Carpal Tunnel Syndrome – When numb hands impair your daily life

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.

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. 

All gain. No pain.

I agree to the terms and conditions of the privacy policy.

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 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. 

All gain. No pain.

I agree to the terms and conditions of the privacy policy.

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.

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.

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.

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. 

All gain. No pain.

I agree to the terms and conditions of the privacy policy.

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.

📌 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

• 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.

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.