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CARPAL TUNNEL SYNDROME

What is carpal tunnel syndrome?

Carpal tunnel syndrome (CTS) is pressure on a nerve in your wrist, the median nerve, causing numbness or tingling and pain in your fingers, hand and wrist. The carpal tunnel is a narrow passageway surrounded by bones and ligaments on the palm side of your hand.

The median nerve provides sensation (ability to feel) to your thumbs, index fingers, long fingers, and part of the ring fingers. It supplies the impulse to some of the muscles going to the thumb. When the median nerve is compressed, the symptoms can include numbness, tingling and weakness in the hand and arm. Carpal tunnel syndrome can occur in one or both of your hands and is a common condition.

How do you get carpal tunnel syndrome?

Carpal Tunnel Syndrome

Carpal tunnel pain is caused by repetitive motion, poor position, or excessive use of the hands and wrists. In many cases, this is related to a person’s job. However, certain medical conditions or genetic factors can also put a person at greater risk for developing carpal tunnel.

Some of the most frequent conditions linked with carpal tunnel syndrome are diabetes, thyroid dysfunction, fluid retention from pregnancy or menopause, high blood pressure, autoimmune disorders such as rheumatoid arthritis or, fractures or trauma to the wrist.

Swelling inside your wrist, and possibly repetitive hand motions, can contribute to carpal tunnel syndrome. The most common cause of this inflammation is an underlying medical condition that causes swelling in the wrist and sometimes obstructed blood flow.

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What are the symptoms of carpal tunnel syndrome?

The symptoms of carpal tunnel syndrome include an ache or pain in your fingers, hand or arm, or tingling and numbness similar to pins and needles. Usually the base of the thumb and index, middle or ring fingers are affected, but not your little finger. You might feel a sensation like an electrical activity in these fingers.

The sensation may travel from your wrist up to your arm. These symptoms often occur while holding a steering wheel, reading a book, phone or newspaper, or may wake you from sleep. Many people “shake out” their hands or change their wrist position to try to relieve their symptoms. The numb feeling may become constant over time.

As the condition progresses you may experience weakness in your hand, a weak thumb or difficulty gripping and drop objects. This may be due to the numbness in your hand or weakness of the thumb’s pinching muscles, which are also controlled by the median nerve. These symptoms often start slowly and come and go and possibly worsen at night.

Some patients notice wasting of the muscles at the base of the thumb in severe longstanding cases.

How is carpal tunnel syndrome diagnosed?

Carpal tunnel syndrome is often a clinical diagnosis so it is important to go over the history of the complaint and the exact symptoms and other medical conditions that can cause. We then do a clinical examination of the nerves in the hand and special tests to look for signs of nerve compression at the wrist.

In some circumstances when the diagnosis is unclear, we may investigate further with nerve conduction studies to assess the function of the median nerve.

How can I avoid or reduce the symptoms of carpal tunnel syndrome?

If you experience mild CTS, you may be able to ease your symptoms with these simple remedies:

  • Take breaks from repetitive tasks with repetitive motions like typing, guitar playing and drilling.
  • Wear wrist splints at night which keep them straight and help relieve pressure. (please see below for advice on wrist splints)
  • Relax your grip or reduce the force you’re using; try using a soft-grip pen or tapping keys more lightly when typing.
  • Try keeping your wrists neutral as much as possible, avoid flexing to the extreme in either direction.
  • Keeping your hands warm can help with pain and stiffness.
  • Stretch your hands and move your wrists to improve blood flow to these areas, before, during and after tasks.
  • Try over-the-counter medications such as anti-inflammatory drugs like ibuprofen because they not only relieve any pain you may have, but they can also reduce inflammation around the nerve.
  • If your symptoms are work-related ask your employer to do a workstation assessment for ergonomics
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How long does it take to develop carpal tunnel syndrome?

The onset of CTS can range from a few days to years depending on the cause. Many professionals who are involved in repetitive work will develop CTS at different rates depending on the nature of their work.

Can carpal tunnel syndrome be cured?

Most of the time, carpal tunnel syndrome gets cured and doesn’t come back. If you have a severe and prolonged case, surgery can help, but your symptoms may not go away completely. In these cases, surgery can stop the condition from getting worse.

What is the non-operative management of carpal tunnel syndrome?

Not all carpal tunnel syndrome cases need surgery. Those with early mild symptoms can try avoidance techniques as described above. Those with persistent night symptoms can try night splinting. You can buy a carpal tunnel wrist splint online here. (we have no connection to the company supplying this splint) It is important to get the right side and size of splint. The metal bar of the splint should be in your palm not over the back of your hand and wrist. Carpal tunnel wrist splints should only be worn during aggravating activities including typing or sleeping. They should not be worn all the time.

In some cases we can use ultrasound guided steroid injections to reduce the inflammation around the nerve to help with symptoms.

What does carpal tunnel surgery involve?

Surgery may be necessary in severe or persistent carpal tunnel syndrome. Patients who have persistent numbness, muscle wasting, severe findings on nerve conduction studies or who are resistant to non-operative treatments may need surgery.  The surgery for carpal tunnel syndrome is called a carpal tunnel decompression, it involves cutting the band of tissue, called the transverse carpal ligament, in the wrist that crosses the median nerve to lessen the pressure on your nerve, and the outcome is usually good. Carpal tunnel syndrome surgery is usually performed as a day-case operation under local anaesthetic. The procedure usually takes about 15 minutes.

Factors that determine success or failure are the age of the patient, duration of symptoms, diabetes mellitus, and if there is weakness (which usually is a late sign).

After the surgery, the gap in the ligament heals with scar tissue, but with more room for the median nerve to pass through.

After carpal tunnel decompression, you can use your hand straight away but it is important to elevate your hand regularly while resting. This this video we demonstrate how to elevate your hand after surgery:

Surgery is not without risk and in this video we discuss the risks of a carpal tunnel decompression operation:

The recovery from carpal tunnel syndrome is relatively quick. In this video we discuss return to activity after carpal tunnel decompression:

Can carpal tunnel syndrome recur after surgery?

The results of carpal tunnel surgery can vary from patient to patient and depend on the severity of the symptoms, how long the patient had the condition, and other factors. Recurrence of carpal tunnel is rare and is usually caused by scar tissue forming around the nerve. In rare cases, some patients may require a revision operation to remove the scar tissue from the nerve.

Further information on surgery (carpal tunnel decompression) for carpal tunnel syndrome can be found here at aboutmyhealth.org.

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Nick Ferran @ Shoulder & Elbow London Ltd

Clinics in:

Chiswick – Harley Street – Harrow – St. Johns Wood