Carpel Tunnel Syndrome

The short description! .. with no medical terms ..

Carpal Tunnel Syndrome is one of the more common examples of the (15+) conditions that are included under the umbrella term Repetitive Strain Injury. You may have heard the term before, but in fact it only represents a small but dangerous percentage of RSI problems.

It causes significant pain in the wrist.

It often occurs in people who work with computers or carry out repetitive manual work with poor posture or activities that require you to work in an awkward position.

Few people are aware that the muscles which operate your fingers, to provide the significant 'grip' which we all possess, are actually positioned in the forearm. There are small muscles in each finger, but these only provide a small amount of grip, and are mainly used to 'ungrip' the fingers. i.e. pull the fingers back after you have finished holding something, or move the fingers sideways, or rotate the thumb. 

The forearm is packed with large powerful muscles, and these are linked to the fingers by tendons (like strong cables) which pass through a hole or 'tunnel' in the middle of the wrist. So when the muscles in the forearm contract, the tendons are pulled through the carpel tunnel, and as they are connected at the other end to the fingers, cause the fingers to bend inwards and create the grip. It's an extraordinary clever system which is now being copied by engineers creating robotic hands.

The problem, however, is that there is also a nerve which passes through the same tunnel, which controls the hand, and this can become compressed due to several factors, causing the pain. One factor is the repetitive use of the hand.


What are the Symptoms?

Tightness, discomfort, stiffness, soreness or burning in the hands, wrists, fingers, forearms, or elbows.

Tingling, coldness, or numbness in the hands.

Clumsiness or loss of strength and coordination in the hands.

Pain that wakes you up at night.

Feeling a need to massage your hands, wrists, and arms.

Pain in the upper back, shoulders, or neck associated with using the computer. 



Repetitive activities doing an activity that involves force, such as lifting or carrying heavy objects.

Repetitive activities which are lightweight, but which subject muscles to strain they are not used to, such as suspending the hand and arm upwards for computer keyboard or mouse use.

Carrying out an activity for a long period of time without adequate rest periods and poor posture.

Activities that require you to work in awkward or tiring positions, and/or using vibrating equipment.

It can come on quite suddenly, 'out of the blue' or gradually increase over a long period. If you continue with your activities and posture it will get worse and worse.

It may get so bad that you aren't able to do routine work or household activities. The pain may get so bad that it's there all the time, even when you're resting.


The video below shows a dissection of an actual human arm and wrist. This is the clearest way of showing how the muscles in the lower arm and wrist function, and how Carpel Tunnel pain originates.


If the video above does not run, click here to view an mp4 version which should work on all devices


 A wrist splint. The splint prevents the wrist from bending, which can place pressure on the median nerve and aggravate your symptoms.

Scars following surgery (above). This procedure is only normally carried out if all other treatments have not been successful. Surgery is normally successful.




The long description!      


The rise of computer use and flat, light-touch keyboards that permit high speed typing have resulted in an epidemic of injuries of the hands, arms, and shoulders.

Use of pointing devices like mice and trackballs are as much of a cause, if not more so. The thousands of repeated keystrokes and long periods of clutching and dragging with mice slowly strains the arm muscles and eventually they react by becoming very painful.

Carpal tunnel syndrome is a medical condition in which the median nerve is compressed as it travels through the wrist at the carpal tunnel and causes pain, numbness and tingling, in the part of the hand that receives sensation from the median nerve. 

Pain may extend up the arm leading to discomfort extending to the shoulder and forearm. The mechanism of injury is compression; there are a variety of contributing factors. Some of the individual predisposing factors include: diabetes, obesity, pregnancy, hypothyroidism, and a narrow-diameter carpal tunnel. CTS may also result from an injury that causes internal scarring or mis-aligned wrist bones. Occupational causes involve use of the hand and arm, such as heavy manual work, work with vibrating tools, and highly repetitive tasks even if they involve low force motions.

The main symptom of CTS is intermittent numbness of the thumb, index, and middle (long) fingers and the radial (thumb) side of the ring finger. The numbness often occurs at night, with hypothesized reasons related to sleep position, such as the wrists being held flexed during sleep or sleeping on one's side. 

Pain in carpal tunnel syndrome is primarily numbness that is so intense that it wakes one from sleep. Pain in electrophysiologically verified CTS is associated with misinterpretation of nociception and depression.

People with CTS experience numbness, tingling, or burning sensations in the thumb and fingers, in particular the index and middle fingers and radial half of the ring finger, because these receive their sensory and motor function (muscle control) from the median nerve. Less-specific symptoms may include pain in the wrists or hands, loss of grip strength, and loss of manual dexterity.

Some suggest that median nerve symptoms can arise from compression at the level of the thoracic outlet or the area where the median nerve passes between the two heads of the pronator teres in the forearm, although this is debated.

Numbness and paresthesias in the median nerve distribution are the hallmark neuropathic symptoms of carpal tunnel entrapment syndrome. Weakness and atrophy of the thumb muscles may occur if the condition remains untreated, because the muscles are not receiving sufficient nerve stimulation.

Most cases of CTS are of unknown cause. Carpal tunnel syndrome can be associated with any condition that causes pressure on the median nerve at the wrist. Some common conditions that can lead to CTS include obesity, oral contraceptives, hypothyroidism, arthritis, diabetes, prediabetes (impaired glucose tolerance), and trauma. Carpal tunnel is also a feature of a form of Charcot-Marie-Tooth syndrome type 1 called hereditary neuropathy with liability to pressure palsies.

Other causes of this condition include intrinsic factors that exert pressure within the tunnel, and extrinsic factors (pressure exerted from outside the tunnel), which include benign tumors such as lipomas, ganglion, and vascular malformation. Carpal tunnel syndrome often is a symptom of transthyretin amyloidosis-associated polyneuropathy and prior carpal tunnel syndrome surgery is very common in individuals who later present with transthyretin amyloid-associated cardiomyopathy, suggesting that transthyretin amyloid deposition may cause carpal tunnel syndrome.

The median nerve can usually move up to 9.6 mm to allow the wrist to flex, and to a lesser extent during extension. Long-term compression of the median nerve can inhibit nerve gliding, which may lead to injury and scarring. When scarring occurs, the nerve will adhere to the tissue around it and become locked into a fixed position, so that less movement is apparent.

Normal pressure of the carpal tunnel has been defined as a range of 2–10 mm, and wrist flexion increases this pressure 8-fold, while extension increases it 10-fold. Repetitive flexion and extension in the wrist significantly increase the fluid pressure in the tunnel through thickening of the synovial tissue that lines the tendons within the carpal tunnel.


Like other forms of RSI, in non-specific terms:

- Stop the activity which caused the problem in the first place.

- Exercise to relax and assist the recovery of muscles, tendons and ligaments.

- Prescriptions of anti-inflammatory drugs and pain killers. Sometimes Steroids.

- In extreme cases surgery may be necessary.






Scars following surgery (above) this procedure is only normally carried out if all other treatments have not been successful. Surgery is normally successful.

More specifically

Treatment for carpal tunnel syndrome (CTS) depends on the severity of the condition and how long you have had it.

In some cases, CTS will improve after a few months without treatment. Moving your hand or shaking your wrist can often help relieve the symptoms.

You should try avoid any activites that make your symptoms worse.

If you work with computer keyboards, there is little evidence that modifications at your workplace are likely to be of any help in relieving your symptoms.

If symptoms persist, there are a range of non-surgical and surgical treatments available that aim to relieve the pressure on the median nerve.

If your CTS is caused by an underlying health condition such as rheumatoid arthritis, treating the condition should improve your symptoms.

Read on to learn about the different treatments you may be offered. You can also see a summary of the pros and cons of these treatments, which allows you to easily compare your options.

Non-surgical treatments

Unless there is thought to be an immediate need for surgery, treatments such as wrist splints and corticosteroid injections are often recommended initially.

There is a lack of evidence to support the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for treating CTS, or for diuretics to help relieve fluid retention.

Wrist splints

A wrist splint is worn to support the wrist and keep it in a neutral position. It should not apply direct pressure over the carpal tunnel.

The splint prevents the wrist from bending, which can place pressure on the median nerve and aggravate your symptoms.

You should begin to notice an improvement in your symptoms within four weeks of wearing the wrist splint. Wrist splints are usually available from larger pharmacies, or your GP may be able to recommend a suitable supplier. They can also be ordered online.


Corticosteroids are a type of steroid medication. Steroids are hormones that are naturally produced in the body. They are powerful chemicals that can help reduce inflammation.

If a wrist splint does not work, corticosteroids may be recommended.

Corticosteroids can be taken as tablets, although for CTS it is likely that you will have a corticosteroid injection directly into your wrist.

One injection is usually recommended to begin with. If the condition responds well to one injection but then recurs, the treatment may be repeated.
Carpal tunnel release surgery

Surgery is usually recommended for cases of CTS, when other treatments have failed to relieve symptoms.

Surgery for CTS is known as carpal tunnel decompression or carpal tunnel release surgery and is performed on an outpatient basis, which means you will not have to stay in hospital overnight.

During surgery the roof of the carpal tunnel, known as the carpal ligament, is cut to reduce pressure on the median nerve in the wrist.

A local anaesthetic is used to numb your hand and wrist, but you will remain awake throughout the operation.

The surgery can be performed as open surgery, which involves making a single cut in the wrist, and is the traditional type of operation.

Some surgeons use keyhole surgery, where special instruments and a long tube with a light at one end and an eyepiece at the other are inserted through small cuts in your wrist, and sometimes your palm. This allows the surgeon to see the carpal ligament on a monitor throughout the operation.

There are no long-term differences in the outcomes of the two approaches.

Your surgeon will be able to discuss the most appropriate method of surgery with you.
Things to consider

A number of things may affect your decision to have surgery. These include:

- possible complications after surgery (see below)
- the recovery time
- how successful non-surgical treatments have been

In most cases, carpal tunnel release surgery provides a complete and permanent cure. However, as with any form of surgery there is always a small risk of complications.

Reported complications of CTS include:

- infection
- failure during surgery to fully separate the roof of the carpal tunnel, usually resulting in persistent CTS symptoms
- bleeding after the operation
- nerve injury
- scarring
- persistent wrist pain, which may be different to the original symptoms
- in rare cases, the return of CTS symptoms long after apparently successful surgery
- complex regional pain syndrome – a rare but chronic (long-term) condition that causes a burning pain in one of the limbs

After surgery

Following carpal tunnel release surgery, your hand will remain in a bandage for a couple of days and you may need to wear a sling. You should keep your hand raised for 48 hours to help reduce any swelling and stiffness in your fingers.

To help prevent stiffness, gently exercise your fingers, shoulder and elbow. You may be able to start these gentle exercises on the day of your operation.

After having surgery for carpal tunnel syndrome (CTS), you can use your hand to do light activities that do not cause excessive pain or discomfort. Try to avoid using your hand for more demanding activities until it has completely recovered, which may take several weeks.

The recovery time for open release surgery is usually slightly longer than the recovery time for keyhole surgery. Studies have also shown that there is less pain during the first three months after keyhole surgery compared with open release surgery. However, both methods have proven to be equally effective in treating CTS.

CTS during pregnancy

If you develop CTS during pregnancy, your symptoms should pass after your baby is born (after about six to 12 weeks).

However, if the median nerve is severely compressed (squashed) or if the symptoms of CTS are chronic (long-lasting), permanent nerve damage and muscle-wasting can occur and treatment will be required. 

Useful products:

See Flextend


carpel tunnel syndrome


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