Carpal Tunnel Syndrome (CTS)
Includes causes, symptoms, anatomy, plus exercises and stretches to treat and prevent carpal tunnel syndrome.
by Brad Walker | Updated July 6, 2025
Carpal tunnel syndrome (CTS) is a common complaint in individuals who perform constant and repetitive motions of the hand and wrist. Any athlete who plays a sport that requires them to repeatedly grasp something, while the wrist joint is twisting and turning, is at an elevated risk of developing carpal tunnel syndrome.
Sports that have a high incidence of carpal tunnel syndrome include most racket sports, handball, swimming, body building, rowing, golf, archery, and rock climbing, although any sport that involves prolonged use of the wrist and hand can cause the condition.
What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is a compression neuropathy in which the median nerve that runs from the forearm to the hand becomes entrapped in the region of the wrist.
This entrapment means that the thumb and the first three fingers, as well as most of the palm can, and often do, become numb. The median nerve also supplies limited movement to the thumb through the Thenar muscles (the lump at the base of the thumb) and so the condition normally causes partial paralysis of the thumb.
Anatomy of the Wrist
As mentioned carpal tunnel syndrome is caused by the entrapment and compression of the median nerve. This nerve runs from the forearm to the hand where it branches to supply innervations to the thumb and the first two fingers.
As it traverses the wrist area, the nerve passes through the carpal tunnel, which is composed of the carpal bones and the transverse carpal ligament. The carpal bones make up the base and sides of the tunnel so that a semicircular shape or valley is formed. Stretched across this, much like a bridge that crosses a valley is the tough transverse ligament.
The median nerve, along with nine tendons that give the thumb and fingers movement, pass through the tunnel and into the hand. The carpal tunnel is a rigid structure, and the inner space is fixed and very confined.
Causes of Carpal Tunnel Syndrome
Carpal tunnel syndrome is an inflammatory disease and so any sport or pastime that is repetitive in its actions can cause either the muscles or the tendons of the wrist to become irritated and inflamed.
In addition to the median nerve, a set of nine tendons also run through the carpal tunnel. When the protective linings, or synovial sheaths, of these tendons become swollen and inflamed this puts excessive pressure firstly on the tendons but also on the median nerve. Other ways in which the pressure becomes increased is when the tough transverse carpal ligament becomes swollen and when a bone fracture or break causes edema (buildup of fluid).
Signs and Symptoms
Most of the symptoms felt by sufferers of carpal tunnel syndrome are due to the entrapment of the median nerve. When the median nerve becomes compressed because of the excess pressure in the carpal tunnel, the nerve signals that are normally transmitted through the nerve become slowed, which results in abnormal sensations in the affected hand. Common symptoms include:
- Weakness in the affected hand, which affects grip. Many sufferers find that picking up a bag or opening a door becomes difficult because they can no longer grip with enough force.
- A feeling of numbness or pins and needles in the thumb, fingers (not the little finger), and the thumb-side of the palm. Alternatively, some individuals may have a tingling or burning sensation instead.
- Impaired coordination of the thumb and forefingers so that fine movements become difficult.
- Pain in the wrist and hand that can stretch up as far as the elbow. The pain that is associated with carpal tunnel syndrome is not actually caused by the nerve compression; rather it is caused by inflammation or by a bone fracture, which in turn causes the nerve compression. Most cases of CTS cause absolutely no damage to the nerve itself and so when the pressure is relieved the symptoms abate.
- Tinel’s sign – this is a diagnostic test that involves tapping the carpal tunnel area lightly to see if a sharp pain is felt. If pain is felt, then a diagnosis of CTS is generally given.
Carpal Tunnel Syndrome Treatment
CTS is a soft tissue injury of the muscles and tendons around the wrist joint and therefore should be treated like any other soft tissue injury.
The initial treatment for carpal tunnel syndrome is the same as most other soft tissue injuries. This involves the application of R.I.C.E.R. (R) rest, (I) ice, (C) compression, (E) elevation and obtaining a (R) referral for appropriate medical treatment. It is critical that the R.I.C.E.R. regimen be implemented for at least the first 48 to 72 hours. Doing this will give you the best possible chance of a complete and full recovery. The following few points are of most importance.
- Rest and Immobilization: Once CTS is diagnosed, it is important that the affected area be rested immediately. Any further movement or stress will only aggravate the condition and prolong recovery. It is also important to keep the injured area as still as possible.
- Ice: By far the most important part. The application of ice will have the greatest effect on reducing swelling and pain. Apply ice as soon as possible after the injury has occurred.
- Anti-inflammatory Medication: The use of anti-inflammatory, NSAIDs (Non-steroidal anti-inflammatory drugs), and analgesic medication can also help to reduce pain and inflammation during the initial stages of treatment.
During the first 48 to 72 hours after an injury like CTS, be sure to avoid any form of heat at the injury site. This includes heat lamps, heat creams, spas, Jacuzzi’s, and saunas. Avoid all movement and massage of the injured area. Also, avoid excessive alcohol. All these things will increase the swelling and pain of your injury.
- The next phase of treatment (after the first 48 to 72 hours) involves a number of physiotherapy techniques. The most common methods used to do this include ultrasound, heat, and massage.
- Next, start to incorporate very gentle range of motion exercises for the muscle groups around the wrist and forearm.
- Once most of the pain has reduced, it is time to move onto the rehabilitation phase of your treatment. The main aim of this phase is to regain the strength, power, endurance, and flexibility of the muscles and tendons in the fingers, hand, wrist, forearm and upper arm.
Carpal Tunnel Syndrome Prevention
Here are some of the things you can do to help prevent carpal tunnel syndrome.
- Warm-Up properly: A good warm-up is essential in getting the body ready for any activity. A well-structured warm-up will prepare your heart, lungs, muscles, joints and your mind for strenuous activity.
- Avoid activities that cause pain: This is self-explanatory, but try to be aware of activities that cause pain or discomfort, and either avoid them or modify them.
- Rest and Recovery: Rest is especially important in helping the soft tissues of the body recover from strenuous activity. Be sure to allow adequate recovery time between workouts or training sessions.
- Strapping: Strapping, or taping can provide an added level of support and stability to weak or injured wrists. A wrist brace can help to stabilize the wrist and stop over-extension and flexion.
- Strengthening: Instead of me trying to explain how to do strength exercises, I simply found some great YouTube videos (below) that have clear visual examples and good descriptions of how to perform exercises for the muscles around your hips and knees.
- Stretching: To prevent CTS, it is important that the muscles in the hand, wrist and forearm be in top condition. Be sure to work on the flexibility of all the muscle groups in the arm. See the photos below for two great wrist stretches for these muscle groups.
Research and References
- Bahr, R. Maehlum, S. (2004) Clinical Guide to Sports Injuries, 1st Edition (ISBN: 978-0736041171)
- Ibrahim, I. Khan, W.S. Goddard, N. Smitham, P. (2012). Carpal Tunnel Syndrome: A Review of the Recent Literature. The Open Orthopaedics Journal, 6:69-76.
- Martini, F. Tallitsch, R. Nath, J. (2009) Human Anatomy, 9th Edition (ISBN: 978-013432076X)
- National Institute of Neurological Disorders and Stroke. (March, 2020). Carpal Tunnel Syndrome Fact Sheet. Retrieved May 10, 2019, from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Carpal-Tunnel-Syndrome-Fact-Sheet.
- Tortora, G. Derrickson, B. (2009) Principles of Anatomy and Physiology, 14th Edition (ISBN: 978-1118866096)
- Walker, B. (2018). The Anatomy of Sports Injuries, 2nd Edition (ISBN: 978-1623172831)
- Wikipedia contributors. (2021, October 23). Carpal tunnel syndrome, In Wikipedia, The Free Encyclopedia.
- Wipperman, J. Goerl, K. (2016). Carpal Tunnel Syndrome: Diagnosis and Management. American Family Physician, 15;94(12):993-999.
About the Author: Brad Walker is often referred to as the "Stretch Coach" and has even been called the Stretching Guru. Magazines such as Runners World, Bicycling, Triathlete, Swimming & Fitness, and Triathlon Sports have all featured his work. Amazon (author page) has listed his books on five Best-Seller lists. Google cites over 100,000 references to him and his work on the internet. And satisfied customers from 122 countries have sent 1,000's of verified customer reviews. If you want to know about stretching, flexibility or sports injury management, Brad Walker is the go-to-guy.
Disclaimer: The health and fitness information presented on this website is intended as an educational resource and is not intended as a substitute for proper medical advice. Please consult your physician or physical therapist before performing any of the exercises described on this website, particularly if you are pregnant, elderly or have any chronic or recurring muscle or joint pain.
