Carpal Tunnel Syndrome is a painful disorder of the hand caused by pressure on your median nerve as it runs through a tunnel in your wrist. Symptoms include numbness, pins and needles, and pain (particularly at night). Anything which causes swelling inside the wrist can cause carpal tunnel syndrome, including repetitive hand movements, pregnancy and arthritis.

What is Your Carpal Tunnel?
Your carpal tunnel protects vital structures such as the median nerve, blood vessels and tendons as they pass to and from your hand. The palm side of your wrist has a band of strong ligaments and the rear of the tunnel is a curved compilation of the wrist bones.

What is the Cause of CTS?
CTS symptoms begin when the pressure inside the tunnel becomes too high. This pressure results in your median nerve becoming compressed as it passes through. The carpal tunnel pressure increase occurs when either of two things happens:
• The tunnel space decreases when the wrist swells.
• When the contents of the tunnel enlarge.

Other Common Causes of CTS
Frequently, the median nerve is compressed elsewhere along its path – not in the carpal tunnel – and replicates carpal tunnel symptoms. Most often, compression occurs in your neck but can occur anywhere along the nerve path as it travels to your hand. Healthy nerves have a supply of fluid called axoplasmic fluid, which provides the nerve with nutrients. Typically, a pressure of about 70 mmHg propels this fluid slowly along the length of the nerve. However, if the nerve is slightly squashed (e.g. by a bulging neck disc), then the flow of this fluid is interrupted. Your nerve will starve, and you may experience carpal tunnel symptoms.

It is essential to confirm the site of your nerve compression. Many patients have had carpal tunnel surgery performed without benefit because the carpal tunnel symptoms originated from nerve compression elsewhere. Your nerves should freely travel along their pathways between your spine and your fingers. Any interference of their slide mobility e.g. scar tissue or tight muscles could cause symptoms,. Your physiotherapist can assess your neurodynamics for abnormalities.

What are the Symptoms of CTS?
CTS sufferers will usually experience the following symptoms in their hand or fingers:
• hand pain or aching
• pins and needles
• numbness especially at night of with wrist flexing
• burning
• weakness or cramping
• perceived swelling

The symptoms are usually worse at night, and your grip will weaken as the condition progresses.Shaking the wrist may ease symptoms temporarily.

How is CTS Diagnosed?
Your physiotherapist or GP will generally diagnose CTS based on your symptoms. Your doctor may refer you for nerve conduction studies to quantify if your electrical nerve impulses slow by compression of the carpal tunnel or further up the arm. An Ultrasound Scan may reveal a median nerve enlargement. An X-ray may identify coexisting pathologies. Treatment will depend on the cause and is usually conservative. If you have these symptoms then it’s good to consult with your Physiotherapist to help to determine the cause.