Carpal Tunnel Syndrome – When numb hands impair your daily life

A hand grabbing the wrist of another hand.

© interstid |

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Wrist pain, paraesthesia (abnormal sensations), tingling in the fingers, numbness, and loss of strength. Does all that sound familiar to you? Then you may have carpal tunnel syndrome, where the metacarpal nerve is compressed in the wrist area. This pressure results in damage, which causes numerous symptoms.

This article explains what carpal tunnel syndrome is, what symptoms can occur, and what causes these symptoms. We also show you what treatment options are available and some exercises you can do yourself to alleviate your pain.

Roland Liebscher-Bracht

Roland Liebscher-Bracht

Germany's most trusted pain specialist and author of several bestselling self-help books on the treatment of pain conditions.

Read more

Roland Liebscher-Bracht is Germany's most trusted pain specialist and author of several bestselling books on pain treatment. Together with his wife, Dr. med. Petra Bracht, he has developed a revolutionary method to treat pain conditions. With the help of the so-called "osteopressure", where you press specific points on your body, and special stretching exercises, pain can be stopped entirely without medication or surgical intervention. This pain treatment allows you to alleviate pain by yourself. Find out how exactly this works in this article or our numerous YouTube videos.

Roland Liebscher-Bracht

Germany's best-known pain specialist and author of several bestselling books on self-help against pain.

Read more

Roland Liebscher-Bracht is Germany's best-known pain specialist and author of several bestselling books on pain treatment. Together with his wife, the physician Dr. Petra Bracht, he has developed a revolutionary new form of pain treatment: With the so-called "Osteopressur", in which certain points on your body are pressed, and special stretching exercises, pain can be stopped completely without medication or surgical intervention. It is particularly important that this pain treatment gives you the opportunity to help yourself against your pain in a self-determined way. You can find out exactly how this works in this article and in the numerous YouTube videos.

1. Overview of Carpal Tunnel Syndrome

In carpal tunnel syndrome, the median nerve (also known as the metacarpal nerve) is compressed in the wrist area. This nerve serves various regions of the hand. It can cause tingling in the fingers, numbness, pain, swelling, functional disorders, and even paralysis when it is pinched or damaged, for example. This section gives you an overview of the wrist area where the carpal tunnel, tendons, and nerves are located so that you can get a better idea of these anatomical structures.

What Role Does the Carpal Tunnel Play in Carpal Tunnel Syndrome?

Carpal tunnel syndrome can often be simply abbreviated as CTS (carpal tunnel syndrome). The so-called carpal tunnel forms the connection between your forearm and hand, and the bones of your wrist limit the available space in this region.

Illustration of carpal tunnel syndrome.

© decade3d – anatomy online |

  • The carpal tunnel is formed by your wrist bones and the carpal ligament (retinaculum flexor) – a coarse band of connective tissue that overlays the bone. At your wrist, this band runs across the carpal canal, which carries tendons and nerves. The carpal band ensures those tendons, tendon sheaths, and nerves remain in their intended place.
  • The median nerve (nervus medianus) extends from the shoulder to the fingers and controls your hand’s muscle movements and sense of touch. It passes through the carpal tunnel together with nine flexor tendons. These flexor tendons are surrounded by tendon sheaths, which can swell and absorb fluid. Tendon sheaths wrap around the tendons and are filled with synovial fluid.

By its very nature, the carpal canal is, therefore, a physiological constriction, which is extremely susceptible to overloading, compression damage, and neurological injury.

However, the carpal tunnel should not be thought of as a rigid tube. Because the carpal bones which form the canal, together with the carpal ligament (retinaculum flexor), are not rigid. Different hand movements result in a shifting of the carpal bones, causing changes to the carpal tunnel’s depth.

This means some hand movements will be allowed lots of space in the carpal canal, while other movements cause the channel to become very flat and narrow.

This effect is primarily due to the carpal ligament (retinaculum flexor), which runs across the carpal canal at the wrist and forms a kind of cover for the carpal tunnel.

With carpal tunnel syndrome, the median nerve becomes irritated or damaged. This often happens due to repetitive movements, i.e., extension or flexion of your wrist or palm. An increased load intensifies median nerve irritation if these movements are exerted with great effort.

However, carpal tunnel space can also alter for other reasons: water retention in the wrist due to diseases such as diabetes or because of hormonal changes, swelling of the tendon sheaths, poorly healed fractures, or arthritis.

📌In a Nutshell: What Is Carpal Tunnel Syndrome?
In carpal tunnel syndrome (also called CTS, carpal tunnel syndrome), the wrist’s median nerve is cramped, causing pain and discomfort.

The Best Exercises and Tips Against Carpal Tunnel Syndrome

We've got your back! Download our FREE PDF guide featuring our 6 most effective exercises for getting rid of Carpal Tunnel Syndrome. 
A preview of the Liebscher & Bracht's guide against carpal tunnel syndrome with the front page on the left side.
All gain. No pain.

2. Symptoms of Carpal Tunnel Syndrome

The symptoms of carpal tunnel syndrome usually start at night and, in the later stages, also become increasingly intense during the day.

Early Symptoms of Carpal Tunnel Syndrome:

Most people with carpal tunnel syndrome report their hands seem to ‘fall asleep’ at night or early in the morning. And if the symptoms only appear at such times, they often disappear when you shake your hands. Initially, moving your hand around at night can also alleviate the pain. Some sufferers report that putting their hands under cold water helps.

At this stage, the irritation mainly affects your middle and ring finger.

Later, the irritation also affects your thumb and forefinger. Here’s an overview of the characteristics and initial symptoms:

• During sleep: tingling of your fingers (falling asleep) at night and in the morning
• Neurological syndromes such as paraesthesia (abnormal sensations) and sensory disorders: first in the middle finger and ring finger, and later in the thumb and index finger as well
• Shaking your hands helps, as does cold water

Later Symptoms of Carpal Tunnel Syndrome:

Sensory disorders caused by tingling hands usually begin at the palm and gradually extend to more fingers (including the thumb and index finger). And since the median nerve (nervus medianus) runs up to the shoulder, severe shoulder pain can also occur. For those affected, everyday activities such as telephoning, reading a newspaper, or riding a bike become increasingly difficult.

A permanent feeling of numbness in the hands leads to a loss of manual dexterity or finger skills. Many notice this when doing handicrafts, or when opening and fastening buttons. In extreme cases, median nerve damage is so severe that the muscle of the ball of the thumb, which is controlled by this nerve, gradually gets weaker.

Even earlier, those affected can hardly hold a cup in their hands, for example. Due to this weakness and loss of sense of touch, fine motor skills, sensitivity, and strength (due to muscle loss), cups and other objects simply slip out of the patient’s grasp against their will.

A hand gripping a glass. Another hand grips the wrist of the hand holding the glass.

© Astrid Gast |

Later stage symptoms of carpal tunnel syndrome in a nutshell:

  • Paraesthesia and pain in the hands
  • Impaired sense of touch and perceived clumsiness
  • Paralysis: loss of sensitivity in the fingers and palm, as well as a distinct numbness
  • Loss of strength, and in extreme cases, muscle loss at the ball of the thumb
  • Loss of fine motor skills in the fingers, especially on the thumb side of the hand
  • Muscle wasting is particularly evident when the hand is stressed

The Best Exercises and Tips Against Carpal Tunnel Syndrome

We've got your back! Download our FREE PDF guide featuring our 6 most effective exercises for getting rid of Carpal Tunnel Syndrome. 
A preview of the Liebscher & Bracht's guide against carpal tunnel syndrome with the front page on the left side.
All gain. No pain.

3. Causes of Carpal Tunnel Syndrome

 The development of carpal tunnel syndrome is caused by increased pressure in the carpal tunnel.1) 

Such pressure increases are mainly due to excessive tension in the muscles, tendons, and fasciae of the arm.

One-sided movements, for example, when using a keyboard, lead to the shortening of the hand’s flexor tendons. As a result, excess tension develops, causing the flexor tendons to swell. When this happens, the carpal tunnel becomes too narrow. The amount and duration of the pressure creating these conditions in the carpal tunnel determine the extent of damage to the median nerve.

A hand using a mouse.

The increased vascular permeability in the carpal tunnel with the leakage of immune cells increases the risk of local inflammation and edema (swelling) in the nerve. This inflammation causes blood circulation around the wrist to deteriorate.

As a result, your pain and discomfort in hand and wrist regions get worse. And in the longer term, nerve damage can occur.

Carpal Tunnel Syndrome: Why Does the Pressure on Nerves and Tendons Increase?

The question now is how and why does pressure increase in the carpal tunnel? The simple answer is that an increase in pressure occurs when there is a mismatch between the tunnel width, tunnel capacity, and content (nerves and tendons).

Certain factors increase the risk of nerves and tendons swelling within the carpal tunnel. These include:2)

  • repetitive movements of the hands and activities with flexion and extension at the wrist,
  • increased strain on the hands, for example by powerful gripping,
  • the effects of hand-arm vibrations, such as the use of vibrating machines such as chainsaws or masonry drills.

Thus some professions and occupational groups have an increased risk of developing carpal tunnel syndrome. Are you on the list?

  • assembly line workers, especially in the automotive industry
  • forest workers handling vibrating tools such as chainsaws
  • cashiers
  • masseurs
  • office workers

Due to repetitive movement patterns in these professions, tendons, tendon sheaths, and nerves in the carpal tunnel become irritated and inflamed and then stretched. This builds up excess pressure, forcing all structures to press against the carpal ligament, which lies across the tunnel.

The Best Exercises and Tips Against Carpal Tunnel Syndrome

We've got your back! Download our FREE PDF guide featuring our 6 most effective exercises for getting rid of Carpal Tunnel Syndrome. 
A preview of the Liebscher & Bracht's guide against carpal tunnel syndrome with the front page on the left side.
All gain. No pain.

4. Diagnosis of Carpal Tunnel Syndrome

Carpal tunnel syndrome has been a recognized work-related illness since January 2015. In one way, it’s a relief that your pain and discomfort are being taken seriously. Yet defining CTS as a ‘work-related illness’ inevitably entails a lengthy diagnostic procedure. But if you need quick and effective help rather than complex investigations, we will explain your different options in section 5.

 Tests for Detecting Carpal Tunnel Syndrome

In conventional medicine, doctors can perform a number of tests if they suspect carpal tunnel syndrome. These examinations usually check your hands to assess your motor skills.

For example, after checking your medical history, the doctor will hand you a round vessel. With limited hand motor skills and sensors, an object of this shape is difficult to grip – with the thumb often unable to function correctly. Where this is the case, a “positive cylinder indication” is considered to strongly suggest carpal tunnel syndrome. However, to be absolutely sure, conditions like osteoarthritis of the thumb, or other major damage, or injuries to the nerve, must be ruled out by an X-ray examination or MRI scan.

📌 Tests to Confirm Carpal Tunnel Syndrome:3) 

  • Phalen test: Keep your arms horizontal and press the backs of your hands together for 60 seconds. If, after this, you experience abnormal body sensations such as numbness or pain in the wrist area, this is a positive indication of carpal tunnel syndrome.
  • Inverted Phalen test: This procedure requires you to press your palms together for 60 seconds. However, this is less reliable than the standard Phalen test,
  • Hoffmann-Tinel sign: With your palm open and wrist relaxed, you will receive a wrist tap or press on the median nerve. If this causes pain or paraesthesia (abnormal sensations), it is considered a sign of carpal tunnel syndrome.
  • Carpal compression test: With your palm open and wrist relaxed, the investigator will press on the median nerve directly over the carpal tunnel. This test is positive if your carpal tunnel symptoms are triggered or intensified.
  • Flexion compression test: With your arms stretched out on a mat, palms facing upwards, your doctor or therapist will bend your wrist upwards by 60 degrees. Simultaneously, thumb pressure will be applied to the median nerve in the carpal tunnel region. Here too, the test is positive if this triggers symptoms.
  • Tourniquet test: In this test, a blood pressure cuff is put on your upper arm and inflated beyond systolic pressure (the upper blood pressure value). If you suffer from carpal tunnel syndrome, you will feel pain and sensory disorders in the median nerve area at your wrist.

Other Diagnostic Procedures

Beyond these tests, sonography in the form of an ultrasound examination of your wrist can also be used for diagnostic purposes. High-resolution sonography can reveal even minor changes in the carpal tunnel region of your wrist, such as a flattening or thickening of the nerve.

As well as an ultrasound examination, magnetic resonance imaging (MRI)4) offers further possibilities for diagnosing carpal tunnel syndrome. This technology can also capture images to confirm any nerve changes at the wrist. However, the creation of MRI images is costly, so this method is rarely used for diagnosis.

An MRT machine.

Neurography (also called electroneurography, or abbreviated as ENG) is considered a reliable and objective proof of carpal tunnel syndrome.5) Thus the Scientific Medical Association working group recommends its use for diagnostic purposes.

Using electroneurography, doctors can measure the nerve conduction speed. This data allows conclusions to be drawn about nerve fiber damage and the tissue’s condition surrounding the nerves. This is done by evaluating “motor and sensory response potentials” after electrical stimulation (gentle stimulation) of your wrist’s nerves.

Don’t worry if these diagnostic procedures seem too long and complicated. Our therapy can help you, or you can help yourself very quickly – and without any lengthy tests. Find out more in the next section and our exercise section.

The Best Exercises and Tips Against Carpal Tunnel Syndrome

We've got your back! Download our FREE PDF guide featuring our 6 most effective exercises for getting rid of Carpal Tunnel Syndrome. 
A preview of the Liebscher & Bracht's guide against carpal tunnel syndrome with the front page on the left side.
All gain. No pain.

5. Treatment of Carpal Tunnel Syndrome

With Liebscher & Bracht pain therapy, we aim to address your current symptoms and show you different ways to become pain-free. But first, we should explain: Liebscher & Bracht pain therapy is an independent manual treatment method that attributes most pain to overstretched muscles and fasciae due to defective or one-sided movements.

Treat Carpal Tunnel Syndrome with Osteopressure and Stretching Exercises

You are probably all too familiar with repetitive movements in your everyday life. For example, in the shoulders and arms, they can lead to overstretched muscles and fasciae, which then exert strong tensile forces on your wrist. If the structures within the tunnel-like constriction of your carpal canal are overstressed, they become tender and swell. They then press against the carpal ligament and cause your symptoms.

Roland Liebscher-Bracht is holding the arm of a skeleton to show how to treat carpal tunnel syndrome.

Our method precisely targets this cause and can gradually reduce the overload.

By pressing receptors in the periosteum (the connective tissue surrounding bones) – applying what is known as osteopressure – acute pain can be quickly and effectively stopped. Our special stretching exercises and foam rolling massages stretch shortened muscles, loosen adhesions in the fasciae, and boost your metabolism and blood circulation at the wrist. Thus you can remain pain-free over the longer term. If your symptoms are not too severe, why not try our exercises in the next section.

📌 Carpal Tunnel Syndrome in Pregnancy:

Some women experience carpal tunnel syndrome for the first time during pregnancy. Statistically speaking, at least seven percent of all pregnant women in Germany suffer from this condition or constriction of the nerve.6) Most women (93 percent) have severe night-time symptoms, sleep problems, or persistent paraesthesia. So if you are pregnant and your wrist pain is increasing, try our exercises to alleviate your symptoms during your pregnancy. Such symptoms often disappear on their own after birth.

Conventional Treatments for Carpal Tunnel Syndrome

A syringe.

Cortisone injections: In conventional medicine, carpal tunnel syndrome is often treated with cortisone or other anti-inflammatory drugs. However, studies show that cortisone injections only offer short term improvements for minor symptoms. Over the longer term, this method does not provide any symptom relief. Furthermore, the patients treated experienced a side effect – local swelling and slight pain at the injection site. 7)

A wrist splint.

© Praisaeng |

Night splints: Conservative therapy assumes your symptoms arise from overuse, and not from one-sided movements and shortened fasciae. One consequence of this assessment is the use of night splints to immobilize the wrists of those affected. A special splint fixes your wrist in a neutral position to help gradually restore healthy function. The brace can then be removed during the day. In our view, protection is not the right approach.

Three surgeons at an operation table.

Surgery: In the case of severe symptoms – for example, if you feel numbness for several weeks and assessments show you have nerve damage – some doctors advise surgery on the carpal tunnel.

In such an operation, the carpal ligament (retinaculum), which extends over the bone channel on the wrist, is cut at the wrist via an incision made under local anesthesia. Two different surgical procedures have been established: open retinaculum division and endoscopic retinaculum division. This kind of surgical intervention is usually done in a clinic on an outpatient basis using a local anesthetic.

  • With open retinaculum division, the carpal ligament is cut via an incision while the site is fully exposed. This means the surgeon (usually a specialist in hand surgery) makes a comparatively large incision, and some connective tissue is removed during the operation.
  • With endoscopic retinaculum division, the hand surgeon makes just a small incision in the palm and cuts the carpal ligament while viewing the site via a tiny internal camera.8)  

In both procedures, cutting the carpal ligament creates more space for the nerve and tissues. It may take a few weeks for everything to heal.

Unfortunately, the procedure is recommended time after time for patients who have not been given a precise diagnosis and suffer from what is known as idiopathic pain in the wrist. This simply means the cause of the pain is unknown. Cutting the carpal ligament can thus be seen as a forlorn attempt to eliminate such pain finally.

With or without a precise diagnosis, we believe surgery is almost always the wrong approach. What the intervention injures or destroys cannot be easily repaired, if it can be repaired at all.

Instead of going under the knife for this procedure, we strongly recommend you try out all the alternatives first, including our pain therapy and exercises.

The Best Exercises and Tips Against Carpal Tunnel Syndrome

We've got your back! Download our FREE PDF guide featuring our 6 most effective exercises for getting rid of Carpal Tunnel Syndrome. 
A preview of the Liebscher & Bracht's guide against carpal tunnel syndrome with the front page on the left side.
All gain. No pain.

6. Carpal Tunnel Syndrome: Exercises for Pain Relief

It’s great that you chose our exercise instead of surgery. With these exercises, you can balance risk factors such as one-sided office work while at the same time, stretching and strengthening the muscles and tendons in your hand. In terms of stretch intensity and regularity, our exercises also go far beyond the measures employed in “normal” physiotherapy – which you won’t now have to attend for months on end.

If you carry out our stretching exercises and foam rolling massages regularly, you will provide your body with the optimal help to permanently switch off the pain.

Are you doing one of our exercises for the first time? Then it’s best to begin by reading our checklist below the exercise description.

A woman is kneeling on a mat and presses one wrist onto a massage ball.

The Best Foam Rolling Massage for Carpal Tunnel Syndrome

Exercise with the mini massage ball:

  • Take our mini massage ball from our fascia set, or any similar ball you have available.
  • Place the mini massage ball on a support surface and roll it over your wrist using circular movements.
  • Focus a little more on the spots where you feel tension or pain, and roll using a circular motion.
  • Work the ball around the whole of your wrist and down into your palm.
A woman is using a foam roller to treat her fingers.

Exercise with the mini foam roller:

  • Now take our mini foam roller and place it on a flat surface.
  • Put the affected hand’s fingertips on the mini foam roller and apply additional pressure from above with your other hand.
  • Roll forward very slowly over the palm of your hand or the palm of your hand and your wrist right up to the forearm.
  • Repeat the exercise with the back of your hand. Start by placing the back of your hand on the mini foam roller and roll very slowly up to the elbow.
A woman is kneeling on a mat, one hand is turned towards her knees and the other turned away from her.

Stretching at the wrist:

  • Get down on all fours and then turn the affected hand so that the fingers point back towards your knee. Make sure you pull your thumb in towards your other fingers. You will find this quite tricky at first, especially if the thumb ball muscles are weakened.
  • If you feel your wrist is now properly stretched, stay in this position for two minutes, making sure you keep your palm to the floor.
  • If you don’t yet feel any tension, pull your shoulders back slightly or bring your buttocks down towards the floor. This will increase the pressure on your wrist.


  • Lean back further so that your wrist lifts, now leaving just your fingers lying flat on the floor.
  • With your free hand, you can also gently pull on the thumb. You will immediately feel a stretch in your thumb ball muscles.
  • Stay in this exercise position for two minutes.

Sources & Studies [+]