What is carpal tunnel syndrome?
Carpal tunnel syndrome is caused by compression of the median nerve in the wrist. The median nerve is one of the nerves which supplies the hand (shown opposite). It passes through the wrist in a narrow channel called the carpal tunnel, along with the flexor digitorum superficialis and flexor pollicis longus tendons.
Carpal tunnel syndrome can be caused by a number of factors, including:
- Traumatic wrist injury such as sprains and fractures.
- Repetitive use of the wrist (Carpal tunnel syndrome is a form of RSI).
- Pregnancy - causing fluid retention in the wrist.
- Use of vibrating machinery.
- Congenital - some people naturally have a smaller, narrower carpal tunnel.
- Arthritis.
All of these conditions can cause a narrowing of the space through which the median nerve passes. The cause may be structural such as with a fracture or congenital cases, or due to swelling, inflammation or fluid retention.
Carpal tunnel syndrome is three times more common in women, probably because they have a smaller carpal tunnel. It also has a higher prevalence in people with diabetes and other conditions which directly affect the nervous system. It usually occurs firstly and sometimes solely in the dominant hand, where it is also more painful. Some professions are more at risk of developing carpal tunnel syndrome, especially people working on an assembly line, who are continually repeating the same movement.
What are the symptoms of carpal tunnel syndrome?
Symptoms usually increase gradually and may initially only be present at night. Carpal tunnel syndrome may be in one or both wrists.
- A dull ache in the wrist and forearm.
- Pain which radiates into the thumb and four fingers (excluding the little finger).
- Sensations of tingling or burning in the hand or four fingers.
- Pain which is worse at night.
- Pain may radiate into the forearm, elbow or shoulder.
- Weakness in the fingers and hands.
How is carpal tunnel syndrome diagnosed?
If you suspect carpal tunnel syndrome you should visit your Doctor as soon as possible. They will ask you about your symptoms and examine your hand and wrist for tenderness, sensation, warmth and colour. They will often try to get you to reproduce your symptoms by performing an aggravating movement, or one of the following tests:
- Tinels sign - Tapping with two fingers over the palm side of the wrist. The test is positive if any of the symptoms are reproduced.
- Phalens test - Place your hands in front of you at chest height with the fingers of the two hands touching. Flex the wrists so that you put the backs of your hands together. Hold this position for a minute. Reproduction of any symptoms is a positive result.
Investigations may also be performed to confirm the diagnosis. You may be offered an MRI scan, ultrasound imaging, electromyography or a nerve conduction study.
Carpal Tunnel Syndrome Treatment
Treatment of carpal tunnel syndrome should initially be conservative and led by your Doctor. The first period of treatment should include complete rest for the wrist, which is normally immobilised in a splint, as shown above. If there is inflammation and swelling present, using a form of cold therapy will help to relieve this. Your Doctor may also prescribe anti-inflammatory medication such as ibuprofen to reduce inflammation, or diuretics to clear fluid retention .
Following a period of immobilisation, stretching and strengthening exercises can be used to help prevent a reoccurrence of symptoms. All exercises should be performed pain-free. If pain occurs, go back a step. Firstly you should aim for a full, pain-free range of motion, before moving on to strengthening. Resistance bands are excellent for performing wrist strengthening exercises.
Other, more alternative treatments, which may be worth trying include acupuncture and yoga, which have been linked to an improvement in carpal tunnel syndrome symptoms.
If symptoms do not improve following rest and anti-inflammatories, other options include Corticosteroids or lidocaine injections. If all of this treatment fails and symptoms persist over a 6 month period, surgery may be required.
What does surgery involve?
A carpal tunnel release is a very common operation, which involves cutting the carpal ligament to make more space for the median nerve. This can either be done as an arthroscopic operation (keyhole), or as an open release, where a 5-6cm incision is made. It is a straightforward procedure which is usually carried out on an outpatient basis. Your hand and wrist will be bandaged and may be placed in a sling for a few days to help it rest and reduce swelling.
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