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

Piriformis Syndrome – Pain in the butt

Piriformis Syndrome

Pain in the butt is a commonly used idiom, but it actually can be a real pain to many as piriformis syndrome. It is commonly seen in people who spend long hours sitting, such as desk bound jobs, long distance driving or riding a motor bike. Many long distance runners, cyclists, and skiers are at a high risk of getting Piriformis Syndrome as well. Symptoms are usually unilateral and are present as pain in the buttock or hamstring area. Affected side may experience neurogenic (nerve related) symptoms such as pins and needles, loss of sensation and weakness down the limb. Symptoms generally get worse with sitting or activities involving running. Many patients also report a feeling of a pebble under the affected buttock while sitting.piriformis-syndrome

Piriformis muscle is found deep under the big gluteal muscles. It runs across the pelvis area outwards and attaches to the femur (thigh bone). It serves as a rotator of the hip joint. It is an external rotator when the hip is extended and an internal rotator when the hip is flexed. Piriformis is very closely related to the sciatic nerve which runs down the leg from the lower back area. Piriformis muscle sits across and over sciatic nerve. In certain people, the sciatic nerve actually passes through the piriformis muscle itself. Any injury, irritation or tightness to the muscle may irritate the sciatic nerve and lead to neurogenic symptoms down the limb.



  • Injury to the muscle – from a fall
  • Limb length discrepancy
  • Jobs involving prolonged sitting
  • Poor sporting technique
  • Muscle imbalance around Lumbopelvic area (lower back and pelvis)
  • Piriformis compensating for weak gluteal muscles
  • Tight hip flexors and adductors
  • Overpronation(flattening) of foot  – causing internal rotation at hip
  • Altered gait biomechanics
  • Any pyogenic infection

Treatment options – Next Page

Move your nerves and relieve your pain



After a long day at work or prolonged sitting, people experience stiffness in the joints and muscles. Then a simple stretch gives so much relief, however many times a nagging discomfort stays there no matter how nicely you have stretched your muscle. The tight muscle which is not responding to your stretch might actually be a nerve. Like our muscles, nerves also get tight from staying in a certain position for too long or tightening of muscles around the nerve.

The key to relieve discomfort coming from nerves is simple – stretch it – floss it or glide it. Nerves also get blood supply and this supply can be increased from these simple techniques. It also helps in improving the movement of the nerve along the joints and muscles by improving their ability to glide.

Below are few simple ways to stretch or floss the nerves. There are many variations to it depending upon location of tightness, symptoms and limiting factors such as joint mobility or any existing conditions.

Upper body nerve stretch

Three main nerves that need to be stretched in the upper body are median nerve, radial nerve and ulnar nerve. To stretch theses nerves is simple and fun as the movement is quite similar to dancing.

Median nerve – (on a call position) Place open palm on your ear as if you are on a call and elbow out and in line with shoulder. Now straighten up your elbow while keeping the wrist in same bend position feel the stretch and come back to starting position. The stretch feel would be in your arm and palm.

median nerve stretch

median nerve stretch


Combined nerve stretch

Next page – Ulnar nerve and Radial nerve Stretch