CARPAL TUNNEL PAIN?

What is carpal tunnel? 

Carpal tunnel syndrome (CTS) is caused by compression of the median nerve, which passes through the carpal tunnel at wrist.  The median nerve controls the sensation to the thumb, index finger, middle finger and half of the ring finger on the palmar/inside of the hand. The nerve also controls the muscles around the thumb, which allow it to move away from the other fingers and out to the side of the hand.

The carpal tunnel is a compartment, formed between the bones at the base of the wrist and the Transverse Carpal Ligament (Flexor Retinaculum). Within this compartment, the median nerve and tendons, which allow the wrist to bend and flex are housed, all of which can normally glide and move freely when the wrist and hand is moved. However when pressure or compression is applied to the nerve within the tunnel, the nerves natural ability to move and function is compromised and symptoms of carpal tunnel are experienced.

The condition often presents gradually over a period of several months or years, with symptoms experienced often dependent on the severity of compression and irritation to the nerve.  

carpal tunnel

 

Symptoms of Carpal Tunnel Syndrome

The most common symptoms associated with carpal tunnel syndrome: 

  • Pins and needles, numbness or a burning feeling in the thumb, index, middle and half of the ring finger on the palmar side of the hand. 
  • Often worse during the night and can wake you up with the above symptoms. Can be eased by shaking the hand for a couple of minutes, but will often return when falling back to sleep.
  • Pain in the wrist and hand with loss of grip strength and clumsiness or dexterity issues when doing tasks such as unscrewing lids etc. 
  • Wasting or a noticeable loss of muscle bulk around the palm side of the thumb. 
What causes carpal tunnel syndrome?

Carpal tunnel often presents gradually over a period of several months or years, and there are various factors associated with the development of the condition including: 

  • Repetitive use / occupation factors such as using a computer or vibrating machinery 
  • Pregnancy 
  • Obesity 
  • Thyroid issues – as this can cause changes to the nerves and may be confused with CTS 
  • Diabetes – as this can cause changes to the nerves and may be confused with CTS 
  • Ganglions or lumps/cysts which can press on the tunnel 
  • Rheumatoid or inflammatory arthritis 
  • Previous trauma or injuries including fractures to the hand or wrist 
  • Hereditary conditions such as Charcot-Marie-Tooth 
  • Gender – more common in females as they naturally have smaller carpal tunnels. 
Investigations:

Nerve conduction studies may be considered to confirm compression of the median nerve at the wrist. These are often not essential to make the diagnosis and treatment will often be offered without routine nerve conduction studies. Nerve conduction studies measure the function of specific nerves by measuring how quickly small electrical impulses can be conducted down the nerve via the point of suspected compression. Such investigations would be booked at a separate hospital based. appointment. 

 

Management options:

Advice: 

  • Avoiding repetitive tasks or activities that cause symptoms or pain to present – as well as regular breaks from activity.  
  • Relax your grip, and avoid increased force gripping activities. 
  • Changing and modifying activities such as using a wrist support when typing or sewing etc. (it may be beneficial to speak to your manager if your symptoms are aggravated by your occupation). 
  • Maintaining good wrist posture / trying to the keep the wrists in a neutral or as straight position as able.  

 

Physiotherapy: 

There is a limited role for physiotherapy in the management and treatment of carpal tunnel syndrome, given the nature of the condition. Nerve gliding exercises have limited research to support their use, nor do stretches or other exercises. Relief of the compression of the nerve is the treatment of choice. 

 

Splints

Splints

Splints:  

Using splints is a recommended as an initial treatment for managing the condition, especially at night time. The role of a splint is to keep the wrist as straight as possible, so to avoid the wrist being bent and compressing the nerve. This is especially important night when the wrist may bend into a compressive position whilst sleeping, however the splint may also be used for repetitive tasks that are known to cause symptoms.    

 

Corticosteroid injections:  

Steroid injections can be used to reduce any inflammation around the nerve within the carpal tunnel. By reducing any inflammation present and irritation, pressure and compression is then eased off the nerve. Injections are associated with minor risks and may not provide long term benefit.  

 

Surgery: 

Surgery is often considered after conservative measures have been triedSurgery may also be depending upon the severity of the compression on the nerve seen suggesting that that other options would not likely improve symptoms. This may be the case if the muscles around the thumb are starting to waste. 

If surgery is considered, you will be referred to a surgeon/specialist who will discuss and be able to inform you further on the procedure and options based on your individual needs.