Do you feel tingling, numbness and pain in your hands and wrist area and raising questions for you? Or have you been to the doctor and you have been told you might have carpal tunnel syndrome.
As a radiographer I will rely on my knowledge about wrist problems and of course rely on scientific medical studies as usually to answer your questions.
Enjoy reading and feel free to ask questions in the comments or share your own experience.🙏
Last updated: March, 2025. Written by Juliet Semakula, a diagnostic radiographer.
Disclaimer: Amazon affiliate links, complete disclosure in the legal notice.
Basics
▶️Let’s first understand what a carpal tunnel syndrome is:
Carpal tunnel syndrome is pressure on a nerve in your wrist. You will feel tingling, numbness and pain in your hands and fingers.
Hand showing median nerve (O) compressed at the wrist resulting in numbness or pain in the areas marked X
▶️How do I know if I have a carpal tunnel? Symptoms:
Usually, people who complain of carpal tunnel syndrome have the following symptoms:
🟣Tingling or pins and needles in your wrist and hand.
🟣Numbness in the hands.
🟣An ache or pain in your fingers, hand or arm.
🟣Some people find it hard to grip anything and feel weakness on the thumb.
Some people who have these symptoms state the symptoms start slowly, they come and go, and they can get worse at night.
Anatomical variations of the median nerve(in red) in carpal tunnel of hand
▶️Can carpal tunnel pain radiate to shoulder, and neck
According to some scientific studies:
In the earliest stages of carpal tunnel syndrome some people do complain of disturbed sleep due to the overwhelming feeling of hand numbness and swelling like sensation which are not grossly observed (Yunoki,2017)
And sometimes pain that radiates from the wrist to the shoulder accompanied by tingling in the hand and fingers
▶️What other conditions can be mistaken for carpal tunnel?
Diagnosing carpal tunnel syndrome before thinking of which treatment to use is very important because many other conditions produce similar symptoms.
🟠Neck pain and spurling may be a sign pointing to cervical spine pathology (Yunoki,2017)
🟠If there is tenderness at the proximal forearm and sensory changes are found in the palm and the first three fingers, pronator teres syndrome should be also considered (Mujadzic, 2007)
🟠Osteoarthritis of the metacarpophalangeal joint or wrist should also be considered if joint pain, pain experienced during motion, or radiologically apparent arthritis is recognized (Onen,2015)
🟠Multiple sclerosis, syringomyelia, and brachial plexus injuries should also be excluded, although they are less common neurological conditions
▶️What causes carpal tunnel syndrome? Scientific studies
The causes of carpal tunnel syndrome are related to a few hypotheses: when the carpal tunnel inside your wrist swells and squeezes one of your median nerves.
You are more at risk of carpal tunnel syndrome if:
🟠Carpal tunnel syndrome can be related to what kind of work you do.
🟠One’s lifestyle example if you are overweight.
🟠Injury to your hand /wrist.
🟠Genetic predisposition.
🟠Repetitive exposure to vibrations or forceful pointed motions are thought to be the most common causes of carpal tunnel syndrome
🟠Specific diseases, such as diabetes, pregnancy and morbid obesity may also be associated with an increased risk for the developing carpal tunnel syndrome.
Osiak et al 2022:
Carpal tunnel syndrome occurs due to an increased interstitial pressure within the carpal tunnel eventually resulting in compression and injury of the median nerve.
It is believed that that due to the mechanical compression of the median nerve, ischaemia develops locally resulting in demyelination of both the small and larger fibres of the medium nerve, hence evoking the symptoms (Yunoki,2017)
▶️Some people wonder if It’s possible for carpal tunnel syndrome to get better on its own.
The truth is some people say if you rest or avoid repetitive motions with your wrists for a while you will feel better.
But it’s much more likely that carpal tunnel syndrome won’t heal unless a healthcare provider diagnoses and treats it.
Although it can be a bit more difficult to treat carpal tunnel if you’ve had symptoms for some time, it’s usually never too late for you to seek help.
so that you can comfortably write and use your hands while taking part in daily activities.
▶️What is the diagnosis for carpal tunnel syndrome?
When your doctor can not diagnose carpal tunnel syndrome with the kind of symptoms you are having. With uncertainty in the diagnosis.
Then the following tests are normally performed to help establish the actual cause.
1️⃣MR imaging sometimes will be done to provide good soft tissue images and identifying rare pathological causes of carpal tunnel syndrome such as a ganglion, haemangioma, or bone deformity, the presence of which may alter surgical intervention
2️⃣Ultrasound may be used for assessing the median nerve morphology.
3️⃣Electrodiagnostic studies (EDX) such as nerve conduction studies (NCS) and electromyography (EMG) are performed.
A table showing provocative tests and manoeuvre for carpal tunnel syndrome
Sensitivity and specificity of provocative tests for carpal tunnel syndrome (Yunoki,2017)
Then after these tests, your doctor will be able to inform you what level your symptoms are and what to do.
Carpal tunnel syndrome is sometimes classified into 3 categories of severity, based on the duration of symptoms and the types of symptoms.
♦️Low (less than 1 year)
♦️Moderate
♦️Severe.
The main way carpal tunnel syndrome is diagnosed is simply by asking you questions and examining you, because it has specific symptoms.
▶️What is the treatment for carpal tunnel syndrome?
Treatment for carpal tunnel syndrome is most of the time selected considering these factors.
♦️The stage of the disease.
♦️The severity of the symptoms.
♦️The patient’s preference.
There two common types of management and treatment for carpal tunnel syndrome are:
1️⃣Conservative therapeutic management
2️⃣Surgical management.
Always the first step will be more conservative treatment before thinking about surgery. This may be determined on how mild or severe your symptoms are.
Remember each type of cure has its advantages and disadvantages, it will be up to you to decide which kind of treatment you prefer.
Non-surgical treatment options:
♦️Pain killers may help for a short term with pain.
♦️Taking Vitamins B6 and B12 , it’s been noted that lack of vitamin B6 or B12 causes symptoms similar to carpal tunnel. For instance, tingling or pins-and-needles in the fingers and hand which are a common sign of vitamin B deficiency.
♦️Nonsteroidal anti-inflammatory drugs.
♦️Local injections such as corticosteroids effective for the treatment of carpal tunnel syndrome known to reduce symptoms for 12 months (Ashworth,2023)
♦️️ Sometimes a steroid injection into your wrist will be prescribed. This helps to bring the swelling around the nerve.
♦️A wrist Splint worn on your hand will help keep your wrist straight to help relieve pressure on the nerve. You can find different wrist splint for carpal tunnel syndrome on Amazon or any store of your choice.
Wearing a splint for 6 weeks before you start feeling better, it’s ok to wear it over night as well.
♦️Exercise for the hand and wrist have been associated with less symptoms of carpal tunnel syndrome.
According to studies done by Carlson 2010:
Of all the suggested conservative treatments. It is believed that splinting and oral or injected corticosteroids may be significantly effective for alleviating the symptoms of carpal tunnel syndrome, although they often provide only short-term relief.
Splinting is commonly known to minimize motion at the wrist and consequently decrease symptoms because carpal tunnel syndrome has been associated with forceful, repetitive hand and wrist activity.
Surgical options
However, if your symptoms are moderate to critical, further testing, such as nerve conduction or needle electrodiagnostic are used to determine whether carpal tunnel syndrome is acute or chronic.
But if there is significant evidence of axonal injury then surgical decompression of the carpal tunnel may be required.
There two types of surgical treatment normally used:
🟩Open carpal tunnel release is seen as the most accepted and reported high success rate with minimal complications
A simple decompression of the median nerve by division of the transverse carpal ligament (TCL) is considered to yield excellent results in 75% of the patients (Kim, 2014)
🟩Endoscopic carpal tunnel release.
Usually, you are numbed with local anaesthetics, your hand will be marked to avoid potential damage of normal structure.
Then the palmaris longus tendon is dissected and retracted radially to protect the palmar cutaneous branch of the median nerve exposing the deep fascia of the forearm.
Image showing an operation of endoscopic carpal tunnel release: Introducing the cannula to the exit portal. HH: hook of hamate, KL: Kaplan line, TCL: transverse carpal ligament. (kim,2014)
This kind of treatment is useful for achieving median nerve decompression, its effectiveness in comparison with the minimally invasive and restoring function of the affected hand.
Also return to work is quicker after endoscopic release by an average of eight days (Vailiadis,2014)
Regardless of which treatment option is selected for you, the most important is to help with your symptoms.
However recent literature, shows a trend toward recommending early surgery with or without median nerve denervation (Jarvik,2009)
More research is needed to determine the best treatment for those with mild and severe symptoms.
▶️Possible long term nerve compression may result into:
🔵Fibrotic changes, which could generate further mechanical pressure causing carpal tunnel syndrome.
🔵Complications such as postoperative bleeding and infection seldom occur.
🔵pain or tenderness in the thenar or hypothenar eminence or radial and ulnar tenderness.
Kim,2014
▶️What will happen if carpal tunnel syndrome is not treated
🔵If you have severe symptoms and leave them untreated it can lead to irreversible nerve damage which may lead to permanent dysfunction of the hand.
🔵This means you may have permanent numbness, pain, weakness or clumsiness
For this reason, it is important to have your symptoms checked for a better diagnosis and treatment.
▶️What do scientific studies say about physical therapy rehabilitation of carpal tunnel syndrome?
Physiotherapy is widely used in the treatment of patients with carpal tunnel syndrome.
However, there is no established algorithm for the use of physical therapy if you have carpal tunnel syndrome.
Are there natural remedies for carpal tunnel syndrome?
Here are some physiotherapeutic methods used for the treatment both before and after surgical treatment if you have carpal tunnel syndrome.
Natural factors: Therapy
🔵Essential oils.
🔵Homeopathy
🔵Acupuncture etc
Some of the performed therapy for carpal tunnel syndrome:
🔵Ultra-high frequency therapy is used based on patients’ tolerance and selectivity of treated tissue according to water percentage.
🔵Artificial light including laser rays.
🔵Magnetic field.
🔵Manual therapy and message
🔵Kinesiotaping
🔵Yoga
Zaralieva,2020
Images showing the devices and application therapeutic techniques : image from (Zaralieva 2020)
According to scientific studies:
Most of these physiotherapy techniques may be given depending on the stage, severity, symptoms, objective changes, individual basis and any accompanying diseases.
Typically, a 10-day course of physiotherapy is carried out, which can be repeated several times after a break of 2-4 weeks.
Zaralieva,2020
▶️How to tell if physical therapy can heal or alleviate carpal tunnel syndrome?
How do you know that physiotherapy is working?
1️⃣Ask anyone you know who has ever had physiotherapy for carpal tunnel syndrome, to see if things got better for them.
However, we can not be sure that it was physio, or the symptoms improved without physiotherapy.
2️⃣Get an experienced physiotherapy because you will be able to get a larger sample of many patients who did well with physiotherapy.
3️⃣You can also rely on clinical medical studies as this article has shown different ways to treat carpal tunnel syndrome.
Here are some reviews of the effectiveness of physiotherapy:
🟠Physiotherapy reduces pain.
🟠Stimulates restoration processes.
🟠Increases range of motion.
🟠Activates immune mechanisms.
🟠Improves biochemical performance
Many of all these treatments discussed here are theoretically more likely to be effective.
However, it is difficult to gather evidence of significant effectiveness of all these treatments.
In this context, I find it more reasonable to think there are so many more effective methods used that are not discussed in this article.
Here is a video showing 5 best tunnel syndrome stretches and exercises by Ask Doctor Jo
We have come to the end of this article, I hope I have answered some of your questions about carpal tunnel syndrome.
Articles used are referenced below and any questions or comments please leave a question.
📚Sources:
Zaralieva A, Georgiev GP, Karabinov V, Iliev A, Aleksiev A. Physical Therapy and Rehabilitation Approaches in Patients with Carpal Tunnel Syndrome. Cureus. 2020 Mar 3;12(3):e7171. doi: 10.7759/cureus.7171. PMID: 32257712; PMCID: PMC7117610.
Osiak K, Elnazir P, Walocha JA, Pasternak A. Carpal tunnel syndrome: state-of-the-art review. Folia Morphol (Warsz). 2022;81(4):851-862. doi: 10.5603/FM.a2021.0121. Epub 2021 Nov 16. PMID: 34783004.
Yunoki M, Kanda T, Suzuki K, Uneda A, Hirashita K, Yoshino K. Importance of Recognizing Carpal Tunnel Syndrome for Neurosurgeons: A Review. Neurol Med Chir (Tokyo). 2017 Apr 15;57(4):172-183. doi: 10.2176/nmc.ra.2016-0225. Epub 2017 Feb 2. PMID: 28154344; PMCID: PMC5409271.
Mujadzic M, Papanicolaou G, Young H, Tsai TM. Simultaneous surgical release of ipsilateral pronator teres and carpal tunnel syndromes. Plast Reconstr Surg. 2007 Jun;119(7):2141-2147. doi: 10.1097/01.prs.0000260703.56453.06. PMID: 17519713.
Onen MR, Kayalar AE, Ilbas EN, Gokcan R, Gulec I, Naderi S. The Role of Wrist Magnetic Resonance Imaging in the Differential Diagnosis of the Carpal Tunnel Syndrome. Turk Neurosurg. 2015;25(5):701-6. doi: 10.5137/1019-5149.JTN.10754-14.2. PMID: 26442534.
Jarvik JG, Comstock BA, Kliot M, Turner JA, Chan L, Heagerty PJ, Hollingworth W, Kerrigan CL, Deyo RA. Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomised parallel-group trial. Lancet. 2009 Sep 26;374(9695):1074-81. doi: 10.1016/S0140-6736(09)61517-8. PMID: 19782873.
Carlson H, Colbert A, Frydl J, Arnall E, Elliot M, Carlson N. Current options for nonsurgical management of carpal tunnel syndrome. Int J Clin Rheumtol. 2010 Feb;5(1):129-142. doi: 10.2217/IJR.09.63. PMID: 20490348; PMCID: PMC2871765.
Kim PT, Lee HJ, Kim TG, Jeon IH. Current approaches for carpal tunnel syndrome. Clin Orthop Surg. 2014 Sep;6(3):253-7. doi: 10.4055/cios.2014.6.3.253. Epub 2014 Aug 5. PMID: 25177448; PMCID: PMC4143510.
Ashworth NL, Bland JD P, Chapman KM, Tardif G, Albarqouni L, Nagendran A. Local corticosteroid injection versus placebo for carpal tunnel syndrome. Cochrane Database of Systematic Reviews 2023, Issue 2. Art. No.: CD015148. DOI: 10.1002/14651858.CD015148. Accessed 27 February 2025.
Vasiliadis HS, Georgoulas P, Shrier I, Salanti G, Scholten RJPM. Endoscopic release for carpal tunnel syndrome. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD008265. DOI: 10.1002/14651858.CD008265.pub2. Accessed 27 February 2025.