Carpal Tunnel Syndrome

By Kim Segler, OTR/L, CHT

What Causes Carpal Tunnel Syndrome?

By: Kim Segler, OTR/L, CHT

Carpal tunnel syndrome is a common condition in which the median nerve is squeezed or compressed as it travels through the wrist, causing numbness, tingling, and pain to the thumb, index finger, long finger, and half of the ring finger.

Carpal tunnel syndrome is a common injury treated by orthopedic surgeons.

Illustration of the carpal tunnel.


The carpal tunnel is a narrow corridor that is about an inch wide. The small wrist bones form the floor, and the sides are the carpal bones. The roof is a strong band of connective tissue which is the transverse carpal ligament. These boundaries are very rigid and do not allow the area to stretch and enlarge. The median nerve runs through the carpal tunnel and nine flexor tendons that bend the fingers and thumb. Furthermore, this syndrome occurs when the tunnel becomes narrowed or tissues around the tendons swell, causing pressure on the nerve.

Causes of Carpal Tunnel may include:

  • Trauma or injury to the wrist.
  • Heredity – This syndrome may be smaller in some people, or there may be anatomic differences that affect the nerve’s amount of space.
  • Pregnancy- Hormonal changes may cause swelling.
  • Health Conditions- Rheumatoid arthritis, Diabetes, Overactive pituitary gland, Underactive thyroid gland
  • Repetitive hand use – Repeating the same wrist motions or using vibratory tools for an extended period of time.
  • Hand and wrist position – Performing activities that involve extreme flexion or extension of the hand and wrist for a prolonged period of time.
  • Sleeping with the wrist in extremes of flexion or extension.

What Will Happen if Carpal Tunnel Syndrome is not Treated?

In most cases, the symptoms begin gradually without a specific injury and worsen with time. Most patients find that their symptoms come and go at first. As the condition worsens, their symptoms may occur more frequently and for longer periods of time. Symptoms could also go away and then come back. Nighttime symptoms are common and may awaken you from sleep. In addition, holding things for a prolonged period of time may bring on symptoms. When diagnosed early, carpal tunnel syndrome is easier to treat. Watch this   VIDEO on why hand pain can’t wait for treatment.

What is the Best Treatment for Carpal Tunnel?

If the diagnosis and treatment starts early, the quick answer is relief can occur without surgery using conservative treatment.

  • Splinting  – a splint that keeps your wrist in a straight position to avoid bending your wrist while sleeping and to avoid movements that increase your pain and numbness.
  • Non-steroidal anti-inflammatories – Medications can reduce pain and inflammation.
  • Activity modification – Changing the way you perform activities keeps your wrist flexed or extended for too long.
  • Nerve gliding – Specific movement patterns where recommendations come from your doctor or therapist that allow the nerve to glide more easily through the carpal tunnel
  • Steroid injections – Cortisone is an anti-inflammatory that may decrease swelling to decrease pain and numbness.
  • Surgery- A carpal tunnel release involves severing the ligament around the wrist to increase the carpal tunnel’s size and reduce pressure on the median nerve.

When Do I Need Surgery?

carpal tunnel syndrome causes numbness in fingers an wrist pain

Carpal tunnel syndrome surgery at JOI

If your carpal tunnel syndrome is not responding to other treatments, i.e… Splinting, activity modification, anti-inflammatories, or steroid injections, then you will need a surgical consult. If you wait too long to have surgery and the nerve is compressed long enough, there will be muscle wasting and permanent nerve damage.

A carpal tunnel release surgery may be performed in two ways: Endoscopic release where the doctor makes a small incision on the wrist and uses a miniature camera called an endoscope to see inside the wrist and a small knife to sever the transverse ligament to relieve pressure on the median nerve. An open carpal tunnel release may be performed by making a small incision in the palm, and the doctor views the inside of the wrist through the incision. The transverse ligament is divided, increasing the size of the carpal tunnel. In most cases, this surgery is done on an outpatient basis. The decision to have surgery is based on the severity of the symptoms.

An ActivArmor cast can help with carpal tunnel syndrome pain

An ActivArmor cast can help with pain from carpal tunnel syndrome

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JOI Rehab

Whether you are suffering from back issues, joint pain, or injuries resulting from any activity, JOI has 12 physical therapy clinics conveniently located in Jacksonville and Northeast FL that specialize in orthopedic rehab.  JOI has the most CHT’s or Certified Hand Therapists to treat carpal tunnel in the Jacksonville.  Give us a call to get you back on the road to recovery.
If you are interested in scheduling an appointment at JOI Rehab for physical therapy, call (904) 858-7045. Come see us!
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