Carpal Tunnel Syndrome
What is carpal tunnel syndrome?
Carpal tunnel syndrome (CTS) occurs when the median nerve is compressed as it passes through the carpal tunnel — a narrow channel on the palm side of the wrist formed by the carpal bones on three sides and the transverse carpal ligament across the top. The median nerve supplies sensation to the thumb, index finger, middle finger and the thumb side of the ring finger, and motor function to the thenar muscles at the base of the thumb. When it is compressed, the result is the characteristic tingling, numbness, and weakness in this distribution that defines CTS.
It is one of the most common peripheral nerve entrapment conditions, affecting approximately three to six percent of the general adult population and significantly more in certain occupational groups.
What causes carpal tunnel syndrome?
CTS develops when the contents of the carpal tunnel — the nine flexor tendons and the median nerve — are compressed, either because the tunnel itself is narrowed or because the tendons and surrounding tissues are swollen. Common contributing factors include repetitive hand and wrist movements, particularly those involving sustained wrist flexion or extension and vibration exposure — keyboard workers, tradespeople and assembly line workers are all at higher risk.
Hormonal changes are a significant factor — pregnancy is strongly associated with CTS due to fluid retention increasing tunnel pressure, and symptoms often resolve after delivery. Thyroid disorders, diabetes, rheumatoid arthritis, obesity, and renal failure all increase CTS risk through various mechanisms affecting tissue swelling and nerve health. Anatomical factors — a congenitally narrow carpal tunnel or variations in tunnel contents — predispose some individuals to CTS at lower loading levels than others.
An important and frequently missed diagnostic consideration: symptoms that appear consistent with CTS — tingling and numbness in the hand and fingers — can also arise from nerve root compression in the cervical spine, particularly at C6 and C7. This is sometimes called a "double crush" when both sites are involved simultaneously. A thorough physiotherapy assessment evaluates the entire upper quarter — neck, shoulder, elbow, forearm and wrist — rather than treating the wrist in isolation. Many patients who have not responded to wrist splinting or carpal tunnel release surgery have an unrecognised cervical component driving their symptoms.
What are the symptoms?
The classic symptom is tingling, numbness or a "pins and needles" sensation in the thumb, index finger, middle finger and thumb half of the ring finger — characteristically worse at night or in the early morning, often waking patients from sleep. Symptoms are also provoked by sustained wrist flexion — holding a phone, driving, reading — and by activities involving grip.
As the condition progresses, pain develops in the wrist and can radiate into the forearm and occasionally the arm. Weakness of grip and pinch strength, and clumsiness with fine motor tasks such as doing up buttons or picking up small objects, indicate involvement of the thenar motor branch. Thenar muscle wasting — visible flattening of the muscle at the base of the thumb — indicates significant and longstanding median nerve compression.
How is it diagnosed?
Clinical assessment by a physiotherapist combines a detailed history — particularly the pattern, timing and provocative factors of symptoms — with physical examination including Tinel's sign (tapping over the carpal tunnel reproduces symptoms), Phalen's test (sustained wrist flexion for 60 seconds), and assessment of median nerve tension and the cervical spine. Grip and pinch strength testing and two-point discrimination assessment quantify the functional and sensory deficit.
Nerve conduction studies provide electrophysiological confirmation and help grade the severity of median nerve compression — information that is useful for surgical decision-making. Ultrasound can visualise median nerve swelling at the level of the carpal tunnel. These investigations are typically arranged through your GP or specialist.
How can physiotherapy help?
Conservative physiotherapy management is effective for mild to moderate CTS and is the appropriate first-line approach for most patients before surgical consideration. Manual therapy techniques to mobilise the carpal bones and surrounding soft tissues can reduce pressure on the nerve, while soft tissue massage helps reduce swelling.
Neural mobilisation — gentle nerve gliding exercises that promote movement of the median nerve through the carpal tunnel and reduce mechanosensitivity — is the most specific physiotherapy intervention for CTS and has good evidence for symptom reduction. The technique involves moving the wrist and fingers through positions that progressively tension then unload the median nerve, improving its capacity to slide freely through the tunnel.
Nocturnal wrist splinting — wearing a splint that holds the wrist in a neutral position during sleep — is the most consistently effective conservative intervention for reducing night symptoms and is inexpensive and well-tolerated. Your physiotherapist will advise on splint fitting and whether daytime use during aggravating activities is appropriate.
Ergonomic assessment and modification of workplace or home activities reduces the sustained wrist positions and repetitive loading that aggravates CTS. For desk workers this includes keyboard and mouse position. For tradespeople and manual workers it may involve tool handle modification, task rotation, and anti-vibration gloves.
Where cervical spine involvement is identified contributing to hand symptoms, cervical physiotherapy is integrated into the management plan — treating the wrist without addressing the cervical component produces limited and often temporary results.
Dry needling of the forearm flexors and carpal tunnel region can assist with pain management and tissue mobility. Real time ultrasound can be used to visualise median nerve mobility during neural mobilisation exercises and guide treatment progression.
For patients who have not responded adequately to conservative management, referral for corticosteroid injection or surgical carpal tunnel release is appropriate. Physiotherapy plays an important post-operative role in optimising recovery after carpal tunnel release surgery.
Our physiotherapists Yulia Khasyanova, Eliane Machado and Bethany Kippen both have experience in upper limb nerve conditions and are members of the Australian Physiotherapy Association. For patients managing CTS alongside repetitive strain injury from workplace activities, WorkCover funded physiotherapy may be available.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Carpal tunnel syndrome (CTS) occurs when the median nerve is compressed as it passes through the carpal tunnel — a narrow channel on the palm side of the wrist formed by the carpal bones on three sides and the transverse carpal ligament across the top. The median nerve supplies sensation to the thumb, index finger, middle finger and the thumb side of the ring finger, and motor function to the thenar muscles at the base of the thumb. When it is compressed, the result is the characteristic tingling, numbness, and weakness in this distribution that defines CTS.
It is one of the most common peripheral nerve entrapment conditions, affecting approximately three to six percent of the general adult population and significantly more in certain occupational groups.
What causes carpal tunnel syndrome?
CTS develops when the contents of the carpal tunnel — the nine flexor tendons and the median nerve — are compressed, either because the tunnel itself is narrowed or because the tendons and surrounding tissues are swollen. Common contributing factors include repetitive hand and wrist movements, particularly those involving sustained wrist flexion or extension and vibration exposure — keyboard workers, tradespeople and assembly line workers are all at higher risk.
Hormonal changes are a significant factor — pregnancy is strongly associated with CTS due to fluid retention increasing tunnel pressure, and symptoms often resolve after delivery. Thyroid disorders, diabetes, rheumatoid arthritis, obesity, and renal failure all increase CTS risk through various mechanisms affecting tissue swelling and nerve health. Anatomical factors — a congenitally narrow carpal tunnel or variations in tunnel contents — predispose some individuals to CTS at lower loading levels than others.
An important and frequently missed diagnostic consideration: symptoms that appear consistent with CTS — tingling and numbness in the hand and fingers — can also arise from nerve root compression in the cervical spine, particularly at C6 and C7. This is sometimes called a "double crush" when both sites are involved simultaneously. A thorough physiotherapy assessment evaluates the entire upper quarter — neck, shoulder, elbow, forearm and wrist — rather than treating the wrist in isolation. Many patients who have not responded to wrist splinting or carpal tunnel release surgery have an unrecognised cervical component driving their symptoms.
What are the symptoms?
The classic symptom is tingling, numbness or a "pins and needles" sensation in the thumb, index finger, middle finger and thumb half of the ring finger — characteristically worse at night or in the early morning, often waking patients from sleep. Symptoms are also provoked by sustained wrist flexion — holding a phone, driving, reading — and by activities involving grip.
As the condition progresses, pain develops in the wrist and can radiate into the forearm and occasionally the arm. Weakness of grip and pinch strength, and clumsiness with fine motor tasks such as doing up buttons or picking up small objects, indicate involvement of the thenar motor branch. Thenar muscle wasting — visible flattening of the muscle at the base of the thumb — indicates significant and longstanding median nerve compression.
How is it diagnosed?
Clinical assessment by a physiotherapist combines a detailed history — particularly the pattern, timing and provocative factors of symptoms — with physical examination including Tinel's sign (tapping over the carpal tunnel reproduces symptoms), Phalen's test (sustained wrist flexion for 60 seconds), and assessment of median nerve tension and the cervical spine. Grip and pinch strength testing and two-point discrimination assessment quantify the functional and sensory deficit.
Nerve conduction studies provide electrophysiological confirmation and help grade the severity of median nerve compression — information that is useful for surgical decision-making. Ultrasound can visualise median nerve swelling at the level of the carpal tunnel. These investigations are typically arranged through your GP or specialist.
How can physiotherapy help?
Conservative physiotherapy management is effective for mild to moderate CTS and is the appropriate first-line approach for most patients before surgical consideration. Manual therapy techniques to mobilise the carpal bones and surrounding soft tissues can reduce pressure on the nerve, while soft tissue massage helps reduce swelling.
Neural mobilisation — gentle nerve gliding exercises that promote movement of the median nerve through the carpal tunnel and reduce mechanosensitivity — is the most specific physiotherapy intervention for CTS and has good evidence for symptom reduction. The technique involves moving the wrist and fingers through positions that progressively tension then unload the median nerve, improving its capacity to slide freely through the tunnel.
Nocturnal wrist splinting — wearing a splint that holds the wrist in a neutral position during sleep — is the most consistently effective conservative intervention for reducing night symptoms and is inexpensive and well-tolerated. Your physiotherapist will advise on splint fitting and whether daytime use during aggravating activities is appropriate.
Ergonomic assessment and modification of workplace or home activities reduces the sustained wrist positions and repetitive loading that aggravates CTS. For desk workers this includes keyboard and mouse position. For tradespeople and manual workers it may involve tool handle modification, task rotation, and anti-vibration gloves.
Where cervical spine involvement is identified contributing to hand symptoms, cervical physiotherapy is integrated into the management plan — treating the wrist without addressing the cervical component produces limited and often temporary results.
Dry needling of the forearm flexors and carpal tunnel region can assist with pain management and tissue mobility. Real time ultrasound can be used to visualise median nerve mobility during neural mobilisation exercises and guide treatment progression.
For patients who have not responded adequately to conservative management, referral for corticosteroid injection or surgical carpal tunnel release is appropriate. Physiotherapy plays an important post-operative role in optimising recovery after carpal tunnel release surgery.
Our physiotherapists Yulia Khasyanova, Eliane Machado and Bethany Kippen both have experience in upper limb nerve conditions and are members of the Australian Physiotherapy Association. For patients managing CTS alongside repetitive strain injury from workplace activities, WorkCover funded physiotherapy may be available.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
