Carpal Tunnel Syndrome - What exactly is it? How do you know if you have it and what exactly you can do for it.

You’ve at least heard of it. If you haven't had it, you know someone who has!

What Is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome (CTS) is one of the most common upper-extremity nerve compression conditions. The carpal tunnel is a narrow passageway located on the palm side of your hand, formed by small wrist bones and a strong ligament called the transverse carpal ligament.

Inside this tunnel run:

• The Median Nerve – responsible for sensation in the thumb, index, middle, and radial side of the ring finger, and motor control to several thumb and hand muscles.

• Nine Flexor Tendons – the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) tendons that help bend your fingers.

When swelling, inflammation, or compression increases inside this small space, the median nerve becomes irritated—leading to numbness, tingling, and weakness.

The blue circles are the structures contained within the Carpal Tunnel Illustration from Atlas of Human Anatomy by Frank H. Netter, MD

Common Symptoms of Carpal Tunnel Syndrome

• Numbness or tingling in the thumb, index, and middle fingers. Sometimes people will tell me their entire hand "falls asleep" but in true CTS the small (pinky) finger is not involved.

• Hand weakness or dropping objects. A very common complaint. Many people report having difficulty holding something as small as a cup of coffee.

• Nighttime symptoms that wake you up. The #1 complaint and typically this first time you experience symptoms.

• Pain radiating into the forearm or up toward the elbow. And for some, up to the shoulder.

• Difficulty pinching, gripping, typing, or opening jars

The red circle is the area of numbness and tingling Illustration from Atlas of Human Anatomy by Frank H. Netter, MD

✋Conservative Management Options

As a Certified Hand Therapist (CHT), treating injuries conservatively is my ultimate goal. Conservative measures are highly effective—especially in mild to moderate CTS. These are the strategies commonly recommended:

1. Wrist Cock-Up Splint

A wrist cock-up splint (sometimes OTC called a carpal tunnel brace) positions your wrist in a neutral to slightly extended position, reducing pressure on the median nerve—especially at night when people unknowingly sleep with their wrists bent (think fetal position).

Benefits:

• Decreases nighttime numbness and tingling

• Reduces inflammation

• Supports wrist during repetitive tasks

• Talk with your therapist concerning wear schedule

  • Generally nighttime wear will suffice, but this can vary depending on your daily activities

2. Activity Modification & Ergonomics

• Keep wrists in a neutral position while typing or using a mouse

• Avoid prolonged gripping, pinching, or wrist flexion.

  • Many complain of symptoms while driving or other activities that require a prolonged grip

• Consider anti-vibration gloves when using power tools or lawn equipment

• Use built-up handles for household items to reduce strain

3. Nerve & Tendon Gliding Exercises

These gentle movements help promote mobility of the median nerve and flexor tendons inside the carpal tunnel.

Median Nerve Glides

Purpose:

To improve the mobility of the median nerve through the carpal tunnel and reduce irritation.

Basic Median Nerve Glide Sequence:

1. Wrist neutral, fingers relaxed.

2. Straighten fingers.

3. Extend wrist.

4. Extend thumb

5. Turn your palm towards your face

6. Gently stretch thumb back

Only perform without increase in numbness or tingling. Hold each position for 2-3 seconds

Perform 10 reps, 1–3 times per day

See video below!

https://www.canva.com/design/DAG7u8IO1oU/KZUHvdYfkZaYmCLeLvt05A/watch?utm_content=DAG7u8IO1oU&utm_campaign=designshare&utm_medium=link2&utm_source=uniquelinks&utlId=h95d8318c1a

FDS / FDP Tendon Glides

Purpose:

To glide the flexor tendons that pass through the carpal tunnel, reducing adhesions and stiffness.

FDS Glide:

• Bend one finger at a time at the middle joint (PIP) while the others stay straight.

FDP Glide:

• Bend just the tip of one finger. Repeat for each finger.

Repeat 10 reps per finger.

See video link below!

https://www.canva.com/design/DAG7vHxrQpw/o8RXVa-KRNdvqM7etn1npw/watch?utm_content=DAG7vHxrQpw&utm_campaign=designshare&utm_medium=link2&utm_source=uniquelinks&utlId=hd4b4cb3a22

Full Hand Tendon Glides

Purpose:

To move all flexor tendons through their full available range to reduce congestion inside the tunnel.

Standard Tendon Glide Sequence:

1. Straight Hand

2. Hook Fist

3. Table top

4. Flat Fist

5. Full Fist

6. Straight Fist

Perform 10 reps once or twice daily.

See video link below!

https://www.canva.com/design/DAG7tIroQxg/qhnWV1QVgviuufwI7vLQVA/watch?utm_content=DAG7tIroQxg&utm_campaign=designshare&utm_medium=link2&utm_source=uniquelinks&utlId=ha5d8cd8c58

Ergonomic considerations

🖥️Workstation & Posture Adjustments

1. Chair and Desk Height

• Neutral Wrist Alignment: Adjust your chair or desk height so that your forearms are parallel to the floor when typing. Your elbows should be at a comfortable angle (90 to 110 degrees) and close to your sides.

• Chair: Use an ergonomic chair with good lumbar support and adjustable height. Your feet should be flat on the floor or a footrest.

• Sit/Stand Desk: Consider an adjustable standing desk to alternate between sitting and standing postures, which promotes movement and reduces sustained strain.

2. Monitor Placement

• Eye Level: Position your monitor so the top of the screen is at or slightly below eye level. This helps maintain good neck and shoulder posture, which can indirectly relieve pressure on nerves leading to the hand.

• Distance: Keep the monitor about an arm's length away.

3. Keyboard and Mouse Positioning

• Centering: Center your keyboard directly in front of you.

• Keyboard Tray: Use an adjustable keyboard tray to help achieve the optimal height and angle (a slight negative tilt is often recommended, where the keyboard slopes away from you).

• Avoid Leaning: Do not rest the heel of your hand or your wrist on the desk while typing or mousing. Your wrists should "float" slightly above the surface.

🖱️ Ergonomic Equipment Recommendations

1. Keyboards

• Split/V-Shaped Keyboards: These designs allow your hands and wrists to maintain a more natural, angled position, reducing strain.

• Low-Profile Keys: Keyboards with keys that require less force and travel distance can reduce impact.

  

2. Mouse and Input Devices

• Vertical Mouse: This type of mouse keeps your wrist in a "handshake" or neutral side position, reducing the inward twisting required by conventional mice.

• Trackball Mouse: A trackball reduces the need for large, repetitive wrist and arm movements, as you move the cursor with your thumb or fingers.

• Ergonomic Mousepad: Use a mousepad with a built-in wrist rest, but remember to rest your wrist only when pausing, not during active mousing.

3. Support Accessories

• Wrist Rests: Use gel or foam wrist rests in front of your keyboard and mouse. Important: Only use them to rest during pauses, not while actively typing or clicking, as resting on them while working can compress the carpal tunnel.

• Wrist Braces/Splints: A physician may recommend wearing a wrist brace or splint, especially at night or during long periods of repetitive activity, to keep the wrist straight and prevent nerve compression.

• Ergonomic Pen/Grips: For tasks involving a lot of writing, larger, softer grips can reduce the force required to hold the pen.

🔄 Habits and Routine Changes

1. Breaks and Stretching

• Frequent Micro-Breaks: Take a short break (1-2 minutes) every 30 minutes or so.

• Alternate Tasks: Change between different tasks to give your hands and wrists a rest from repetitive motions.

• Stretching: Gently stretch your hands, fingers, and wrists periodically throughout the day to improve blood flow and relieve tension. Simple stretches include neck, shoulder, forearm stretches, spreading your fingers wide, or gently shaking your hands out.

2. Technique

• Use a Lighter Touch: Train yourself to use a lighter touch when typing and clicking, reducing the force exerted by your hands and fingers. Find a keyboard cover that creates softer typing.

• Vary Input: If possible, explore voice-to-text software to reduce total keyboard/mouse time.

3. General Health

• Good Posture: Maintaining overall good posture (straight back, relaxed shoulders) prevents strain that can travel down to the wrists.

• Anti-inflammatory Diet: Beneficial for a variety of diagnoses and highly recommended for overall health. Decreasing sugar consumption may also provide some relief.

When to Seek Professional Care

If symptoms persist beyond several weeks—or your hand begins to weaken—it’s important to be evaluated by a Certified Hand Therapist or an Orthopedic Hand Specialist/Surgeon. Early treatment dramatically improves outcomes.

Final Thoughts

Carpal Tunnel Syndrome can be frustrating, but with proper education and targeted conservative care, most people see excellent improvement. As a Certified Hand Therapist, I’ve helped many patients reduce numbness/tingling, restore function, improve strength, and return to the tasks they love.