What it is
Carpal tunnel syndrome is the compression of the median nerve where it passes through the wrist. Numbness or tingling in the thumb, index, middle, and part of the ring finger is typical. Night waking, reduced pinch, and clumsiness follow in more advanced cases.
Care reduces pressure on the nerve, restoring strength and dexterity. Splinting and task changes help early. Surgery is considered when symptoms persist or weakness continues to progress.
What happens when it occurs
Inflamed tenosynovium, fluid shifts, or wrist positions that narrow the tunnel raise pressure around the nerve. Night flexion and desk postures are common drivers. Calming the nerve with neutral wrist splinting and graded loading restores comfort and function.
Common causes and risk factors
- Prolonged or repeated wrist flexion or extension in work or sleep
- Pregnancy‑related fluid changes
- Diabetes and thyroid disease
- Repetitive grip and vibration exposure
Who is most affected
Adults in desk‑based roles, manual work with tools, and during pregnancy. Women present more often than men.
Typical symptoms
- Night tingling or numbness in the median‑innervated fingers
- Hand clumsiness, dropping objects, weak pinch
- Symptoms with prolonged driving, phone, or keyboard use
When to seek care
If numbness persists, if weakness appears, or if night waking continues despite simple changes.
How we diagnose
History and examination (Phalen’s, Tinel’s, sensory testing, thenar strength). Nerve conduction studies are used when the diagnosis is uncertain, for persistent symptoms, or before surgery to assess nerve function.
Management
- Night wrist‑neutral splinting and reducing prolonged flexion or extension
- Task and workstation changes to reduce pressure
- Tendon and nerve gliding drills were kept mild and brief
- Strength for the forearm and intrinsic hand muscles
- Steroid injection for selected persistent cases
- Surgical release (open or endoscopic) when weakness or persistent symptoms remain
Rehabilitation milestones
Phase 1 weeks 0–2: splinting, position changes, gentle glides.
Phase 2 weeks 2–8: progressive strength and dexterity, posture endurance, task practice.
Post‑op: protect wound, early motion, gradual strength with return to work by criteria.
Readiness to progress
- No night waking and symptoms stable
- Pinch and grip improving toward targets
- Workdays completed without next‑day flare
Long-term care
- Avoid long periods of extreme wrist positions
- Pad tool handles and desk edges
- Maintain forearm and hand strength
Australia snapshot
- Among the most common nerve entrapments managed in Australian clinics
- Women present more often, and pregnancy commonly reveals symptoms
- Most improve with splinting and task change; surgical outcomes are strong when needed
Latest insights
Position is medicine. Night‑neutral splinting changes symptoms quickly.
Dexterity returns as the nerve calms and strength rises.
