The carpal tunnel is an opening through the wrist to the hand that is formed by the bones of the wrist on one side and the transverse carpal ligament on the other. (Ligaments connect bones together.) This opening forms the carpal tunnel.

The median nerve passes through the carpal tunnel into the hand. It gives sensation to the thumb, index finger, long finger, and half of the ring finger. It also sends a nerve branch to control the thenar muscles of the thumb.

The median nerve and flexor tendons pass through the carpel tunnel. The median nerve rests on top of the tendons, just below the transverse carpal ligament. The flexor tendons are important because they allow movement of the fingers, thumb, and hand, such as when grasping. The tendons are covered by a material called tenosynovium. The tenosynovium is a slippery covering that allows the tendons to glide next to each other as they are worked.

Any condition that makes the area inside the carpal tunnel smaller or increases the size of the tissues within the tunnel can lead to symptoms of CTS. For example, a traumatic wrist injury may cause swelling and extra pressure within the carpal tunnel. The area inside the tunnel can also be reduced after a wrist fracture or dislocation if the bone pushes into the tunnel.

Any condition that causes abnormal pressure in the tunnel can produce symptoms of CTS. Various types of arthritis can cause swelling and pressure in the carpal tunnel. Fractured wrist bones may later cause CTS if the healed fragments result in abnormal irritation on the flexor tendons.

Other conditions in the body can produce symptoms of CTS. Pregnancy can cause fluid to be retained, leading to extra pressure in the carpal tunnel. Diabetics may report symptoms of CTS, which may be from a problem in the nerve (called neuropathy) or from actual pressure on the median nerve. People with low thyroid function (called hypothyroidism) are more prone to problems of CTS.

One of the first symptoms of CTS is gradual tingling and numbness in the areas supplied by the median nerve. This is typically followed by dull, vague pain where the nerve gives sensation in the hand. The hand may begin to feel like it's asleep, especially in the early morning hours after a night's rest.

Sometimes pain may even spread up the arm to the shoulder. If the condition progresses, the thenar muscles of the thumb can weaken, causing the hand to be clumsy when picking up a glass or cup. If the pressure keeps building in the carpal tunnel, the thenar muscles may begin to shrink (atrophy).

When you visit Skill Builders, our physiotherapist in Barrie begins the evaluation by obtaining a history of the problem, followed by a thorough physical examination. Your description of the symptoms and the physical examination are the most important parts in the diagnosis of CTS. Commonly, patients will complain first of waking in the middle of the night with pain and a feeling that the whole hand is asleep.

Careful investigation usually shows that the little finger is unaffected. This can be a key piece of information to make the diagnosis. If you awaken with your hand asleep, pinch your little finger to see if it is numb also, and be sure to tell our physiotherapist if it is or isn't. Other complaints include numbness while using the hand for gripping activities, such as sweeping, hammering, or driving.

Some patients may be referred to a doctor for further diagnosis. Once your diagnostic examination is complete, the physiotherapists at Skill Builders have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle.

When you begin your physiotherapy in Barrie, our physiotherapist will recommend that you change or stop the activities that are causing your symptoms if at all possible. Avoid repetitive hand motions, heavy grasping, holding onto vibrating tools, and positioning or working with your wrist bent down and out. If you smoke, talk to your doctor about ways to help you quit. Lose weight if you are overweight. Reduce your caffeine intake.

Our physiotherapist will often have you wear a wrist brace. This sometimes decreases the symptoms in the early stages of CTS. A  brace keeps the wrist in a resting position, not bent back or bent down too  far. When the wrist is in this position, the carpal tunnel is as big as it can  be, so the nerve has as much room as possible inside the carpal tunnel. A  brace can be especially helpful for easing the numbness and pain felt at night  because it can keep your hand from curling under as you sleep. The wrist brace  can also be worn during the day to calm symptoms and rest the tissues in the  carpal tunnel.

The main focus of our treatment is to reduce or eliminate the cause of pressure  in the carpal tunnel. Our physiotherapist may check your workstation and the way you  do your work tasks. We may provide suggestions about the use of healthy body alignment and  wrist positions, helpful exercises, and tips on how to prevent future  problems. Our physiotherapist may also begin treatments to reduce inflammation and  to encourage normal gliding of the tendons and median nerve within the carpal  tunnel.

Although time required for recovery is different for every patient, as a  general rule, you may see improvement in four to six weeks. We may ask you to continue  wearing your wrist splint at night to control symptoms and keep your wrist  from curling under as you sleep. Try to do your activities using healthy body  and wrist alignment. Limit activities that require repeated motions, heavy  grasping, and vibration in the hand.

It generally takes longer to recover after open carpal tunnel release. Pain  and symptoms usually begin to improve, but you may have tenderness in the area  of the incision for several months after surgery.

Patients who wait too long to seek medical advice sometimes have difficulty  adjusting after surgery. Poor coping skills in the presence of persistent pain  and numbness may result in disappointment or dissatisfaction with the results  of surgery. Recovery may take longer than expected when nerve damage is  severe. In some cases, symptoms are not entirely alleviated.

When the stitches are removed, you may begin your physiotherapist program. Our treatments are used at first to ease pain and  inflammation. Our physiotherapist may apply gentle massage to the incision to help  reduce sensitivity in and around the incision and limit scar tissue from  building up. We will show you some special exercises that you can do to  encourage normal gliding of the tendons and median nerve within the carpal  tunnel.

As you progress, our therapist will give you exercises to help strengthen  and stabilize the muscles and joints in the hand, wrist, and arm. We use other  exercises to improve fine motor control and dexterity of the hand. Our physiotherapist will also work with you to help you do your daily and work activities  safely and with the least amount of strain on your wrist and hand.

When your recovery is well under way, regular visits to  Skill Builders will end. Although we will continue to be a resource, you  will eventually be in charge of doing your exercises as part of an ongoing  home program.