• Pain, numbness, burning or tingling  in median nerve distribution of hand - thumb, index and middle fingers and half of the ring finger. 
• Symptoms often worse at night/first thing in morning
• May have difficulty holding / dropping objects
• Feeling of hand weakness, reduced sensation and reduced grip strength
• Positive on provocative testing i.e. Tinels, Durkans, Phalens median distribution, little finger usually spared

• Vary activities during the day, minimising tasks that require repeated squeezing, gripping, wringing, etc.
• Alternate activities between heavier and lighter activities to reduce any strain.
• Avoid prolonged wrist flexion/extension for any period of time.
• Hanging arm out of bed or shaking the hand, when they are numb or tingling may help
• If overweight, losing some weight may help
• Symptoms can settle within a year or so in 1 in 4 cases. So, not treating is an option, particularly if symptoms are mild or if pregnant or under 30 years old

• Confirm diagnosis of CTS through clinical history, provocative testing. Rule out neck related issues
• Provide patient with the below, and emphasize importance of trying a night splint (info on splints in the below hyperlink):
  • Carpal tunnel syndrome leaflet - BSSH.ac.uk
  • CTS exercise leaflet (Median nerve glide) - handtherapyacademy.com
  • Wrist splint information
• Direct Patient to NHS Inform Website for further info - https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/conditions/carpal-tunnel-syndrome
  • Carpal tunnel syndrome information booklet

• Moderate/Severe symptoms including thenar muscle wasting
• Symptoms involving ulnar nerve; nerve conduction tests may be required
• If symptoms persist following 6-8 weeks of self management

Refer via SCI Gateway to Occupational Therapy Hand Clinic and include following in referral:

• Duration of: self management - ? tried splint for 6 weeks or more
• Precipitating factors i.e. injury/trauma, Occupation
• Provocative testing (Tinel’s Durkan’s, Phalen’s) results , median distribution or not,
• Night-time symptoms
• Hand dominance , activity related symptoms