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Carpal Tunnel Syndrome

Written by Jacob Hughes, Physiotherapist at NSW North Coast. Article from March 2016.

Carpal Tunnel Syndrome (CTS) is a painful disorder of the hand caused by pressure on the median nerve, as it runs through the carpal tunnel of the wrist. The condition can be caused by a number of factors which can be treated conservatively, and, if identified early, can be avoided altogether.

What is the Carpal Tunnel?

The carpal tunnel is on the palm side of the wrist and is formed by 8 small bones in the wrist (called carpal bones). These make up three sides of the tunnel, and a thick transverse ligament makes up the fourth side. The flexor tendons of the wrist and the median nerve run through this tunnel.

Common Causes

Increased pressure in the carpal tunnel can be caused by the following:

  • Traumatic injury.
  • Partial subluxation of the carpal bones.
  • Fracture.
  • Tenosynovitis (inflammation or swelling of the tendon).
  • Arthritis.
  • Repetitive wrist movements e.g. painting or typing.

Signs and Symptoms

  • Hand pain or aching.
  • Pins and needles.
  • Numbness, especially at night.
  • Burning.
  • Weakness or cramping.
  • Perceived swelling.


CTS can usually be treated conservatively by a Physiotherapist, through a variety of different methods. The use of splints, particularly worn at night, can provide relief of symptoms by holding the wrist in position. Patient education on avoiding repetitive movements and activity modification is also effective in decreasing symptoms, and recurrence of flare ups. Hands-on manual therapy techniques may also be applied, such as carpal bone mobilisation and flexor retinaculum stretching, to open up the carpal tunnel. In more severe or irritable cases, surgical intervention may be required.

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