The carpal tunnel is narrow passageway on the palm side of the wrist that is surrounded by the carpals (small bones of hand/wrist) and many ligaments. Within the carpal tunnel you can find tendons that flex the fingers as well as the median nerve. In the hand the median nerve is responsible for the movement of the thumb as well as providing sensation to the palm side of the hand and fingers (except the pinky). Generally , the carpal tunnel is a small space with a limited amount of extra room so the median nerve can be vulnerable to anything which further reduces the space inside the tunnel.

What causes carpal tunnel syndrome?

Carpal tunnel typically occurs when the median nerve that sits in the tunnel becomes compressed. This compression can come from repetitive hand motions (mouse use, typing, working with vibrating tools, sleeping with the wrists curled in), general health related factors and the anatomy of the wrist. Carpal tunnel can be the result of one or many factors all together and the research is not clear on the exact cause of carpal tunnel.

In general, researchers have identified some things that may make people more predisposed to carpal tunnel syndrome:

• Having changes to your wrist structure from arthritis, a fracture or dislocation
• Changes to your body fluid levels such as retaining water (common during pregnancy and menopause
• Having a condition or addiction that can damage nerves
• Having an inflammatory condition such as rheumatoid arthritis
• Having a medical condition such as kidney disease, thyroid disorder or lymphedema
• Using some types of prescription drugs

Females and obese people are also statistically more likely to suffer from carpal tunnel than other individuals.

What does carpal tunnel syndrome feel like?

Carpal tunnel symptoms typically come on gradually and can include:

• Numbness or tingling in the fingers and hand not including the pinky which may be accompanied by pain or a burning feeling in the fingers or wrist
• Pain which may radiate up the forearm
• Weakness in the affected hand which may cause you to drop objects

Usually some positions or activities will make the symptoms of carpal tunnel worse while shaking the hands or arms or stretching may relieve symptoms. Over time symptoms can go from being intermittent to becoming constant.

How do I know if I have carpal tunnel syndrome?

If you are having symptoms of carpal tunnel syndrome you can see a variety of healthcare providers including medical doctors, physiotherapists, chiropractors or even naturopathic doctors. Your healthcare provider will perform a history and an exam of the affected area and may refer you for some specialized testing that could include an x-ray, ultrasound or nerve conduction study.  While these special tests may be helpful, they are not always necessary to make a diagnosis of carpal tunnel syndrome or to begin treatment. 

Carpal tunnel treatments

An important part of treating patients who are suffering from carpal tunnel syndrome involves identifying the underlying causes and factors related to why they developed the problem in the first place. In some cases, like when it is related to pregnancy, the symptoms of carpal tunnel may resolve on their own, in other cases treatment by a healthcare professional may be necessary. 

Some options for treating carpal tunnel syndrome and relieving symptoms of this condition can include:

• Cessation or reduction of aggravating activities
• Using a brace or splint (usually at night)
• Rehab exercises or stretches
• Using cold packs to reduce swelling and inflammation
• Taking over-the-counter or prescribed medications to treat inflammation and pain
• Pain relief injections (e.g. corticosteroids)
• Soft tissue techniques which treat the surrounding muscle, tendons and ligaments
• Extracorporeal Shockwave Therapy
• Carpal tunnel surgery

Shockwave therapy for carpal tunnel syndrome

At the Unpain Clinic we love shockwave therapy for carpal tunnel syndrome. Shockwave therapy uses non-invasive sound waves that stimulate cellular healing in tissues and it is one of the most well-researched healing modalities in regenerative medicine to date. In systematic reviews shockwave therapy has been found to improve symptoms and functional performance in patients suffering with carpal tunnel syndrome.

Carpal tunnel surgery

If your carpal tunnel pain does not respond to conservative types of care, you may be referred for surgery. Depending on the complexity of your carpal tunnel syndrome this surgery could be a simple day surgery or may require general anaesthesia. Your consulting surgical team will let you know the best approach and will work with you to create a recovery plan.

FAQ about Carpal Tunnel Syndrome

How can I prevent carpal tunnel syndrome?

There isn’t much evidence for any specific way of preventing carpal tunnel, but some suggestions include:

• Working on your ergonomics – find a comfortable mouse, make sure your keyboard height is adjusted to elbow height or slightly below elbow height, use a small pad to support your wrists, sit or stand with proper posture, find a pen with an oversized grip, find ways to work on tasks in a more comfortable position.
• Taking frequent breaks from aggravating activities, especially if these activities require you to use a great deal of force, a firm grip or work in an uncomfortable position.
• Keeping your hands and wrists warm – people who work in cold environments are more likely to develop hand pain and stiffness

What are some carpal tunnel stretches and exercises?

Flexor Stretch

• Hold your arm out with your elbow straight
• With your hand in a comfortable position, use your other hand to pull your fingers back into extension until you feel a stretch on the palmar side of your arm and inside part of your elbow.
• Hold for 30-40 seconds, switch arms and repeat[h1] .

Extensor Strengthening

• Hold a soup can or small weight in your hand and hang your wrist over edge of table, palm down.
• Raise your wrist up without lifting your arm off the table then relax your wrist back down and repeat. Perform 10-20 repetitions

Ball Squeeze

• Hold a stress ball or tennis ball in your hand
• Squeeze the ball as much as you can for 3-4 seconds and release
• Repeat 10-20 times per hand.

Scapular retraction

• Sit or stand with good posture and use the muscles between your shoulder blades to pull them together and down
• Hold for 5 seconds, relax and repeat. Perform 10-20 reps.

Should I try physiotherapy for carpal tunnel syndrome?

Yes, absolutely! You can also see a chiropractor for carpal tunnel syndrome treatment. At the Unpain Clinic we have a wonderful physiotherapist and chiropractor who can assess you and will work with you to help you find the best treatment for your carpal tunnel syndrome.