Your Handy Guide to Carpal Tunnel Syndrome Treatment

One of the most common hand injuries is the Carpal Tunnel Syndrome (CTS), a progressive condition that affects the hand and wrist. It can cause significant discomfort due to the pressure on the compressed median nerve. While it's often associated with overuse and repetitive motions, it can also develop following a direct injury to the wrist. CTS can often be treated effectively without surgery, especially when diagnosed and treated early.

In this guide, we'll explore this condition in depth — from causes and symptoms to diagnosis, treatment, and prevention — using a clear and practical approach. We'll also cover management strategies, preparation for carpal tunnel release surgery (if needed), and conservative treatments like hand therapy. But let's first understand the basics.

Carpal Tunnel Syndrome – Definition

The carpal tunnel is a narrow passage made up of bones (carpal bones) and the transverse carpal ligament. Swelling within this tunnel leads to nerve compression, causing pain, numbness, and weakness. This is when carpal tunnel syndrome occurs, running from the forearm into the hand and eventually compressing the wrist.

CTS can range in severity:

• Mild (Early Stage): Occasional numbness or wrist pain, especially at night
• Moderate: Persistent symptoms that interfere with daily activities
• Severe (Advanced Stage): Permanent nerve damage, muscle atrophy, and significant loss of hand function

Causes of Carpal Tunnel Syndrome

Carpal tunnel syndrome arises from increased pressure within the carpal tunnel, leading to compression of the median nerve as it passes through the wrist into the palm. This pressure increase is often multifactorial, involving various anatomical and physiological factors: 

- Anatomical Factors

• A naturally narrow carpal tunnel, which may be hereditary
• Smaller carpal tunnel size in women, making them more susceptible
• Structural changes in bones and joints due to conditions like osteoarthritis or wrist trauma

- Swelling and Inflammation

• Repetitive hand movements or prolonged wrist flexion/extension
• Inflammatory conditions such as rheumatoid arthritis
• Hormonal or metabolic changes, including those during pregnancy, menopause, or thyroid imbalances

- Other Contributing Factors

• Fluctuations in blood sugar levels, as seen in type 2 diabetes
• Wrist injuries like strains, sprains, dislocations, or fractures
• Obesity, which can increase pressure within the carpal tunnel
• Fluid retention in pregnant or menopausal women
• Underlying medical conditions and certain autoimmune diseases
• Prolonged exposure to vibrations, such as from using certain power tools
• Weight gain, high blood pressure, and addictive habits like smoking and alcohol consumption

Risk Factors for Carpal Tunnel Syndrome

Certain people are more likely to develop CTS, as suggested by the causes we've outlined above. Common risk factors include:

• Ageing - CTS is more common in the elderly
• Gender - women are at higher risk, especially during pregnancy
• Obesity or excess weight
• Medical conditions such as diabetes, rheumatoid arthritis, and hypothyroidism
• Workplace ergonomics - roles that require frequent or forceful repetitive wrist movement
• Past wrist injuries or a chronic ankle sprain history
• Other conditions like cubital tunnel syndrome or patellofemoral pain syndrome may co-exist or worsen the risk

Symptoms of Carpal Tunnel Syndrome

Carpal tunnel syndrome symptoms typically develop gradually and affect the thumb, index, middle, and part of the ring finger, which are all areas supplied by the median nerve. Symptoms may come and go at first, but often worsen over time without treatment. Common signs include:

1. Numbness and Tingling

• You may feel numbness or a “pins and needles” sensation, especially in the thumb, index, and middle fingers.
• These sensations often occur at night or when waking up, and may be relieved by shaking or moving the hand.
• Over time, these symptoms can become constant during the day, especially during activities like holding a phone or steering wheel.

2. Pain or Discomfort

• Aching pain may radiate from the wrist into the palm or up the forearm.
• Pain often worsens with repetitive hand use or prolonged wrist flexion.
• Some people report a burning or cramping sensation in the hand.

3. Weakness and Clumsiness

• You might notice a weakened grip, making it harder to hold objects, turn keys, or open jars.
• Fine motor skills can be affected, leading to frequent dropping of items.
• Muscle atrophy (wasting) in the base of the thumb can occur in advanced cases, particularly in the thenar eminence.

4. Sensory Loss

• In severe or prolonged cases, there may be decreased sensitivity to touch, heat, or cold in the affected fingers.
• This can interfere with tasks requiring tactile feedback, such as typing or buttoning clothes.

5. Symptoms in Both Hands

• Although symptoms often start in the dominant hand, many people eventually experience carpal tunnel syndrome in both hands.

These symptoms can mimic or overlap with other conditions, so it’s important to seek medical evaluation, especially if symptoms persist, worsen, or interfere with daily activities.

How Is Carpal Tunnel Syndrome Diagnosed

To diagnose carpal tunnel syndrome, doctors rely on a combination of clinical assessment and tests. They will start by asking about your symptoms: when they began, what makes them improve or worsen, and whether they affect your daily activities. They’ll also ask about:

• Your job and repetitive hand use
• Any past injuries to the wrist
• Underlying health conditions like diabetes or thyroid problems

Examination and Tests

The doctor will examine your hand, wrist, and arm, looking for signs such as:

• Numbness or tingling in the thumb, index, and middle fingers
• Weak grip strength or muscle wasting at the base of the thumb
• Reduced sensation or delayed response to touch

Several quick clinical tests may be done to reproduce symptoms:

• Tinel’s Sign: Tapping over the median nerve at the wrist to see if it triggers tingling or pain
• Phalen’s Test: Bending your wrists together (backs of the hands touching) for 60 seconds to see if numbness or tingling occurs
• Durkan’s Test: Applying pressure directly over the carpal tunnel to provoke symptoms

These are quick, in-clinic screening tools used widely by family physicians in Singapore and sports clinicians.

Imaging

Though not always necessary, imaging such as ultrasound (peripheral nerve ultrasound) or MRI helps rule out other conditions and assess the transverse carpal ligament.

• Ultrasound or MRI may be used if there’s a suspected mass, ganglion cyst, or structural abnormality.
• X-rays aren’t typically used to diagnose carpal tunnel itself, but may rule out fractures or arthritis.

Electromyogram and Nerve Conduction

A nerve conduction study and electromyogram (EMG) are key to confirming CTS and assessing its severity. These tests measure how well the median nerve transmits electrical signals and detect nerve damage. These are the go-to tests if the diagnosis isn’t clear:

• Nerve conduction study: Measures how fast electrical impulses travel through the median nerve; slower speeds can indicate compression.
• Electromyography (EMG): Evaluates muscle activity and can help rule out other conditions like nerve root problems or other neuropathies.

Carpal Tunnel Syndrome Treatment

You might ask, "How is carpal tunnel syndrome treated?" The answer depends on the severity of your symptoms. In early or moderate stages, non-invasive methods are often effective in providing carpal tunnel relief without surgery.

Conservative Treatments and Medication

Most treatment plans begin with conservative options to reduce pressure on the median nerve:

• Wrist splinting: Commonly used at night, wrist splints help keep the wrist in a neutral position, easing compression on the nerve.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): These relieve pain and reduce inflammation in the wrist area.
• Corticosteroid injections: For persistent symptoms, steroid injections into the carpal tunnel space can reduce swelling and provide temporary relief, even in advanced stages.

These conservative treatments are often first-line options recommended in carpal tunnel syndrome brochures and public health resources from Singapore's medical research groups.

Physiotherapy

Physiotherapy plays a key role in helping patients manage carpal tunnel syndrome, especially when guided by rehabilitation professionals like Phoenix Rehab. A physical or occupational therapist may recommend:

• Nerve gliding exercises or gentle movements help the median nerve move freely within the carpal tunnel
• Wrist and hand strengthening to support surrounding muscles and reduce strain on the wrist
• Ergonomic education, helping patients minimize repetitive wrist motions and improve posture during activities
• Physiotherapy for wrist pain, which may include soft tissue mobilisation, ultrasound therapy, or taping techniques to relieve pain, reduce swelling, and restore normal wrist function over time

Additionally, many patients see improvement when guided by clinics like the Exercise Medicine Centre (often referred to as the Sports and Exercise Medicine Centre or SEMC) or members of the Singapore Healthy Youth Committee.

Carpal Tunnel Release Surgery and Neurolysis

When nonsurgical treatments fail, doctors may recommend:

• Open carpal tunnel release: The transverse carpal ligament is cut to relieve pressure
• Endoscopic carpal tunnel release: A less invasive method using a small camera (popular in sports medicine settings)
• Neurolysis: Sometimes done alongside carpal tunnel surgery to free the median nerve from scar tissue

These procedures, supported by orthopaedic surgery units and CGH medical audit committee guidelines, are usually effective when properly timed.

What You Can Do

Simple lifestyle changes can help treat carpal tunnel syndrome or complement ongoing care:

• Take regular breaks during activities involving the hands.
• Improve wrist posture using ergonomic keyboards or tools.
• Maintain a healthy weight.
• Manage chronic conditions like diabetes or neck pain.
• Use cold packs to reduce swelling.
• Practise nerve gliding exercises daily.

These adjustments are encouraged in community outreach by the Medicine Singapore Public Outreach and Sports Safety Committee.

Preparing for Your Doctor’s Appointment

Before seeing a healthcare provider, prepare well to make the most of the visit and make your appointment more productive.

Start by noting down your symptoms: when they began, what makes them worse, and how they affect your daily tasks. If you’ve tried any conservative treatments like wearing a wrist splint or doing nerve gliding exercises, be ready to share those details. Bring a list of medications, and if your job or hobbies involve repetitive movements, mention them.

Don’t hesitate to ask questions. Knowing enables you to make informed decisions for treating carpal tunnel syndrome effectively.

What To Ask Your Doctor

What is likely causing my carpal tunnel syndrome symptoms?

• Do I need a nerve conduction study or other diagnostic tests to diagnose carpal tunnel syndrome?
• Am I a candidate for carpal tunnel syndrome surgery?
• What are the pros and cons of endoscopic carpal tunnel release versus open surgery?
• Are there nonsurgical treatments I can try first to relieve pain and manage carpal tunnel syndrome?
• What lifestyle changes or home care options can support carpal tunnel relief?

Taking an active role in your care leads to good results, whether you opt for physiotherapy, carpal tunnel release surgery, or other approaches.

Preventing Carpal Tunnel Syndrome

While not always avoidable, CTS can often be prevented or its progression slowed:

• Optimise your workstation: Use ergonomic tools and adjust your hand and wrist position to relieve pressure on the median nerve.
• Perform daily stretches and strengthening exercises: Regular movement helps reduce stiffness and supports thumb muscles and surrounding tendons.
• Take breaks during repetitive tasks: Whether typing, using tools, or playing an instrument, pause often to reduce swelling and strain.
• Stay physically active: As recommended by the Sports Medicine Association Singapore, general activity promotes circulation and musculoskeletal health.
• Use proper gear during physical activities: Wear wrist guards or supports for activities like weightlifting, cycling, or fencing — guidance supported by the Singapore sports safety committee.
• Monitor other joint or nerve conditions: If you have conditions like cubital tunnel syndrome, neck pain, or a chronic ankle sprain, they may influence how you use your hands and wrists.

Promoting carpal tunnel syndrome prevention is a public health goal highlighted in Medicine Singapore campaigns and health conference working committee initiatives.

Conclusion

Carpal tunnel syndrome is a manageable condition if recognised early and treated properly. From nonsurgical treatments to carpal tunnel release surgery, patients have a wide range of options to regain hand function and relieve symptoms. Whether you’re facing mild tingling or moderate symptoms, the key is timely diagnosis and a tailored approach to treatment. Speak to a specialist, follow through with care, and take steps to prevent carpal tunnel syndrome in the future.