Carpal Tunnel Syndrome (CTS) is one of the most common nerve problems affecting the hand. It can start quietly: a bit of tingling in the fingers at night, a numb patch when holding the phone, a strange “electric” feeling when you drive or scroll on the phone for too long. Over time, it may become harder to open jars, grip small objects, or trust your hand for fine work.
This article explains Carpal Tunnel Syndrome in clear, everyday language—what it is, why it happens, how it affects daily activities, and what kinds of management options and rehabilitation strategies are commonly used. The aim is to help you understand the condition and make thoughtful choices, not to make guaranteed promises of cure.
What is Carpal Tunnel Syndrome?
The carpal tunnel is a narrow passageway in the wrist formed by small carpal bones and a strong band of tissue on top (the transverse carpal ligament). Several tendons and one important nerve—the median nerve—run through this tunnel into the hand.
Carpal Tunnel Syndrome happens when there is increased pressure in this tunnel, irritating or compressing the median nerve. Because this nerve supplies sensation to the thumb, index finger, middle finger and part of the ring finger—plus some of the muscles at the base of the thumb—symptoms appear in those areas.
People with CTS often describe:
- Tingling or “pins and needles”
- Numbness
- Burning or electric sensations
- Weakness or clumsiness of the hand
These symptoms are usually felt in the thumb, index and middle fingers (sometimes half of the ring finger). The little finger is often spared, which helps distinguish CTS from other conditions.
How Carpal Tunnel Syndrome shows up in daily life
In the early stages, symptoms may seem minor or occasional. Many people notice:
- Night-time tingling or numbness that wakes them up
- Hands feeling “dead” in the morning and needing to be shaken out
- Increased symptoms when reading, driving, holding a phone or cycling—anything that involves sustained wrist position
As CTS progresses, symptoms may also appear:
- When gripping steering wheels, tools, or handlebars
- During repeated gripping, typing, or handling small objects
- When doing fine motor tasks such as fastening buttons, sewing, or using certain instruments
Some people report dropping objects more often, feeling clumsy, or noticing that the thumb side of the hand feels weaker. In more advanced cases, the muscles at the base of the thumb may look slightly shrunken, and sustained numbness may interfere with safety (for example, difficulty feeling sharp edges or hot objects).
Because CTS can disturb sleep and interfere with work and household tasks, its impact is often much larger than the “small area” of the wrist and hand suggests.
Why Carpal Tunnel Syndrome develops
Carpal Tunnel Syndrome usually doesn’t have a single, simple cause. Instead, it results from a combination of anatomy, load and systemic factors.
Some people naturally have a narrower carpal tunnel, making them more vulnerable to symptoms when swelling or extra pressure is present. Conditions such as diabetes, thyroid issues, pregnancy, inflammatory arthritis and fluid retention can also influence how easily the nerve becomes irritated.
Mechanical factors matter too. Repeated or sustained wrist positions—especially prolonged flexion or extension—can increase pressure in the tunnel. Jobs or tasks that involve:
- Repetitive hand and wrist movements
- Strong gripping or forceful use of tools
- Vibrating tools
- Long hours at a keyboard without adequate breaks
may contribute to CTS symptoms, particularly when there is limited rest and recovery.
However, not everyone with CTS has a physically demanding job, and not everyone who types all day gets CTS. It is usually the overall mix of anatomy, health conditions, workload, rest, and sometimes simple chance that shapes who develops symptoms.
Getting a proper diagnosis
Because tingling and numbness in the hand can come from many different sources (neck, shoulder, elbow, peripheral nerves, or even systemic conditions), it is important to get a professional assessment rather than self-diagnosing.
A healthcare provider will often:
- Ask about your symptoms, when they started, and what makes them better or worse
- Examine sensation, strength and reflexes in your hand and arm
- Perform specific tests at the wrist that may reproduce symptoms
In some cases, nerve conduction studies or electromyography (EMG) are recommended to assess how well the median nerve is conducting signals and to help distinguish CTS from other nerve problems.
This information helps guide decisions about management: whether conservative care is reasonable, whether further tests are needed, and when to consider more invasive options.
Conservative management: what often comes first
For many people with mild to moderate CTS, initial management is non-surgical. Common elements include:
Night wrist splints
A neutral-position wrist splint worn at night can help keep the wrist from bending excessively during sleep, which often reduces night-time tingling and waking. Many people unknowingly sleep with the wrist flexed or curled, which increases tunnel pressure. A splint does not cure the condition by itself, but it can give the nerve some relief and improve sleep.
Activity modification
Making small changes in how you use your hands can reduce repeated strain. This might involve:
- Adjusting keyboard and mouse position so the wrist stays more neutral
- Altering grip on tools, pens or steering wheels
- Reducing prolonged or awkward wrist positions where possible
- Taking short, regular breaks during repetitive work
Sometimes small ergonomic adjustments at work or home make a noticeable difference.
Symptom management and exercises
Under guidance from a therapist or health professional, gentle tendon gliding exercises, nerve gliding strategies and forearm stretches may be introduced. These are usually done within a comfortable range and tailored to your symptoms. The goal is to maintain movement, promote circulation and reduce stiffness without provoking flare-ups.
Medication such as non-steroidal anti-inflammatory drugs (NSAIDs) may be used under medical advice for symptom relief, though they are not a stand-alone solution.
If symptoms are mild and relatively recent, these measures may be enough to stabilise or ease the problem. If symptoms are more advanced, persistent or worsening, other options might be considered.
Injections and surgical options
For some people, particularly when pain and night symptoms are significant, a doctor may suggest a corticosteroid injection into the carpal tunnel. This can reduce inflammation and pressure around the median nerve for a period of time. Some people experience substantial short- to medium-term relief; in others, the effect is partial or temporary.
When symptoms are severe, when there is muscle wasting or ongoing numbness, or when conservative treatment does not provide sufficient relief, surgical decompression (carpal tunnel release) may be recommended. This procedure aims to relieve pressure on the median nerve by releasing the transverse carpal ligament.
After surgery, most people follow a graded rehabilitation plan to:
- Allow the wound to heal
- Restore comfortable finger and wrist movement
- Gradually return to work and heavier tasks
Even with surgery, outcomes depend on many factors, including how long the nerve has been compressed, general health, other conditions and how daily activities are managed afterwards. Surgery is not an automatic “reset button”, but for many, it offers meaningful relief when carefully chosen and well supported.
The role of occupational therapy in Carpal Tunnel Syndrome
Occupational therapists focus on how CTS affects your real day—not just your test results.
In practice, OT might involve:
Detailed activity analysis
The therapist looks at how you use your hands at work, at home and during leisure. This includes keyboard and mouse use, tool handling, childcare, cooking, hobbies, phone and tablet use, and driving. The aim is to identify patterns of load that could be modified without disrupting your life completely.
Task and environment modification
OT can help you:
- Adjust your workstation so that wrists are more neutral and shoulders relaxed
- Use different grips or handles that require less force
- Break tasks into manageable chunks with rest periods
- Rearrange kitchen or work layouts so that frequently used items are nearer and easier to handle
These changes may sound small, but they can reduce the constant background strain that keeps the median nerve irritated.
Splint education and practical strategies
If a splint is recommended, OT can help ensure it fits properly and is used in a way that makes sense for your work, sleep and daily routines. They can also guide you in integrating gentle exercises and stretches into your day without overdoing it.
Planning return to work or activity after surgery
For those who undergo surgical release, occupational therapists can help plan a graded return to work and daily tasks—reducing the risk of jumping too quickly back into high loads that overwhelm healing tissues.
Living with CTS: balancing protection and use
A common mistake with hand pain and numbness is swinging between two extremes: using the hand as if nothing is wrong, or avoiding almost all activity out of fear. For Carpal Tunnel Syndrome, the most helpful path is often in the middle.
Completely immobilising the hand for long periods can lead to stiffness, weakness and increased sensitivity. Using it aggressively through significant symptoms can keep the nerve irritated. The goal is balanced, thoughtful use:
- Protect the wrist from extremes of position, especially for long periods
- Use splints strategically (often at night, and sometimes during high-load tasks if advised)
- Keep the fingers and wrist moving comfortably through a pain-aware range
- Modify tasks rather than abandoning everything that involves the hand
An occupational therapist or hand therapist can help fine-tune this balance according to your specific job and lifestyle.
When to seek prompt medical advice
Most mild CTS symptoms develop gradually and can be explored with your usual healthcare provider or therapist. However, you should seek timely medical advice if you notice:
- Persistent numbness that no longer improves with changes of position
- Progressive weakness or obvious wasting of the thumb muscles
- Increasing clumsiness or frequent dropping of objects
- Symptoms that are rapidly worsening or significantly disrupting sleep and function
These signs may indicate more advanced nerve compression that requires closer investigation and more decisive management.
A realistic and hopeful outlook
Carpal Tunnel Syndrome can be frustrating, especially when it interferes with sleep, work and the small hand tasks that make up daily life. It is easy to feel that your hands are “wearing out” or that you must choose between pain and giving up important activities.
The more balanced view is that CTS is manageable, especially when caught early and approached from multiple angles: understanding your risk factors, adjusting how you use your hands, considering splints and therapy, and discussing medical or surgical options when necessary.
Occupational therapy and other rehabilitation services do not promise to erase CTS in every case. What they can offer is a clearer understanding of how your hands are working, practical changes that reduce strain, and guidance through decisions about further treatment. Many people find that with time, information and well-chosen strategies, their hands can support a more comfortable and sustainable way of living and working again.
This article is for general education and does not replace individual medical advice. For personalised assessment and recommendations, please consult your healthcare provider or rehabilitation team.
