General info

Data about the condition

The carpal tunnel is literally that: a tunnel. It is a narrow passageway running from the base of the hand’s palm to just above the wrist. The “walls” of the carpal tunnel are formed by wrist and hand bones, and “the roof” is a ligament that runs lengthwise across the wrist known as the transverse carpal ligament.

Carpal tunnel syndrome (CTS) is an entrapment neuropathy caused by compression of the median nerve as it travels through the wrist’s carpal tunnel.

Pain also can radiate up the affected arm. With further progression, hand weakness, decreased fine motor coordination, clumsiness, and thenar atrophy can occur.

Articulațiile mâinii, Sindromul Tunelului Carpian
Articulațiile mâinii, Sindromul Tunelului Carpian


Early symptoms of carpal tunnel syndrome include pain, numbness, and paresthesias. Symptoms typically present, with some variability, in the thumb, index finger, middle finger, and the radial half (thumb side) of the ring finger.


Carpal tunnel syndrome results from increased pressure in the carpal tunnel and subsequent compression of the median nerve. The most common causes of carpal tunnel syndrome include genetic predisposition, history of repetitive wrist movements such as typing, or machine work as well as obesity, autoimmune disorders such as rheumatoid arthritis, and pregnancy.


The initial, nonsurgical treatment options recommended for carpal tunnel syndrome include the following:

  • Resting the affected hand and wrist for at least two weeks. This includes avoiding whatever activities usually trigger pain.
  • Wearing a splint at night to immobilize the wrist in a neutral position. This is a good solution for people with mild to moderate carpal tunnel syndrome whose symptoms flare up for a few weeks, then dissipate. It is important to take occasional breaks from wearing the splint, as constant wear can contribute to joints stiffening and muscles weakening.
  • Ice therapy can reduce swelling and numb pain signals in the wrist and hand. When using ice or a cold pack, limit sessions to no more than 20 minutes and use a barrier between ice and skin to protect the skin from damage.
  • Workplace changes to improve ergonomics or reduce repetitive motions may be helpful. For assembly workers, this may include more frequent breaks or a temporary shift in assigned duties. For office workers, this may include the use of an ergonomic keyboard or supportive mousepad. However, there is not much evidence that modified computer equipment can prevent or relieve symptoms.

The objectives of the Recovery Program


The objectives of the Recovery Program

If you have mild or moderate symptoms of carpal tunnel syndrome, you may be able to relieve the pain with a few simple exercises. You will get the best results if you do them with other treatments, such as using a splint and adjusting your activities so that they reduce the pressure on your hand and wrist.

  • Shake your hand – This exercise is very easy. It is especially useful at night, when symptoms may be worse. If you wake up in pain or numbness, just shake your hands for relief.
  • Fist to the fans – Squeeze your fist and then open your fingers as an event, and stretch them as far as you can. Repeat 5-10 times.
  • Touch thumb – One at a time, touch the tip of each finger with your fingertip so that you get a round shape. Repeat a few times.
  • Massage therapy can help treat and prevent carpal tunnel syndrome by promoting circulation, relieving inflammation, helping to eliminate metabolic residues and soothing irritated muscles and tendons. Apply light pressure to the muscles in the shoulder, arm, wrist and hand. Start the massage with light touches and avoid too much pressure. Start from the shoulder and move your arm to the small muscles on your wrist and fingers. Use your palm, thumb and fingers to apply the massage.
  • Hydrotherapy, this alternative remedy is effective not only for relieving pain, but also for reducing inflammation and promoting the body’s natural healing process. During a session, the affected hand and wrist can be immersed in warm water for a few minutes, followed by a shorter exposure to cold water.

Methodical Indications

If carpal tunnel syndrome is identified early conservative treatment is recommended.

  • Initially, the patient should be instructed in modifying symptom provoking wrist movement, For example, proper hand ergonomics such as placing the keyboard at a proper height and minimizing flexion, extension, abduction, and adduction of the hand when typing.
  • It should be recommended to decrease repetitive activities if possible.
  • Non-surgical treatment comprises ,vitamin B6  and splinting/hand brace.

Did you know ?

  • It is the most common nerve entrapment neuropathy, accounting for 90% of all neuropathies.
  • The prevalence of carpal tunnel syndrome is estimated to be 2.7-5.8% of the general adult population, with a lifetime incidence of 10-15%, depending on occupational risk 4.
  • Carpal tunnel syndrome usually occurs between ages 36 and 60 and is more common in women.
  • 1.O’connor D, Page MJ, Marshall SC, Massy-westropp N. Ergonomic positioning or equipment for treating carpal tunnel syndrome. Cochrane Database Syst Rev. 2012;1:CD009600.
  •  Radiopedia CTS Available from: (last accessed 23.3.2020)
  • Jump up↑ Michelsen H, Posner MA. Medical history of carpal tunnel syndrome. Hand clinics. 2002 May 1;18(2):257-68.
  • Jump up↑ Bagatur A.E., Zorer G. The carpal tunnel syndrome is a bilateral disorder. J Bone Joint Surg Br. 2001;83(5):655–658.
  • Jump up↑ Schuind F., Ventura M., Pasteels J.L. Idiopathic carpal tunnel syndrome: histologic study of flexor tendon synovium. J Hand Surg Am. 1990;15(3):497–503.
  • Jump up↑ Gray, Henry. Anatomy of the Human Body. Philadelphia: Lea & Febiger, 1918;, 2000. [Date of Printout].
  • Jump up↑ Jesus Filho AG, do Nascimento BF. Comparative study between physical examination, electroneuromyography and ultrasonography in diagnosing carpal tunnel syndrome. Revista Brasileira de Ortopedia (English Edition). 2014 September–October; 49(5): 446–451.
  • ↑ Jump up to:10.0 10.1 10.2 10.3 Ashworth NL, MBChB. Carpal Tunnel Syndrome Clinical Presentation [Internet]. 1994 [Updated 2014 Aug 25; cited 2015 March 20].fckLRAvailable from:fckLR
  • ↑ Jump up to:11.0 11.1 Krom de M.C.T.F.M., MD, KnipschildP.G. Prof. Efficacy of provocative tests for diagnosis of carpal tunnel syndrome. The Lancet. 1990 Feb 17; Vol.335 Issue 8686: 393-395.
  • Jump up↑ Hadi M, Gibbons E, Fitzpatrick R. A structured review of patient-reported outcome measures for procedures for carpal tunnel syndrome. Oxford: Departmet of Public Health (University of Oxford); 2011. 33p.
  • Jump up↑ Sambandam SN, Priyanka P, Gul A, Ilango B. Critical analysis of outcome measures used in the assessment of carpal tunnel sundrome. Int Orthop. 2008 Aug; 32(4):497-504.
  • ↑ Jump up to:14.0 14.1 14.2 14.3 14.4 14.5 14.6 O’Connor D, Marshall SC, Massy-Westropp N, Pitt V. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome (Review). The Cochrane database of systematic reviews. 2012; volume (7):1-106.
  • ↑ Jump up to:15.0 15.1 15.2 15.3 15.4 15.5 Huisstede BM, Hoogvliet P, Randsdorp MS, Glerum S, van Middelknoop M, Koes BW. Carpal Tunnel Syndrome. Part I: Effectiveness of Nonsurgical Treatments–A Systematic Review. Archives of physical medicine and rehabilitation. 2010 Jul; 91(7):981-1004.

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