Carpal Tunnel Syndrome or Median Neuropathy is caused by compression of the median nerve at the front of the wrist. Pain or weakness in the hand and forearm is often accompanied by tingling and sometimes numbness in the fingers.
The carpal tunnel is formed by the transverse carpal ligament passing over the bones (carpals) and soft tissues of the inside of the wrist. Running through this carpal tunnel are the tendons (flexor tendons) that allow you to curl your fingers to grip things.
Also running through this tunnel alongside the flexor tendons, is the Median nerve.
This nerve originates from your neck area and is one of three nerves that connect to your hand. Appart from transmitting sensation from the thumb and fingers to the brain, it is also responsible for controling some of the muscles of the thumb.
The main fingers affected by this nerve are particularly the index, middle and (occasionally) the ring fingers.
For various reasons, pressure/repeated use of this area, causes the tendons to swell and overfill the carpal tunnel, placing pressure on the median nerve.
What causes carpal tunnel syndrome?
Carpal tunnel syndrome develops for a variety of reasons and in some cases can get better without treatment. It is known that women tend to be affected more than men.
Some factors which can lead to development of CTS are;
- A fracture or injury of the wrist
- Carrying out manual tasks that you are not used to or for too long a period, such as pruning, clipping hedges, DIY.
- Rheumatoid arthritis or other conditions affecting the joints
- Osteoarthritis in the wrist
- Growth related medical conditions such as acromegaly
- Fluid rention (such as during pregnancy or menstrual cycle)
- Being overweight
- Underactive thyroid gland
- Certain medicines, such as oral contraceptives
People who’s occupations involve repeated use of the hands or strain on the wrist are at risk of developing CTS.
There are other conditions which have similar symptoms to Carpal tunnel syndrome, such as a trapped or damaged nerve in the neck or shoulder region.
Symptoms of carpal tunnel syndrome
- Pain or aching, in the hand, forearm and sometimes the upper arm.
- Tingling or numbness, mainly in the thumb and first three fingers.
- Weakening grip and pain (especially at the base of the thumb and wrist) when performing tasks such as buttoning a shirt or sewing.
Symptoms are usually worse in the thumb, index and middle fingers but can affect your whole hand. The aching may sometimes extend up into the forearm as the muscles are put under increasing strain. Problems can even appear at the elbow and even the shoulder and neck as the body subconsciously adapts movements to accommodate the damaged wrist.
It is usually the dominant side that is affected, ie: if you are right handed, the symptoms will usually appear in this hand but it can affect both hands. Sometimes because of the cause of the condition and sometimes because we use our non dominant hand more in order to rest and compensate for the injured one.
Pain and aching is usually worse at night and feels like a deep tooth ache, often disturbing the sufferers’ sleep. Tightening and contraction of the tendons and soft tissues during the night, often means that opening your fingers or gripping can be very painful in the morning.
Once the person is active, symptoms may ease as tissues warm and become more flexible, but the pain and tingling can appear during the working day, especially if the person carries out tasks which involve the hands.
Diagnosis of Carpal tunnel syndrome
A detailed history of how the condition started and what the symptoms are, is usually enough but a doctor or therapist will sometimes confirm their suspicion by tapping on the median nerve area over the wrist and ask the patient to flex the wrist to see if the symptoms appear, this is called Tinnel’s sign. If the practitioner is unsure or if the test is positive, you may be referred to a specialist to find out the extent of the damage to the median nerve. They do this by performing a nerve conduction test.
Treatment of CTS
The first aim of treatment for CTS is to reduce pressure on the median nerve and the earlier that treatment begins, the more effective it is.
You may be sent for ultrasound treatment to reduce swelling in the tendons, along with massage and mobilisation of the wrist to help reduce muscle spasm and tightness in the tendons.
Your doctor or therapist will try to determine the cause of the problem and if necessary advise on changes that need to be made. Sometimes, changing the way you carry out a task and how often you rest may resolve the problem.
You may be advised to perform special stretching exercises, apply cold compresses or even use a specially designed Carpal tunnel splint at night or even during the day to help keep the wrist straight, easing compression on the carpal tunnel.
In most cases, anti-inflammatory drugs such as ibuprofen do not seem to help, but you may require a strong painkiller.
Depending on the severity of the condition, your medical practitioner may prescribe steroid tablets such as Prednisolone or even steroid injections into the carpal tunnel. This may not always be successful.
Some people find that acupuncture or the use of a TENS machine helps to relieve symptoms of carpal tunnel syndrome.
In some severe cases, surgery may be needed to release the carpal tunnel. The simple procedure is carried out to make more space in the carpal tunnel by cutting the ligament which is placing pressure on the tendons and nerves.
Most cases of CTS are effectively treated with physiotherapy techniques if the condition is caught in the first few weeks.