Carpal Tunnel Syndrome

Overview

The carpal tunnel is a narrow passage on the palm side of the wrist, formed by the wrist bones below and a tough ligament across the top. Nine tendons and the median nerve squeeze through it. When the space becomes tighter — because the tendons swell, fluid builds up, or the wrist is held bent for long periods — the nerve is compressed and starts to misfire.

The result is tingling, numbness or burning in the thumb, index finger, middle finger and half of the ring finger. Symptoms are classically worse at night and first thing in the morning; many people wake and shake their hand to get the feeling back. Driving, holding a phone, reading a book and typing are common triggers during the day. In longer-standing cases, grip becomes weak, small objects get dropped, and the muscle at the base of the thumb can shrink.

Carpal tunnel syndrome is the most common nerve entrapment in the body. It affects women more often than men, is common during pregnancy (when it usually settles after birth), and becomes more frequent with age. Mild cases often improve with activity changes and night positioning, while persistent cases with weakness may need a specialist opinion.

Causes and risk factors

• Repetitive wrist and finger use, especially with the wrist bent: typing, mouse work, phone use, tools
• Pregnancy and hormonal changes, including the menopause
• Diabetes, thyroid disease, rheumatoid arthritis
• Being overweight
• A previous wrist fracture or arthritis narrowing the tunnel
• Sleeping with the wrists curled under the chin or pillow
• Family history and naturally smaller wrist dimensions

How we may be able to help

Tingling in the hand can come from the wrist, elbow, shoulder or neck, so we assess the whole pathway of the nerve rather than only the wrist. Specific tests reproduce carpal tunnel symptoms, and we check sensation, thumb strength and the neck. We do not provide hand therapy or make splints; if a night splint is likely to help, we will say so and advise where to obtain one. If there is weakness, muscle wasting, or symptoms have not improved with conservative care, we can arrange an online private GP consultation for nerve conduction studies and a specialist referral.

For mild to moderate cases, physiotherapy includes nerve and tendon gliding exercises that help the median nerve move freely through the tunnel, advice on wrist positions at work and at night, and strengthening of the shoulder and forearm so the wrist is not overloaded. Hands-on treatment — mobilisation of the wrist bones, and IASTM or dry needling for the tight forearm flexor muscles whose tendons run through the tunnel — may reduce pressure on the nerve. Therapeutic ultrasound over the carpal tunnel is sometimes used for mild cases.

Where neck or upper back stiffness is contributing to nerve irritation (a "double crush"), our chiropractor can assess and treat it. Our posture scan can show forward-shoulder positions that place the nerve under tension along its length.

What you can do at home

• Keep your wrists straight at night — avoid curling them under your pillow; a soft wrist support from a pharmacy may help
• Set up your desk so your forearms are supported and your wrists are level with the keyboard, not bent up
• Take short breaks from typing or phone scrolling every 30 minutes and shake out the hands
• Try gentle nerve glides your therapist shows you — stop if tingling increases
• Avoid gripping tools or steering wheels tightly for long periods
• If you are pregnant, symptoms often settle after birth; positioning advice can help in the meantime