Carpal tunnel syndrome
Carpal tunnel syndrome is a condition in which the median
nerve is squeezed where it passes through the wrist. This
nerve controls some of the muscles that move the thumb; it also
carries information back to the brain about sensations in your
thumb and fingers.
When the nerve is squeezed it can cause pain or aching, tingling
or numbness in the affected hand. Women are more likely than men to
develop carpal tunnel syndrome but the condition affects people of
all ages.
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Symptoms of carpal tunnel syndrome
If you have carpal tunnel syndrome you may experience pain,
aching, tingling or numbness. The symptoms are usually worse in the
thumb, index and middle fingers, though sometimes it may feel that
your whole hand is affected. You may also have an ache in your
forearm. It can affect one hand or both but your primary hand will
be worst affected.
The symptoms tend to be worse at night and may disturb your
sleep, or in the morning when you wake. Hanging your hand out of
bed or shaking it around will often relieve the pain and
tingling.
You may not notice the problem at all during the day, though
certain activities – such as writing, typing, DIY or housework –
can bring on symptoms. However, if the nerve is badly squeezed you
may have symptoms throughout the day. Your hand may feel weak, or
the fingers numb, or both and you may have a tendency to drop
things.
What causes carpal tunnel syndrome?
The median nerve is very sensitive to
pressure, so there are a number of factors that can cause carpal
tunnel syndrome. It may not be possible to say what the cause is in
your particular case.
Here is a list of the possible causes of
carpal tunnel syndrome:
- an accumulation of fat or fluid within the carpal tunnel
- a fracture of the wrist leading to narrowing or distortion of
the tunnel
- arthritis of the wrist, particularly from rheumatoid arthritis,
if there is swelling of the wrist joint or the tendons that run
through the carpal tunnel
- fluid retention – this can affect women during pregnancy or can
be related to periods
- an underactive thyroid gland
- diabetes.
Your risk of developing carpal tunnel syndrome may be greater if
your job places heavy demands on your wrist or if you use vibrating
tools.
How is carpal tunnel syndrome diagnosed?
Your doctor will examine your hand and wrist for any
abnormalities. If the wrist is swollen due to arthritis or tendon
swelling, this could be the cause of your symptoms. If you've had
the condition for some time there may be signs of muscle wasting at
the base of the thumb. If the problem is severe the thumb, index
and middle fingers may be insensitive (numb) to either a gentle
touch or to a pin prick.
To confirm the diagnosis your doctor may tap over the median
nerve on the palm side of your wrist or ask you to bend your palm
towards your forearm for up to a minute. If you have carpal tunnel
syndrome these tests will cause a sharp tingling pain in the
fingers and thumb.
Tests
A nerve conduction test may help if there is any doubt about the
diagnosis. Small electrodes are placed on the skin just above the
wrist to stimulate the median nerve. If you have carpal tunnel
syndrome there will be a delay before the impulse arrives in the
thumb muscles. The length of the delay can be measured and this
will give an indication of how badly the nerve is being
squeezed.
Carpal tunnel syndrome treatments
People with carpal tunnel syndrome are typically offered a
variety of treatments, including diuretics, splints and
steroid injections. This section also looks at carpal tunnel
release surgery.
Simple treatments can often help, including:
- diuretics (water tablets) – particularly if you suffer from
fluid retention
- a resting splint for your wrist – if your symptoms are worse at
night
- a working splint – if your symptoms are brought on by
particular activities.
An occupational therapist or physiotherapist
will be able to advise you about the different types of splint.
Drugs
If splinting doesn't help, some doctors recommend a steroid
injection. A small quantity of steroid is injected into the carpal
tunnel. This can be uncomfortable, but the injection can relieve
the symptoms for several weeks. A steroid injection into the wrist
joint itself may help if you have arthritis in your wrist.
Surgery
You may need surgery if any of the following symptoms persist in
spite of treatment:
- weakness
- pins and needles
- loss of feeling in the thumb, index and middle fingers
- numbness and pain at night that prevents sleep.
Carpal tunnel release surgery relieves pain by reducing the
pressure on the median nerve. Surgery usually takes place as a
day-case and you can expect to recover in less than a month. The
operation is normally carried out under a local anaesthetic and
usually leaves only a small scar.
If you've had carpal tunnel syndrome for a long time –
especially if you have muscle-wasting or loss of sensation – the
operation may not bring a complete recovery, but the pain should be
greatly reduced. For most people the surgery is very
successful.
Self-help and daily living
Unfortunately, no particular diet or exercises have been shown
to help either to relieve or prevent carpal tunnel syndrome.
If you think your work may be causing your symptoms you should
discuss this with your supervisor or an occupational health nurse.
If necessary, your local JobCentre Plus office can put you in touch
with a Disability Employment Adviser who will be able to advise on
changes to your equipment or working techniques.