01/13/2026
Carpal Tunnel Syndrome (CTS) is caused by pressure on the median nerve in the wrist's carpal tunnel
Symptoms
• Numbness, tingling, or burning in the thumb, index, middle, and half of the ring finger (pinky unaffected).
• Pain in the hand, wrist, or forearm that can extend up the arm.
• Weakness when gripping objects, dropping things.
• Symptoms often start slowly in the dominant hand and worsen at night or during activities like driving.
Causes & Risk Factors
• Compression: Pressure on the median nerve within the carpal tunnel.
• Repetitive Motion: High hand/wrist repetition activities.
• Anatomy: The carpal tunnel is a narrow passage formed by bones and ligaments.
• Other Factors: Pregnancy, obesity, diabetes, arthritis, and hypothyroidism.
Key Soft Tissues Involved
• Synovium (Synovial Tissue): This tissue surrounds and lubricates the tendons. Swelling or inflammation of the synovium is a primary cause of reduced space in the tunnel.
• Flexor Tendons: These tendons pass through the tunnel, and inflammation (tenosynovitis) or thickening of these tendons increases pressure.
• Transverse Carpal Ligament: This tough band of connective tissue forms the roof of the carpal tunnel and can harden or shorten, tightening the tunnel space.
• Subsynovial Connective Tissue (SSCT): Fibrosis of this tissue can restrict the normal gliding of the tendons and the median nerve, contributing to increased internal pressure.
• Me dian Nerve: While not technically "soft tissue" in the same way as muscle or ligament, the outer covering of the nerve (myelin sheath) is injured and compressed, leading to symptoms.
• Muscle Groups: In advanced stages, the muscles at the base of the thumb (thenar muscles) may become weak or atrophy.
Pathophysiology and Symptoms
• Inflammation and Swelling: Repetitive motions,, hormonal changes (e.g., pregnancy, thyroid issues), or underlying conditions like diabetes can cause these tissues to swell.
• Fibrosis: Chronic irritation can lead to tissue scarring, further narrowing the passage.
• Ischemia: High pressure inside the tunnel compresses blood vessels, causing a lack of blood flow to the nerve.
Massage can help relieve symptoms by reducing inflammation and using cross fiber friction to improve fibrosis if presents.
