Carpal Tunnel Syndrome

Median nerve injury

Carpal tunnel syndrome is causes chronic wrist pain, numbness, pins, and needles.

Carpal tunnel syndrome symptoms

Symptoms of carpal tunnel syndrome usually develop gradually over time and may initially only be present at night. They occur in just one hand, or both at the same time and consist of:

  • A dull ache in the wrist and forearm
  • Pain which radiates into the thumb and four fingers of your hand, but not the little finger
  • Tingling or burning pain.
  • Pain is often worse at night and radiates into the forearm, elbow or even shoulder
  • Weakness in the hand and fingers, with difficulty gripping
Carpal tunnel syndrome symptoms
Carpal tunnel symptoms

Carpal tunnel assessment & diagnosis

A professional therapist will do specific assessment tests to help diagnose Carpal tunnel syndrome:

Phalen’s sign

Phalen’s sign is where the patient bends the wrists to push the backs of the hands together, holding for 1 minute. If tingling radiates into the thumb, index finger and middle of the fourth finger then the test is positive.

Tinel’s sign

Tinel’s sign is where the therapist taps with two fingers over the palm side of the wrist. The test is positive for Carpal tunnel syndrome if it reproduces tingling or other symptoms.

Imaging

Investigations for example, MRI scan, ultrasound imaging, electromyography or a nerve conduction study also help confirm the diagnosis.

What is Carpal tunnel syndrome?

Carpal tunnel syndrome

Compression of the median nerve in the wrist causes Carpal tunnel syndrome. The nerve and tendons of the flexor digitorum superficialis and flexor pollicis longus muscles pass through a narrow channel in the wrist called the carpal tunnel.

The tunnel narrows, creating pressure on the nerve for a number of reasons:

  • Traumatic wrist injury such as wrist sprains and broken wrists
  • Repetitive strain injury or RSI caused by overuse of the wrist
  • Pregnancy which causes fluid retention in the wrist
  • Use of vibrating machinery which may cause damage or inflammation to the soft tissues
  • It may be congenital meaning some people naturally have a smaller, narrower carpal tunnel
  • Arthritis
Carpal tunnel syndrome

All of these conditions can cause a narrowing of the space through which the median nerve passes.

Who is most at risk?

Symptoms are three times more common in women. This is probably because they generally 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 first in the dominant hand and sometimes, but not always also occurs in the nondominant hand.

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 should initially be conservative which means without surgery.

Rest

Rest from activities which cause pain or make it worse. Continuing to use a painful wrist will not allow inflammation to settle down and soft tissues to heal. This may include work-related activities such as typing at a keyboard, DIY or sport-specific training including racket sports. If you are an athlete then use this opportunity to work on another aspect of your game or maintain fitness with aerobic exercise.

Carpal tunnel splint

A wrist splint can protect and immobilize the wrist. This helps to rest, whilst still allowing some function of the hand. Wrist splints are made from neoprene with a metal spoon or stay which prevents movement.

Ice/cold therapy

If there is inflammation and swelling present, using a form of cold therapy will help to relieve this. Apply ice or a specialist cold wrap to the wrist for 10 minutes at a time, hourly in the early stages. Reduce frequency as your symptoms improve.

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Cold therapy

Medication

Your doctor may also prescribe anti-inflammatory medication such as ibuprofen to reduce inflammation, or diuretics to clear fluid retention.

Acupuncture

Some evidence shows Acupuncture improves carpal tunnel syndrome symptoms. Acupuncture is inserting needles of various lengths and diameters into specific points over the body. The therapist inserts, rotates and then either removes immediately or leaves the needle in place for several minutes.

Injections

If symptoms do not improve 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.

Exercises for carpal tunnel syndrome

Following a period of immobilization, stretching and strengthening exercises help prevent symptoms from returning. Exercises should be pain-free. If pain occurs, go back a step or rest for longer.

Initially, wrist mobility and gentle stretching exercises should be done to restore a full pain-free range of motion at the joint. Later, isometric (static) strengthening and finally dynamic exercises (involving movement) are performed.

Read more on Carpal tunnel syndrome exercises.

Surgery

If after conservative treatment has been tried for a few weeks and not been successful then surgery is often considered.

Surgery for carpal tunnel syndrome is a carpal tunnel release and is a very common operation, which involves cutting the carpal ligament to make more space for the median nerve.

This is either done as an arthroscopic operation (keyhole), or as an open release, where a 5-6cm incision is made. It is a straightforward procedure that 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 them rest and reduce swelling.

References

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