1. Introduction / Plain Theory

Carpal Tunnel Syndrome (CTS) is a condition caused by compression of the median nerve as it passes through the carpal tunnel — a narrow space in the wrist formed by carpal bones and the transverse carpal ligament.

The median nerve controls sensation in the thumb, index, middle, and part of the ring finger, as well as fine motor control of some hand muscles.
When the nerve becomes compressed or irritated, it can lead to pain, tingling, and weakness in the hand and wrist.

CTS is the most common nerve entrapment syndrome, affecting approximately 3–6% of adults, particularly those performing repetitive wrist or hand movements — such as office workers, assembly-line employees, musicians, and healthcare professionals.

2. Typical Symptoms and Functional Impact

• Tingling or numbness in the thumb, index, and middle fingers.

• Burning or aching pain in the wrist or hand, often worse at night.

• Hand weakness or clumsiness, especially when gripping small objects.

• Symptoms aggravated by typing, driving, or holding a phone.

• Occasionally radiating discomfort into the forearm or shoulder.

Functional impact:
Carpal tunnel syndrome can significantly limit work, sports, and everyday hand use.
If untreated, long-term compression can lead to muscle wasting (thenar atrophy) and persistent sensory changes.

Red flags:
Severe weakness, constant numbness, or night pain disrupting sleep should prompt medical evaluation to rule out progressive nerve damage.

3. Contributing Factors / Underlying Causes

Carpal tunnel syndrome develops from increased pressure within the carpal tunnel or reduced nerve gliding.
Contributing factors include:

• Repetitive wrist flexion and gripping (keyboard, mouse, tools).

• Prolonged static posture and poor ergonomics.

• Swelling or inflammation in tendons or surrounding tissues.

• Hormonal changes (e.g. pregnancy, menopause).

• Metabolic conditions (e.g. diabetes, hypothyroidism).

• Fascial or muscular tension in the forearm, shoulder, or thoracic outlet.

• Neck or upper back restrictions influencing neural and vascular mobility.

From an osteopathic perspective, CTS often represents a multi-level entrapment — where tension in the neck, shoulder, or forearm contributes to increased strain on the nerve at the wrist.

4. Osteopathic Approach

Osteopathic care for carpal tunnel syndrome aims to reduce mechanical compression, improve circulation, and restore nerve mobility throughout the entire upper limb.

An osteopathic assessment may include:

• Palpation and testing of wrist, elbow, shoulder, and cervical regions.

• Gentle mobilisation of the wrist, carpal bones, and transverse ligament.

• Myofascial release for forearm flexors, pronators, and hand muscles.

• Treatment of the thoracic outlet and cervical spine to improve nerve and vascular dynamics.

• Indirect and functional techniques to reduce pain and promote relaxation.

• Advice on ergonomics, movement breaks, and gentle stretching.

When symptoms are advanced, osteopathic care can complement medical management such as splinting, anti-inflammatory strategies, or, in severe cases, surgical decompression — while supporting post-operative recovery and preventing recurrence.

The goal is to restore optimal nerve health and mechanical balance, not merely to treat the wrist locally.

5. Scientific Evidence & References

Evidence supports manual therapy and multimodal conservative care for mild-to-moderate carpal tunnel syndrome.
Studies demonstrate that mobilisation of the carpal bones, soft-tissue release, and nerve-gliding techniques can improve pain, sensory function, and hand strength — often reducing the need for surgical intervention.

Osteopathic approaches are consistent with evidence-based conservative care guidelines, targeting mechanical, fascial, and systemic factors influencing nerve compression.

References

1. Keith MW, Masear V, Amadio PC, et al. American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of carpal tunnel syndrome. J Bone Joint Surg Am. 2010;92(1):218–219. Link

2. Piazzini DB, Aprile I, Ferrara PE, et al. A systematic review of conservative treatment of carpal tunnel syndrome. Clin Rehabil. 2007;21(4):299–314. Link

3. Page MJ, O’Connor D, Pitt V, Massy-Westropp N. Exercise and mobilisation interventions for carpal tunnel syndrome. Cochrane Database Syst Rev. 2012;(6):CD009899. Link

4. Tal-Akabi A, Rushton A. A study to investigate the effect of carpal bone mobilisation as a treatment for carpal tunnel syndrome. Man Ther. 2000;5(4):214–222. Link

5. Degenhardt BF, Johnson JC, Fossum C, et al. Osteopathic manipulative treatment in upper extremity entrapment neuropathies: pragmatic pilot study. J Bodyw Mov Ther. 2017;21(4):857–865. Link

6. Wolny T, Saulicz E. Effect of manual therapy on the clinical and neurophysiological outcomes in carpal tunnel syndrome: a systematic review and meta-analysis. Clin Rehabil. 2018;32(12):1596–1608. Link

7. Fernández-de-Las-Peñas C, et al. Manual therapy versus surgery for carpal tunnel syndrome: a randomized clinical trial. J Pain. 2015;16(11):1087–1094. Link

8. Xie Y, Chen Z, Yang Z, et al. Comparative efficacy of manual therapy interventions for carpal tunnel syndrome: network meta-analysis. Front Pain Res. 2024;15:1507371. Link