you can do yourself to make the problem diminish such as:

  • Taking more frequent breaks
  • Avoiding activities that make the symptoms worse
  • Applying cold packs to reduce swelling

Some of the treatments that can be provided through manual therapy include:

  • Wrist splinting, which will hold your wrist in a neutral position while you’re sleeping to relieve some of the symptoms you get at night
  • Release of tight muscles around the wrist and forearm muscles
  • Neurodynamic mobilisation of the median nerve that is compressed through flossing techniques
  • Ergonomic and postural advice on reducing further complications of CTS

Other treatment modalities include ultrasound-guided injection. They are very effective for the treatment of carpal tunnel syndrome. It is injected into the nerve in the carpal tunnel using ultrasound guidance which gives precision, maximising the effectiveness and reduces any chances of complications and side effects.


Papanicolaou GD, McCabe SJ, Firrell J. The prevalence and characteristics of nerve compression symptoms in the general population. The Journal of hand surgery. 2001 May 1;26(3):460-6.
Rayegani SM, Raeissadat SA, Ahmadi-Dastgerdi M, Bavaghar N, Rahimi-Dehgolan S. Comparing The Efficacy Of Local Triamcinolone Injection In Carpal Tunnel Syndrome Using Three Different Approaches with or without Ultrasound Guidance. Journal of pain research. 2019;12:2951.
Wolny T, Linek P. Is manual therapy based on neurodynamic techniques effective in the treatment of carpal tunnel syndrome? A randomized controlled trial. Clinical rehabilitation. 2019 Mar;33(3):408-17.

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