The carpal tunnel is a structure located within the wrist formed by the carpal bones as the “floor” and the strong transverse carpal ligament as the “roof.” Multiple structures run through this tunnel including all of the tendons that bend, or flex, your fingers, and the median nerve, which gives sensation to the palm of the hand, the thumb, index, long, and half of the ring fingers, on the palm side of the hand. Carpal Tunnel Syndrome occurs when there is swelling within the tunnel, resulting in increased pressure on the median nerve, causing pain, tingling, and numbness in the hand and fingers. 

• Overuse of your hands, often repetitive jobs such as typing, assembly line work, or constant fine motor tasks.
• It typically occurs in women more often than men due to the small diameter of the carpal tunnel, making the nerve more susceptible to compression.
• Following injuries of the hand and wrist, there is often swelling, which can increase pressure inside the tunnel, causing carpal tunnel symptoms.
• Pregnancy, due to increased water retention

• Typically, following preventative measures, treatment is started conservatively including avoiding positions and motions that increase pain and symptoms and modifying activities to help decrease symptoms. 
• Rest, ice, splinting, anti-inflammatory medications, and occupational therapy for exercises and education. 
• If conservative treatments fail, surgery may be considered to decrease pressure on the median nerve in the carpal tunnel. Consultation with a hand surgeon may be necessary to discuss the appropriate treatment plan.

• Splinting- custom thermoplastic splint is created to immobilize the wrist in a neutral position to allow for a rested position and prevent increased pressure in the carpal tunnel. Often this splint is worn at night to start, but can be progressed to daytime use if necessary
• Modalities- moist heat, ice, ultrasound, infrared laser to decrease inflammation and pain
• Manual therapy- this includes scar massage after surgical intervention, soft tissue mobilization, or manual edema mobilization to decrease edema in the hand and wrist and improve symptoms
• Therapeutic exercise- exercises such as tendon glides, median nerve mobilizations, strengthening when symptoms are resolved, and sensory re-education.
• Home exercise education- education on activity modification, prevention, and treatment plan