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Carpal Tunnel Syndrome
Carpal tunnel syndrome s probably the most common cause of wrist pain. Symptoms include a dull ache in the wrist and forearm with pain which may radiate into the hand and fingers, often worse at night.
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. 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 symptoms
Symptoms of carpal tunnel syndrome usually increase gradually over time and may initially only be present at night. Carpal tunnel syndrome can occur in one or both wrists at the same time. Symptoms include:
- A dull ache in the wrist and forearm.
- Pain which radiates into the thumb and four fingers but not 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.
Carpal Tunnel Test
Carpal tunnel syndrome symptoms can be reproduced to help diagnosis will often try to get you to reproduce your symptoms by performing one of the following tests:
- Phalen's sign is where bends the wrists and holds for one minute by pushing the backs of the hands together. If the test is positive and Carpal tunnel is indicated then tingling that radiates into the thumb, index finger and the middle half of the forth finger.
- Tinel's sign is where the therapist or athletic trainer taps with two fingers over the palm side of the wrist. Test is positive if there is a tingling sensation or other symptoms are reproduced.
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 causes
Carpal tunnel syndrome can be caused by a number of factors, including:
- Traumatic wrist injury such as wrist sprains and broken wrists.
- Repetitive use of the wrist is a common cause. Carpal tunnel syndrome is a form of RSI or repetitive strain injury.
- Pregnancy which causes fluid retention in the wrist.
- Use of vibrating machinery.
- It may be congenital meaning 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 symptoms are 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.
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. 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.
Carpal tunnel syndrome surgery
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.
