Carpal Tunnel Syndrome – Painful Wrist & Hand

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is a common condition affecting hand and wrist. It occurs most frequently in middle and old age. It is one of the widely known neuropathy (nerve related) condition. The nerve affected in Carpal tunnel syndrome is known as Median nerve. The median nerve is responsible for sensation over the palm side of thumb and three fingers (index, middle and ring)(fig. 1). It also supplies to the small muscles in hand, which controls the function of the thumb and fingers. After running in arm and forearm, median nerve enters the hand through a narrow passage known as carpal tunnel. Carpal tunnel is formed by bones and ligaments. Tendons of the forearm muscles attaching to the fingers and median nerve pass through this tunnel.

median nerve supply

fig. 1

When the space in the canal is compromised, it causes compression and reduced blood flow to median nerve. The reasons for reduced space can range from swelling and other structural changes such as thickening of the tendons. It can be unilateral affecting one side or bilateral (both hands). Usually the symptoms may include pain, pins and needles, numbness, weak grip and burning sensation. Affected area is the area where the nerve supplies – thumb and index, middle and ring finger. Symptoms tend to worsen overtime following a gradual onset.  Carpal tunnel Syndrome is also characterized by its Nocturnal Symptoms (Symptoms occurring/aggravated in the night). Other aggravating factors include, repetitive wrist movements, writing, typing prolonged flexion or extension position of wrist, gripping and driving a car.


  • Wrist injuries/fracture
  • Jobs involving use of vibrating tools (e.g. Drilling machines)
  • Office jobs involving use of computer
  • Fluid retention from pregnancy or menopause
  • Tendon inflammation
  • Congenital predisposition – born with a smaller carpal tunnel
  • Obesity
  • Rheumatoid Arthritis
  • High blood pressure
  • Thyroid Dysfunction
  • Diabetes
  • Cyst or tumor

Treatment options – Next page

Sitting Posture – Are you practicing it right??

What is the right sitting posture?

In the previous article on posture, we discussed basics of a right sitting posture. This article will focus on the neutral joint position while sitting and cues to correct them. Now days, majority of people spend their time at work or home, sitting in front of a computer. We tend to ignore the fact that human being was evolved to be active, to walk, to run and not sit for 8+hours at a desk. A plethora of problems arises from prolonged sitting and also the way we sit. Health conditions can range from chronic neck and low back pain, fatigue, increased risk of cardiovascular, metabolic disorders and many more.

Interestingly many people are aware of these facts but they find it hard to do anything about it. It’s surely not that feasible or practical to just change your line/type of work. However, there are ways to reduce the impact of sitting on the body. The most common sitting posture mistakes we encounter at work are slouched posture, forward head, resting to one side and bad work station ergonomics. There are more if we look down further at the position of feet which can lead to poor blood flow and knee joint pain.

Common Sitting posture mistakes


  • Forward head posture
  • Neck rotated (commonly seen in people working on two screens and also if the screen is kept on the side)
  • Hunched back
  • Protracted shoulders
  • Arms kept too far from the body
  • Forearms not resting on the table
  • Side bending or listing at back (tends to happen when people rest to one side – specially on the opposite side of hand using mouse)
  • Posterior pelvic tilt ( which forces the spine to hunch)
  • Sitting forward (buttocks not close to back rest)
  • Crossing of legs
  • Knees excessively bend and feet kept under the chair either straight or crossed
  • Feet kept far from the body
  • Sitting for prolonged hours without regular breaks and enough movementincorrect-foot-postures

Continue reading – Page 2 of 3

Understanding Correct Posture Part – 1

Understanding Correct Posture

For years we have been told to sit and stand straight maintaining a good posture. In spite all said, poor posture has become an epidemic among humans, thanks to the urban lifestyle. Life has become nothing but long hours of sitting at work and living in the new world of mobile phones and tablets. This digital world has surely made things easy, fast and accessible but at the cost of your movement, physical work and health. These are the side effects of urbanization, which we have already discussed in detail in one of our articles. Please click here to read it if you have missed.

posture 4

Correct posture is when the whole musculoskeletal system is working at its optimum. Right alignment of joints and a good balance between the muscles, ensuring no excessive strain is placed on any structure. A correct posture not only engages the right muscles, it also reduces your effort in carrying out activities. Now the million dollar question is what a correct posture is and how one can avoid excessive strain on the joints and muscles.  The most common answer would be standing and sitting straight. However, “straight” is not the right word when it comes to many joints of the body. The right word here should be neutral. Being straight somewhat corrects your posture but if you are not aware of the neutral position, compensation is meant to happen to achieve a straight posture. Many a times the word “straight” can be misleading.


Next important thing to consider while correcting posture is to include each and every joint. However, we often only concentrate at one particular area of body or joint. For example, when people try to correct their sitting posture they seem more focused on straightening their spine, ignoring the pelvis shoulders, feet and arm position. Our whole skeletal system is a chain. If you change something at one end it will affect the whole chain. This makes it important to understand the neutral position of every joint in our skeletal system.

When and why to use an Ice Pack?

When and why to use an Ice Pack?

Article by Adele Ang


Senior Sports and Musculoskeletal Physiotherapist

About the Author : Adele specialize in Sports and Musculoskeletal Physiotherapy.  She also pursued the Polestar Pilates Method, which is a comprehensive method using Pilates as exercise therapy for rehabilitation of injuries.

In Asian cultures, applying cold packs to injured body parts is frowned upon. As there is a belief that it can lead to ‘rheumatism’, which is typically characterised as stiff and achy joints. As a kid, my dad would rub a hard-boiled egg, straight out of boiling water, on a bruise formed on my head or my knees the very moment after sustaining these bruises.

I was told that this is done to improve blood circulation to the bruise, for the bruise to dissolve, as well as to avoid having to cut the bruise out as it will be ‘dead flesh’, should blood permanently fail to return to the bruise. Really frightened that this threat might really happen, I endured the painful hot egg treatment with every bruise I sustained as a kid.

Applying cold therapy to injuries is not common practice in Asian cultures, whether it’s Traditional Chinese Medicine or Ayurvedic Medicine, heat therapy is still a treatment of choice. As such, it’s not common knowledge among some patients when to apply heat and when to apply cold.

Here are 3 pointers to help you decide to reach for ice whenever you sustained an injury.

1.First 72 hours

The basic guideline is that cold therapy should be applied in the first 3 days following an injury. Inflammation which is our bodies healing mechanism happens immediately following an injury, whereby blood flow is increased to that area to commence healing. As a result of inflammation, pain is experienced and the injured area will be swollen and warm to touch.

2.Red, swollen and warm to touch (past 72 hours)

When the area concerned presents with redness, swelling and is warm to touch. These 3 things suggest that the injured structures are still inflamed. Cold therapy may at times need to be continued after 72 hours especially when the injury sustained is extensive and/or it affects parts of our body such as the foot and ankle which usually have more persistent swelling due to continuous load on these areas if weight is placed on then as well as due to gravity pulling more fluid down to those areas.

3.Difficulty moving the injured area due to pain

Usually pain is intense and unremitting and episodic as well. May have been more than a few days, could be weeks or months prior but is episodic. A recurring injury to the same area may result in such a presentation, usually heat therapy is applied but should you feel worse or in more pain after, you may respond better to cold therapy. This may be due to repeated inflammatory responses to the injured area usually resulting from repeated aggravation of the same area as a result of insufficient rest as well as not receiving proper treatment, including physiotherapy and rehabilitation following the injury.

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