Carpal Tunnel Syndrome

Waking up at night with a numb, tingling hand. Dropping things you should be able to hold. A persistent ache in the wrist that worsens with typing and eases when you shake your hand out. These are the classic symptoms of carpal tunnel syndrome — the most common peripheral nerve entrapment condition in the body. The median nerve, which supplies sensation to the thumb, index, middle and the thumb-side of the ring finger, passes through the carpal tunnel, a narrow fibrous channel at the wrist — and when the pressure inside that tunnel rises, the nerve is compressed.

The carpal tunnel is bounded on three sides by the carpal bones and on the fourth by the transverse carpal ligament, a rigid band. Nine flexor tendons pass through it alongside the median nerve, and the space is fixed — it cannot expand. The most common contributor is tenosynovitis: inflammation and thickening of the tendon sheaths that increases the effective volume of content within the tunnel, often from repetitive wrist and finger movement, particularly sustained wrist flexion during typing or mouse use. Wrist position matters directly — tunnel pressure is lowest with the wrist neutral, and rises significantly with sustained flexion or extension, which is exactly why symptoms are worst at night and during prolonged typing.

Systemic factors — pregnancy, hypothyroidism, diabetes, rheumatoid arthritis, obesity — all increase susceptibility, and a smaller carpal tunnel cross-section is one reason women are affected significantly more often than men. For mild-to-moderate cases, the evidence for conservative management is good: physiotherapy produces outcomes comparable to surgery at one year. Splinting the wrist in neutral at night, nerve and tendon gliding exercises, manual therapy to the wrist joint, and ergonomic correction are the core of that programme.