How carpal tunnel syndrome is treated

Carpal tunnel syndrome (CTS) occurs when certain nerves are compressed at the wrist leading to numbness, tingling, and pain in the fingers and hand.

This article on the carpal tunnel syndrome symptoms and treatment is written by Jackie Griffiths, a freelance journalist who writes health, medical, biological, and pharmaceutical articles for national and international journals, newsletters and web sites.

The carpal tunnel is a narrow, rigid passageway of bone at the base of the hand housing the median nerve. This is a key nerve which runs from the forearm to the hand, and controls sensations to the palm side of the thumb and fingers (except the little finger).

Carpal tunnel syndrome is a progressive condition but can sometimes go away on its own without any treatment. It may also be referred to as median neuropathy at the wrist.


A survey found that CTS affects 7% of women and only 1% of men. It can occur at any age but is prevalent in people in their 40s and 50s.

Carpal tunnel syndrome (CTS) occurs when certain nerves are compressed at the wrist leading to numbness, tingling, and pain in the fingers and hand.

The symptoms are caused by the squashing of the median nerve. Exactly why this happens is unknown. If a tendon that passes through the carpal tunnel becomes inflamed and swells it may put pressure on the nearby median nerve. Other influencing factors are:

  • Bone conditions in the wrist – such as rheumatoid arthritis, which can cause thickening of the ligament that covers the carpal tunnel
  • Wrist injuries – such as joint dislocations and fractures
  • Hormonal changes – such as an underactive thyroid gland (hypothyroidism), an overactive thyroid gland (hyperthyroidism), the menopause, or taking oral contraceptive pills
  • Other conditions – such as pregnancy, obesity, and diabetes mellitus, which can cause water retention (oedema) and swelling in the wrist
  • Rare conditions – such as cysts, growths, or swellings of tendons or blood vessels in the carpal tunnel

There are claims that CTS can be caused by repetitive activities such as working on an assembly line, but the correlation remains unclear. One study found that heavy computer use (up to seven hours a day) does not increase the risk.


Symptoms of carpal tunnel syndrome usually start gradually, with frequent sensations of numbness and burning or tingling (paresthesia) in the palm of the hand and the thumb, index, and middle fingers. This may first occur at night in one or both hands, since many people sleep with their wrists flexed which further compresses the carpal tunnel.

As the condition progresses, you may have trouble gripping or making a fist, and later suffer weakness, dropping objects unexpectedly. There is often continued pain or aching in the hand and sometimes the lower forearm.

Early Carpal tunnel syndrome symptoms are often mistakenly put down to restricted blood circulation. However, it’s important to note that unless there’s significant numbness or paresthesia present, it’s unlikely that CTS will be diagnosed. Diagnosis requires a medical history for associated conditions and a physical examination using one or more of the following techniques:

  • Phalen’s manoeuvre involves flexing the wrist gently as far as possible and awaiting symptoms
  • Tinel’s sign involves lightly tapping the area over the nerve to elicit symptoms
  • The carpal compression test involves applying a firm pressure over the nerve to elicit symptoms
  • A muscle test or EMG (electromyography) measures the electrical activity of the resting and tensed muscle with a fine needle.


There are a number of Carpal Tunnel Syndrome treatment options. Simply resting the wrist by not squeezing or gripping may help, as will losing weight (if you are overweight) or seeking treatment for existing conditions (such as arthritis).

Direct treatments for CTS include:

  • Wrist splints – these hold the wrist in a fixed position to maximise space in the carpal tunnel. They are worn day or night.
  • Non-steroidal or anti-inflammatory drugs (NSAIDSs) – such as aspirin or ibuprofen can reduce inflammation and relieve pain.
  • Corticosteroids – taken orally or injected into the wrist will reduce inflammation and ease other symptoms.
  • Diuretic tablets – will help you pass urine and therefore reduce fluid retention to minimise swelling.
  • Ultrasound treatment – for a minimum of 20 sessions can relieve symptoms in some people, although it is not understood why.
  • Wrist and finger exercises – relieve pressure on the median nerve but could also make the condition worse.
  • Surgery – may be required if Carpal Tunnel Syndrome symptoms are persistent or severe. Under local anaesthetic, the carpal ligament is cut to release pressure on the median nerve.

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