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, and they affect more people in Bangalore’s desk-working population than most people realise.
Carpal tunnel syndrome is pressure on the median nerve inside a fixed space at the wrist — the most common nerve entrapment in the body. For mild-to-moderate cases, physiotherapy produces outcomes comparable to surgery at one year: a neutral-position night splint (often the fastest relief), nerve and tendon gliding exercises, and ergonomic correction of wrist position during typing. Surgery is reserved for severe cases with thenar muscle wasting or those that fail a genuine conservative trial.
Carpal tunnel syndrome is 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. When the pressure inside this tunnel rises, the nerve is compressed, and the characteristic symptoms result. Understanding what increases that pressure, and what reduces it, is the foundation of effective management.
What Causes Carpal Tunnel Syndrome
The carpal tunnel is bounded on three sides by the carpal bones of the wrist and on the fourth by the transverse carpal ligament, a rigid fibrous band. Nine flexor tendons also pass through the tunnel alongside the median nerve. The space is fixed — it cannot expand. When anything increases the volume of content within the tunnel, pressure rises and the nerve suffers first, because nerve tissue is more sensitive to compression than tendon.
The most common contributor is tenosynovitis of the flexor tendons — inflammation and thickening of the tendon sheaths that increases the effective volume of the tendons within the tunnel. Repetitive wrist and finger movements, particularly sustained wrist flexion during typing or mouse use, contribute to this over time.
Wrist position is directly relevant. Carpal tunnel pressure is lowest with the wrist in a neutral position, roughly zero to ten degrees of extension. Sustained wrist flexion — the position many people hold their wrists in while typing without a wrist rest — and sustained extension both significantly increase tunnel pressure. This is exactly why symptoms are worst at night, when many people sleep with their wrists flexed, and during prolonged typing.
Systemic factors increase susceptibility: pregnancy (fluid retention raises tunnel pressure), hypothyroidism, diabetes, rheumatoid arthritis, and obesity are all associated with higher rates of carpal tunnel syndrome. Anatomical variation plays a role too — a smaller carpal tunnel cross-section, one reason women are significantly more commonly affected than men, reduces the margin before nerve compression occurs.
Symptoms and Telling CTS Apart From Other Conditions
Classic symptoms are concentrated in the median nerve distribution: the thumb, index, middle, and thumb-side of the ring finger. The little finger should be unaffected, which helps distinguish carpal tunnel syndrome from ulnar nerve entrapment (cubital tunnel syndrome), which affects the little and ring fingers.
Night symptoms are characteristic — waking in the early hours with a numb, tingling, or burning hand, often relieved by hanging the hand down or shaking it out. This happens because lying down reduces gravitational venous drainage from the arm, increasing tissue pressure, and many people sleep in positions that flex the wrist. Severe or long-standing carpal tunnel syndrome causes weakness and wasting of the thenar muscles (the pad of muscle at the base of the thumb) — a sign that intervention shouldn’t be delayed.
Not all hand numbness and tingling is carpal tunnel syndrome. Cervical nerve root compression from disc herniation or cervical spondylosis can produce similar symptoms, and thoracic outlet syndrome, where the brachial plexus is compressed between the first rib and clavicle, can mimic it too. A careful clinical assessment distinguishes between these conditions.
Physiotherapy for Carpal Tunnel Syndrome
The evidence for conservative management of mild-to-moderate carpal tunnel syndrome is good. Surgery is clearly more effective for severe cases with significant neurological compromise, but for mild-to-moderate presentations, physiotherapy produces outcomes comparable to surgery at one year.
Wrist splinting in a neutral position, particularly at night, is one of the most evidence-supported conservative interventions. The neutral splint prevents the wrist falling into a flexed position during sleep, reducing overnight tunnel pressure — improvement in night symptoms is often the first sign the management approach is working. Nerve mobilisation exercises, also called neural gliding, are specific movements designed to improve median nerve mobility through the tunnel and reduce its mechanosensitivity, performed gently within symptom-free ranges. Tendon gliding exercises mobilise the flexor tendons through the tunnel, reducing tendon adhesion and the tenosynovitis that contributes to increased pressure.
Manual therapy to the carpal bones and wrist joint can improve carpal bone mobility and may reduce tunnel pressure, with some evidence of benefit for techniques directed at the transverse carpal ligament specifically. Ergonomic assessment and modification is an important component too — keyboard and mouse positioning, wrist position during typing, and the presence or absence of a wrist rest are all assessed and modified where necessary, the same principle behind managing most desk-driven ergonomic strain, and it overlaps closely with the tendon-loading thinking behind treating tennis elbow.
When Surgery Is Appropriate
Carpal tunnel release surgery involves cutting the transverse carpal ligament to enlarge the tunnel and reduce pressure on the nerve. It’s one of the most commonly performed surgical procedures and has a high success rate for appropriate cases.
Surgery is recommended for severe carpal tunnel syndrome with significant thenar muscle wasting or weakness, for cases where neurophysiological testing shows significant nerve damage, and for mild-to-moderate cases that have failed a genuine trial of conservative management. The decision should be based on clinical findings and the patient’s symptoms and quality of life, not imaging findings alone. Post-surgical physiotherapy after carpal tunnel release reduces scar tissue formation, restores wrist strength and range of motion, and accelerates return to normal hand function.
