Carpal Tunnel Syndrome: What It Is, What the Research Says, and How Physiotherapy Can Help
- Javier Diaz
- Mar 31
- 6 min read
What Is Carpal Tunnel Syndrome?
You’re lying in bed, and your hand goes numb. Again. You shake it out, flex your fingers, and try to fall back asleep — but by morning, the tingling is still there. Sound familiar? If you’re dealing with numbness, tingling, or weakness in your hand and wrist, there’s a decent chance you’re dealing with carpal tunnel syndrome — and you’re far from alone. It’s the most common nerve entrapment condition out there, and it’s one of the issues we see regularly at Pursuit Physiotherapy in Burlington.
Carpal tunnel syndrome (CTS) happens when the median nerve — the nerve responsible for sensation in your thumb, index finger, middle finger, and part of your ring finger — gets compressed as it passes through a narrow passageway in your wrist called the carpal tunnel. That tunnel is tight to begin with. When anything increases pressure inside it — swelling, inflammation, thickened tendons — the nerve gets squeezed, and that’s when symptoms start.
What Causes Carpal Tunnel Syndrome?
There’s a common belief that CTS is caused by typing all day, and while repetitive hand movements can contribute, the picture is more complex than that. Many people develop carpal tunnel syndrome regardless of what they do for work.
Some of the most recognized contributing factors include:
Repetitive wrist and hand motions — typing, assembly work, using vibrating tools, or even prolonged gripping (think cycling or weightlifting)
Sustained wrist positions — working with your wrist bent for extended periods, whether at a desk or on a job site
Anatomical factors — some people simply have a smaller carpal tunnel, which means less room for the nerve
Hormonal and metabolic changes — pregnancy, diabetes, thyroid conditions, and menopause are all associated with higher CTS rates
Inflammatory conditions — rheumatoid arthritis and other inflammatory conditions can cause swelling within the tunnel
Women are affected more often than men, and the condition tends to be more common in adults over 40 — though we see it across all age groups at our Burlington clinic.
Signs You Might Have Carpal Tunnel Syndrome
CTS symptoms typically creep in gradually. They don’t usually show up overnight. Here’s what to watch for:
Early Symptoms
Numbness or tingling in your thumb, index, and middle fingers — especially at night. Many people describe waking up feeling like their entire hand has “fallen asleep.” You might also notice a pins-and-needles sensation while driving, holding your phone, or reading a book.
Progressing Symptoms
As the condition advances, you might start dropping things. Your grip weakens. Buttoning a shirt or turning a key feels harder than it should. In more advanced cases, the muscles at the base of your thumb can actually start to waste away — a sign that the nerve has been compressed for too long.
Here’s the thing: not every case of hand numbness or wrist pain is carpal tunnel. There are other potential nerve entrapment sites, and conditions like cervical radiculopathy (a pinched nerve in the neck) can mimic CTS symptoms. Getting a proper assessment matters — and that’s something we take seriously at Pursuit Physiotherapy.
How Physiotherapy Treats Carpal Tunnel Syndrome in Burlington
If you’ve been told your only options are a wrist splint or surgery, you’re missing a big piece of the picture. Physiotherapy for carpal tunnel syndrome is effective, especially for mild to moderate cases — and recent research backs this up.
At Pursuit Physiotherapy, we take a one-on-one approach to CTS. Your initial assessment is thorough — we don’t just look at your wrist. We assess your entire upper limb, from your neck to your fingertips, because median nerve compression can be influenced by restrictions anywhere along that chain.
Here’s what treatment typically involves:
Hands-on techniques including soft tissue release, joint mobilizations of the wrist and hand, and nerve mobilization can help reduce pressure on the median nerve and improve tissue mobility. Our manual therapy approach is specific and targeted — not a generic rubdown.
Neurodynamic Exercises
These are exercises designed to gently move the median nerve through its full range, reducing sensitivity and improving the nerve’s ability to glide freely through the carpal tunnel. Research has shown that neurodynamic therapy, combined with exercise, can be effective for mild to moderate CTS — and in some cases, results have been maintained for over six months without the need for surgery.
Strengthening and Stabilization
Weakness in the hand and wrist muscles often accompanies CTS. Targeted strengthening — particularly of the intrinsic hand muscles and the muscles that control wrist position — helps support the area and reduce strain on the nerve.
As part of our treatment toolkit, medical acupuncture can help manage pain and reduce local inflammation. Javier Diaz, our clinic director and a medical acupuncture instructor at McMaster University, integrates this approach when appropriate to complement hands-on treatment and exercise.
Education and Activity Modification
We’ll work with you on identifying what’s aggravating your symptoms — whether it’s your workstation setup, your sleeping position, or specific activities — and give you practical strategies to reduce nerve irritation without putting your life on hold.
What the Research Says: Injection vs. Surgery for Carpal Tunnel
One question patients in Burlington often ask us is: “Should I just get a cortisone shot?” It’s a fair question. Cortisone injections can provide short-term relief — and in the first three months, research actually shows they may outperform surgery for symptom reduction.
But the long-term picture tells a different story.
A long-term follow-up study by Ly-Pen and colleagues, published in Hand (2022), tracked carpal tunnel patients treated with either corticosteroid injection or surgical decompression for over six years. The injection group had roughly a 42% treatment failure rate at 6+ years, while the surgery group had only about 12%.
The injection group tended to progressively need additional interventions over time, while the surgery group’s failures mostly occurred within the first year. So what does this mean for you?
Injections can be a reasonable starting point — especially for mild or recent-onset CTS — but they’re not a long-term fix for everyone
Surgery is generally more durable — particularly for moderate to severe cases, and it’s a safe procedure with a serious complication rate of less than 0.1%
Conservative physiotherapy should be tried first for mild to moderate cases — neurodynamic therapy, exercise, and manual treatment can be effective and are far less invasive than either injection or surgery
The takeaway isn’t that one approach is universally better — it’s that the right treatment depends on the severity and duration of your symptoms, and that physiotherapy plays a critical role regardless of which path you end up on.
What to Expect at Your First Appointment
When you come in for a carpal tunnel assessment at Pursuit Physiotherapy, here’s what you can expect. Your session is one-on-one — no being passed between therapists or sharing time with other patients. We’ll start with a detailed conversation about your symptoms, your daily activities, and what you’ve already tried. From there, we’ll do a thorough physical examination of your wrist, hand, forearm, elbow, shoulder, and neck.
Why the neck? Because the median nerve starts there. A restriction or irritation higher up the chain can amplify symptoms at the wrist — and missing that connection means missing the full picture.
You’ll leave your first appointment with a clear understanding of what’s going on, a plan for treatment, and usually a few things you can start doing at home right away.
Three Things You Can Do at Home Right Now
Wear a wrist splint at night. A neutral-position splint keeps your wrist from curling while you sleep, which reduces pressure on the median nerve. This alone can significantly reduce nighttime symptoms.
Try a basic nerve glide. Extend your arm out in front of you, straighten your elbow, extend your wrist back (fingers pointing to the ceiling), then gently tilt your head away from that arm. Hold for 5 seconds, release, and repeat 10 times. This should feel like a gentle stretch — never painful.
Check your wrist position at work. If you spend time at a desk, make sure your wrists aren’t resting in a bent position while typing. A neutral wrist — not flexed up or down — reduces pressure inside the carpal tunnel.
When to See a Physiotherapist for Carpal Tunnel
Don’t wait until you’re dropping things to get help. If you’ve had numbness, tingling, or pain in your hand and wrist for more than a couple of weeks — especially if it’s waking you up at night — it’s worth getting assessed. Early intervention gives you the best chance of resolving symptoms with conservative treatment and avoiding the need for more invasive options down the road.
And if you’ve already had a cortisone injection or surgery, physiotherapy is still a key part of your recovery. We help patients across Burlington, Oakville, Hamilton, Waterdown, and Milton get back to using their hands without pain.
Ready to get to the root of it?
Book a one-on-one assessment at Pursuit Physiotherapy.
#201-4125 Upper Middle Road, Burlington | (905) 331-8993
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