Carpal Tunnel Syndrome

Definition

Carpal Tunnel Syndrome is a compressive neuropathy of the median nerve as it passes through the carpal tunnel in the wrist.
It causes pain, tingling, numbness, and weakness in the hand, especially in the thumb, index, and middle fingers.
Anatomy

Carpal Tunnel Boundaries:

Floor & sides: Carpal bones

Roof: Flexor retinaculum (transverse carpal ligament)

Causes / Risk Factors

Repetitive wrist movements (typing, sewing, assembly line work)

Wrist fracture or arthritis

Diabetes, hypothyroidism, pregnancy (fluid retention)

Rheumatoid arthritis

Prolonged wrist flexion/extension (poor ergonomics)

Clinical Features

Pain, numbness, or tingling in thumb, index, middle, and radial half of ring finger

Night pain and symptoms on waking

Weak grip and clumsiness in hand

Thenar muscle wasting (in long-standing cases)

Medical Management

Rest and activity modification

Wrist splinting (especially at night, neutral position)

NSAIDs for pain relief

Corticosteroid injections (for persistent cases)

Surgical: Carpal tunnel release — if conservative treatment fails
Physiotherapy Management
Acute Phase (Pain & Inflammation)

Goals: Pain relief and reducing pressure on the nerve

Rest and Splinting: Keep wrist in neutral position

Modalities:

TENS or IFT – for pain

Ultrasound – to reduce inflammation

Cryotherapy – for swelling

Education: Avoid repetitive wrist movements and prolonged flexion/extension

Subacute Phase

Goals: Improve mobility and flexibility

Stretching Exercises:

Wrist and finger flexor stretch

Wrist extensor stretch

Median Nerve Gliding Exercises:

Wrist extension + finger extension + elbow extension

Gentle, pain-free "flossing" motion

Tendon Gliding Exercises:

Straight hand → hook fist → full fist → flat fist

Strengthening & Functional Phase

Goals: Strengthening and prevention of recurrence

Strengthen wrist flexors/extensors and grip muscles (soft ball or putty)

Isometric → isotonic exercises

Ergonomic corrections at workplace

Ergonomic & Home Advice

Maintain neutral wrist position
Avoid prolonged typing without breaks
Adjust keyboard and mouse position
Use wrist rest or ergonomic aids
Night splinting to keep wrist neutral
Regular hand and wrist stretches during work

                Complications 

Permanent median nerve damage
Thenar muscle atrophy
Loss of fine motor control
summary
Aspect Details
Nerve Involved Median nerve
Common Symptoms Numbness, tingling, pain in thumb–middle fingers
Tests Phalen’s, Tinel’s
Modalities TENS, Ultrasound, Splint
Exercises Nerve gliding, stretching, grip strengthening

Written by : Dayana Onkarappa Senior Physiotherapist at Advanced Physiotherapy Clinic and Homecare
https://physioji.com/[](url)
Prevention Ergonomic corrections, posture training