Carpel Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a condition that causes pain, numbness, tingling, and weakness in the hand and wrist. It occurs when the median nerve, which runs through a narrow passage in the wrist called the carpal tunnel, is compressed or irritated.

Pathoanatomy of carpal tunnel syndrome

The carpal tunnel is a small space in the wrist bones that allows tendons, ligaments, and nerves to pass through to the hand. When swelling or pressure affects the median nerve, it can lead to abnormal sensations or loss of function in the hand and fingers.

Causes of carpal tunnel syndrome

CTS or Carpel tunnel syndrome is caused by excessive pressure on the median nerve due to swelling or irritation in the wrist. Common causes include:

• Repetitive hand movements (e.g., typing, using tools)
• Arthritis
• Wrist injuries (sprains, fractures)
• Ganglion cysts

Symptoms of carpal tunnel syndrome

   Common Symptoms:

• Numbness in the wrist, hand, or fingers (especially fingertips)
• Pain in the wrist, hand, or fingers
• Tingling sensations
• Weak grip or difficulty holding objects (e.g., phone, steering wheel, pen, keyboard)
• Symptoms often worsen over time, beginning with nighttime discomfort and eventually affecting daily activities

Diagnosis

Special test

• Tinel’s Sign – Tapping the wrist to check for tingling sensations
• Phalen’s Test – Holding the wrist in a flexed position to assess symptoms

Radiological investigation

• Wrist X-rays – To rule out fractures or arthritis
• Electromyography (EMG) – To evaluate nerve function

Physiotherapy treatment of carpal tunnel syndrome

 Wrist and Hand Exercises

• Nerve Gliding Exercises: Help the median nerve move smoothly through the carpal tunnel.
  • Extend your fingers and thumb, then slowly bend them into a fist.
  • Open your hand and extend your wrist, then bend the wrist downward.
• Tendon Gliding Exercises: Reduce stiffness and improve mobility.
  • Make different fist shapes: straight fingers, claw fist, hook fist, and full fist.
• Wrist Flexor and Extensor Stretching: Improves flexibility and reduces tension.
  • Hold your fingers with the opposite hand and gently pull them back.
  • Stretch in both directions (up and down) for 15–30 seconds.

 Manual Therapy

• Soft Tissue Massage: Reduces muscle tightness in the wrist and forearm.
• Joint Mobilization: Helps improve wrist joint mobility and relieve pressure on the median nerve.

 Modalities for Pain Relief

• Ultrasound Therapy: Reduces inflammation and promotes healing.
• TENS (Transcutaneous Electrical Nerve Stimulation): Helps reduce pain and nerve irritation.
• Cold and Heat Therapy: Ice reduces swelling, while heat improves circulation.

 Strengthening Exercises

• Grip Strengthening: Use a soft ball or putty to improve grip strength.
• Wrist Resistance Exercises: Using light weights or resistance bands to strengthen wrist muscles

 Ergonomic and Postural Corrections

• Wrist Splints: Maintain the wrist in a neutral position, especially at night.
• Workplace Adjustments: Proper keyboard positioning, wrist support, and reducing repetitive strain. 

Activity Modification

• Avoid repetitive gripping and forceful wrist movements.
• Take regular breaks when using computers or tools.