Carpal Tunnel Syndrome

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This page has been designed to give you the right information about carpal tunnel syndrome and the rehabilitation that may help with your recovery.

What is carpal tunnel syndrome?

Carpal tunnel syndrome is a collection of symptoms associated with the irritation of one of the main nerves that goes into your hand.

What are nerves and what do they do?

You have three main nerves that go into your hand to provide it with the ability to work properly (move and feel). The nerve that causes carpal tunnel syndrome if it's irritated is called the median nerve. The median nerve provides sensory function (ability to feel touch or temperature) to half of your palm, your thumb, first and middle fingers, along with half of your ring finger. It also provides the motor function (tells your muscles what to do) to the front of your forearm, thumb and some smaller muscles in your hand.

So what happens when a nerve is irritated?

Firstly, it is important to know that a nerve can be irritated without being damaged. Nerves by their very nature are very sensitive and can be upset by a number of things. A good example of this is when you hit your funny bone, which is actually a nerve (ulna nerve) and not a bone at all. Even a minor bump to your funny bone can cause pain, pins and needles or a burning sensation to travel into your hand.

If a nerve is irritated it can cause discomfort, pins and needles or numbness. Sometimes, if a nerve is really upset it can even cause the muscles that it supplies to appear weak.

Can you explain it in a different way, I still don’t understand?

Absolutely.

Think of your nerves as a motorway, with the nerve impulses as cars and lorries going up and down the road normally when everything is working well.

If your nerve is irritated, it is a bit like having a motorway with roadworks on it.

If 1 lane is closed, the road will still work but things might get slowed up, the drivers might get frustrated and grumpy and some deliveries might be late. If we apply this idea to your nerve, this might cause some discomfort, tingling or numbness.

If 2 lanes are closed on the motorway, the traffic will definitely be slowed down and more drivers will be cross and more people will be late for meetings, and deliveries will almost definitely be delayed.

Again, applying this idea to your nerve, if your nerve is more irritated, it is likely that you may experience pain, tingles, numbness and/or the feeling that the muscles might be weakened.

If all 3 lanes on the motorway are closed, nothing can get through and effectively the road would stop working properly.

From a nerve point of view, this would be the equivalent of what is known as a nerve palsy, which is when the nerve stops working properly.

Luckily, this is rare, but should you have any symptoms like this, you must seek urgent medical help via 999 or A&E.

What can cause carpal tunnel syndrome?

In many cases, carpal tunnel syndrome will start for no obvious reason, however, there are certain factors that may raise the chances of you developing an issue:

If you are pregnant
If you are overweight
If you are diabetic
If you have had an injury to your wrist

What are the common symptoms of carpal tunnel syndrome?

There are a number of symptoms seen commonly with carpal tunnel syndrome; we’ve broken our answer down into sections.

Nerve irritations can cause a number of symptoms, with one of the most common being pins and needles or numbness. Typically, you will feel this in your thumb, index, middle and part of your ring finger. However, sometimes people experience symptoms into the hand, forearm or even up to the elbow. In most cases, the symptoms will tend to come and go.

For most people, these symptoms will appear at night, or if you are holding your hand in one position such as driving or typing.

Similar to pins and needles, pain can sometimes be a feature of a nerve irritation, and again similar to pins and needles it is most often felt in the thumb, index, middle and part of the ring finger.

Sometimes, nerve irritations can cause a change in how well the nerve and the muscles ‘communicate’ or ‘talk’ to each other, which can make the muscle appear weak. In most cases, the weakness will be felt in the thumb. Weakness is not something you need to be overly concerned with in carpal tunnel syndrome as it is not uncommon, however, do read our section on ‘Is there anything I should look out for?' to help guide you with what to look for if weakness of your thumb is part of your complaint.

What can I do to help myself?

Firstly, it’s important that you know that you can feel better. Sometimes, these issues can be really quite sore and can get in the way of things that you would normally take for granted, making you feel that you’ll never get better. However, if it hasn’t settled by itself, there are options available that can help.

Understanding the issue is often the best place to start. Reading the information above can help you better understand that carpal tunnel syndrome is not a damaging or dangerous problem and that it can get better.

As with most aches and pains, looking at the things that seem to cause your symptoms and making some changes or adaptations is a good place to start. What this means in English is that there are likely to be certain things that make your symptoms worse and if you are able to look at those things and see how you can still get the task done but maybe in a different way, you may find that your hand is less irritated. An example might be to take more breaks if you are typing for a long time or looking at your sleeping position.

If you’ve explored the idea of adjusting what you can to reduce how easily your hand is irritated but have had no luck, a simple night resting splint can be a useful way of helping carpal tunnel syndrome. For some people, this is the most effective option at reducing their symptoms. These splints often have a metal bar on the palm side which will limit how easily you can bend your wrist (which is often something that will irritate carpal tunnel syndrome). They are to be worn at night and preferably not during the day to avoid your wrist getting stiff or weakened.
These splints can be easily purchased online (search: carpal tunnel splint) or can be provided by the physiotherapy department (you would to be registered with us to do this and would require you either self-refer or be referred to us by your GP surgery).

Is there anything else I can do?

Yes there is. Hamzeh et al (2020) discovered that exercise can be beneficial in the management of mild to moderate carpal tunnel syndrome. They highlighted that all exercise seemed to help, but a particular type of exercise appeared to be of most use, with the positive effects being reported by patients for up to 6 months.

You can find some of these exercises at the bottom of the page.

Is there anything I should look out for?

In most cases, hand symptoms associated with carpal tunnel syndrome are easily recognised, but occasionally there are things that do not fit and should be highlighted to your doctor, nurse or physio.

Pins and needles, numbness or weakness affecting your entire arm, leg or face. If you recently developed these symptoms, you should seek urgent medical attention via A&E or by calling 999.

Any changes in your speech, ability to swallow or the appearance of your face. If you recently developed these symptoms, you should seek urgent medical attention via A&E or by calling 999.

If moving your neck makes your hand symptoms worse, this may indicate that your symptoms might be coming from your neck and may need a different approach to rehabilitation to help you recover.

If the pins and needles/numbness become constant (i.e. they do not go away), you should inform your physio or GP.

If you notice that the size of your thumb muscles starts to reduce (your thumb muscles are normally round and quite soft; a loss of muscle size will give them a flattened or sunken appearance), you should inform your physio or GP.

What can physiotherapy do for me?

As mentioned before, the mainstay of treatment for carpal tunnel syndrome is the use of a night resting splint and exercise. Both of these can be offered by the physiotherapy department (please note, the exercises can also be found at the bottom of this page).

What happens if the splint/exercises don’t help?

The night resting splint should be tried for at least 8 weeks, as it may take some time for your symptoms to calm down.

If you have tried the splint/exercises for 8 weeks and your symptoms are no better (or worse - see above), you should inform your physio or GP as they can discuss other options.

What are these other options?

If the splint/exercises do not help, then you may well be offered a corticosteroid injection for your carpal tunnel syndrome. These can often be very useful but if that fails to improve matters, you may be referred onto an orthopaedic surgeon (bone and joint specialist) to discuss the option of surgery.

Frequently asked questions

Q: I want to try the splint but I don’t know what one is best. Can you help?

A: Yes we can. Our physiotherapy department can happily provide you with a night resting splint, however, you would need to either self-refer or be referred by your GP surgery into our service. Please note, you will be assessed on an individual basis and the decision as to whether a splint is the right option for you will be made between you and the physio.

Q: Can I use the splint during the day?

A: You can, but it is advised that you use it mostly at night, given that carpal tunnel syndrome affects people mostly at night. Using the splint during the day may cause you to become a bit reliant on it and may mean your wrist doesn’t get used as much, which might cause issues with stiffness, weakness and worry.

Q: Can I adapt the exercises?

A: Absolutely. The exercises can be adjusted, modified or adapted to help you get the best out of them. It is a good idea to try and keep the general theme of the exercise the same, but adjusting the position of your arm or hand can sometimes make a difference.

Exercises

The following programme is a rough guide that might be useful for your carpal tunnel syndrome. Your physiotherapist will be able to guide you if any adaptations are needed.

Early stage

Exercise tip: Try to complete this exercise in a slow, rhythmical fashion like the ticking of a clock. Aim to exercise for 30 seconds and repeat little and often throughout the day. You can adapt the exercise if needed (i.e. don’t fully straighten your elbow or start with your arm lower).

Move onto the next stage when you start to feel that this exercise is becoming less effective.

Early Stage

Middle stage

Exercise tip: Try to complete this exercise in a slow, rhythmical fashion like the ticking of a clock. Aim to exercise for 30 seconds and repeat little and often throughout the day. You can adapt the exercise if needed (i.e. don’t fully straighten your elbow or don’t reach so high).

You don’t have to do both exercises.

Move onto the next stage when you start to feel that this exercise is becoming less effective.

Middle stage - Exercise 1

Middle stage - Exercise 2

Late stage

Exercise tip: Try to complete this exercise in a slow, rhythmical fashion like the ticking of a clock. Aim to exercise for 30 seconds and repeat little and often throughout the day. You can adapt the exercise if needed (i.e. don’t turn so far away or have your hand lower on the wall).

Late stage

Need more help? Refer yourself here.

References:

Hamzeh, H., Madi, M., Alghwiri, A.A. and Hawwamdeh, Z. (2020) The long-term effect of neurodynamics vs exercise therapy on pain and function in people with carpal tunnel syndrome: a randomised parallel-group clinical trial. The Journal of Hand Therapy, So894-1130(20)30144-7. Doi:101016/j.jht.2020.07.005 Epub ahead of print/ PMID: 32893098 (accessed on 19.02/2021).