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Carpal-tunnel-syndrome | Blog | Physio.co.uk | Leading physiotherapy provider in Liverpool and Manchester.

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What is it?

Carpal tunnel syndrome (CTS) is the most common non traumatic cause of wrist and hand pain and can be related to chronic neck, shoulder and arm complaints.

The symptoms are caused by irritation to the median nerve at the level of the ‘carpal tunnel’, which is an anatomical area situated on the palm side of the lower forearm.

This results in tingling, numbness, pain and muscle weakness experienced within the hand and can often (in 55-65% of people) present bilaterally (ie on both sides of the body) at some point.

There is thought to be an association with other medical conditions but more so with workplace duties and postures. Working in sustained postures that require adopting a flexed or extended wrist position, using high levels of arm vibration or hammering, or performing repetitive hand movements for a lengthy period of time can lead to increased pressure at the carpal tunnel.

This increased pressure at the carpal tunnel area can result in irritation or compression to the median nerve, which can result in impeded function. Long term compression could lead to local demyelination (loss of nerve insulation) and even axonal loss (nerve damage).

Carpal tunnel

Carpal tunnel

Who gets it?

It is estimated that as much as 7-16% of the UK population experience CTS symptoms at some point in their lives. People that are affected include:

  • 3-4 times as many women than men
  • People usually in their 40’s and above
  • Associated with obesity, rheumatoid conditions, diabetes, dysfunction to thyroid gland, pregnancy and renal dialysis therapy
  • Previous history or family history of genetically acquired neuropathy
  • People using some types of oral contraceptives
  • People using medications that cause fluid retention

What are the symptoms?

Patients with Carpal Tunnel Syndrome will normally complain of the following issues:

  • History of pins and needles in the hand, which is often worse at night
  • Altered sensation and/or pain in the distribution of the median nerve area (outermost 3 ½ digits of the hand- see below)
  • Reduction of grip strength
  • Writer’s cramp
  • Sensitivity to cold temperatures
  • Pain exacerbated by sustained positions at work
  • Positive ‘Flick sign’ – shaking of hands eases symptoms
Median nerve distribution

Median nerve distribution

What we look for in clinic

  • Tinel’s sign – this is when we tap on and around the median nerve to attempt to reproduce the symptoms
  • Phalen’s test – holding the below position for up to 30 seconds and the symptoms being replicated would be a positive test
  • Weakness of abductor pollicis brevis (the thumb muscles responsible for performing a ‘pincer’ grip)
  • Sensory and motor (movement) deficits during specific testing
  • Subjectively demonstrating CTS using the below questionnaire:

Questionnaire for CTS

What are the stages of CTS?

  • Stage 1 – Frequent sleep disturbances with reports of pain from the wrist to the shoulder and tingling in hands and fingers. Shaking the hands relieves symptoms. There can be a persistent sensation of hand stiffness in the mornings
  • Stage 2 – Symptoms are persistent during the day which are exacerbated by sustained wrist postures or repetitive wrist and hand movements. There could also be motor deficits at this stage when the patient may have dropped an object because they are unable to feel their fingers
  • Stage 3 – Atrophy (muscle wasting) may start to be seen in the thenar eminence (musculature at the base of the thumb). This is evidence of an extended period of time where the conductivity of muscles has been hindered. In this stage, the sensory symptoms may start to reduce and unfortunately surgical decompression is often not successful.

What can physiotherapy do to help?

If symptoms are mild and infrequent there is a possibility that the symptoms could resolve spontaneously within months. However, with persistent symptoms then it is advised to seek professional help.

Current research advocates the use of physiotherapy to assist with treating CTS in the first two stages of the condition. Treatments may include performing specific mobilisations at the wrist joint, as well as nerve ‘glide’ exercises and massage.

Additionally, work or activity modifications and additional adjuncts (such as specific splints) may be considered to reduce symptoms, in conjunction with an individually tailored home exercise plan.

Furthermore, alternative grip techniques and equipment adaptations may be considered for manual workers in order to allow continuation of daily activities.

If you are experiencing any of the above symptoms mentioned and would like to book an assessment with one of our therapists, please get in touch on 0330 088 7800 or by visiting physio.co.uk.


Ballestero-Pérez R, Plaza-Manzano G, Urraca-Gesto A, et al (2017) Effectiveness of Nerve Gliding Exercises on Carpal Tunnel Syndrome: A Systematic Review, In Journal of Manipulative and Physiological Therapeutics, Volume 40, Issue 1, 2017, Pages 50-59

Bouter L, De Vet H., Schoulton, Van Molen M, Uitdehaagh BMJ. (2012). Surgical Treatment Options for Carpal Tunnel Syndrome. Huisstede BM, Hoogveliset P, Manon RS, Glerum S et al. Carpal Tunnel Syndrome. Part I: Effectiveness of non-surgical treatment. Pp. 958.

Burke FD, Ellis J, McKenna H, et al (2003) Primary care management of carpal tunnel syndrome Postgraduate Medical Journal;79:433-437

Huisstede BM., Randsdrop MS., Coert H et al. (2010). Carpal Tunnel Syndrome. Part II: Effectiveness of Surgical Treatment – a systematic review. Arch Phys Med Rehab. Vol. 91. Pp. 1005-1023.

Ibrahim I, W.S. Khan, N. Goddard and P. Smitham (2012).  Carpal Tunnel Syndrome: A Review of the Recent Literature. Orthopaedics Journal (Suppl 1: M8) 69-76.

Wolny T, Saulicz E, Linek P et al (2017) Efficacy of Manual Therapy Including Neurodynamic Techniques for the Treatment of Carpal Tunnel Syndrome: A Randomized Controlled Trial, In Journal of Manipulative and Physiological Therapeutics, Volume 40, Issue 4, Pages 263-272