Carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is a relatively common condition where a nerve (the median nerve) is squashed as it passes through a short tunnel at the wrist.

If you have CTS, try to stay positive. There is a lot you can do to help yourself.

The carpal tunnel

The carpal tunnel contains the tendons that bend the fingers and thumb as well as the nerve.

As it's a small space, any swelling in this area can cause pressure on the nerve. This can stop it working properly.

Carpal is a term that refers to the wrist bones.

What causes carpal tunnel syndrome?

Often the cause of CTS is unknown, but it can be caused by:

• repeated forceful movements of your wrist, for example using a screwdriver or vibration tools, or computer-based activities
• diabetes
• inflammation of the tendons
• a wrist fracture
• rheumatoid arthritis in your wrist joint
• pregnancy or the menopause
• thyroid problems
• cysts in your carpal tunnel

How common are they?

CTS is more likely to affect women than men. It tends to develop in people between 50 to 54 and 75 to 84 years of age.

It's also common during pregnancy, affecting up to 50% of pregnant women. This may be due to the extra fluid putting pressure in the carpal tunnel.

Carpal tunnel syndrome symptoms

CTS symptoms range from mild to severe, and include:

• an altered feeling in hand, usually of the thumb, index, middle and ring fingers
• tingling that's often worse at night or first thing in the morning
• pain in the hands (and sometimes wrist or forearm) - this might be worse holding an object when the hand's elevated
• weakness and wasting of the muscles at the base of the thumb
• weakness of pinch grip
• clumsiness and dropping objects easily
• fingers feeling swollen or heavy

Most symptoms settle with time.

How it's diagnosed

To diagnose CTS, a healthcare professional might:

• ask you about it and examine your wrist and hand
• test the movement, feeling and strength
• use a Tinel’s test (tapping over the tunnel) or Phalen’s test (squashing the tunnel)
• take a blood sample to test for any inflammation or thyroid problems

Sometimes nothing abnormal is found.

Nerve tests

In some cases, nerve conduction tests are needed to confirm the diagnosis.

Nerve tests are sometimes ordered to find out how badly the nerve is squashed.

Treating carpal tunnel syndrome

Sometimes CTS improves after 6 months without treatment, especially if you’re pregnant or under 30 years old. 1 in 4 people will have no symptoms within a year without treatment.

If symptoms are mild, having no treatment is an option. This can be reviewed if your symptoms get worse.

If the condition's part of a more general medical condition (such as arthritis) then treatment of that condition may help.

Self-help

It’s important to try to limit any activities that make your symptoms worse and avoid overusing your wrist by lots of squeezing, gripping and wringing.

It may help if you:

• change the way you make repetitive movements and reduce how often you do them
• increase the amount of rest you take between periods of activity
• lose some weight if you're overweight

To keep your wrists mobile, stretch them back or reach forwards as if pushing a door open, then reach upwards as if pushing the ceiling - try this 10 times in a row, 4 times a day.

If your feel a numb or tingling sensation, hang your arm out of bed or shake your hands.

Wrist splint

A wrist splint is used to keep the wrist in a midline position and may settle the problem within a few weeks.

It's common to wear a splint just at night. This is often enough to ease symptoms.

You may be offered this as the first treatment.

Medication

Many people take medication to cope with their pain and symptoms, and help them remain active.

You may be prescribed pain medication to ease the pain. Make sure you take any medication as prescribed, and get advice from a GP, pharmacist or suitably trained healthcare professional.

Steroid injections

A steroid injection into the carpal tunnel is an option, but this is only done by a suitably trained health care practitioner.

Surgery

Surgery to open the roof of the tunnel to reduce the pressure on the nerve may be required.

The is usually done under local anaesthesic, but sometimes regional anaesthesic (injected at the shoulder to numb the entire arm) or general anaesthesic is needed.

Recovering from surgery

Surgery is usually successful but if you've had symptoms for a long time there may be only partial recovery.

From the day of the surgery:

• your hand can be used for light activities
• it generally takes about 3 months to regain strength and a fully comfortable scar

Work

If you have CTS try to stay at or get back to work as soon as possible. You don't need to be fully pain and symptom free to return to work.

Research shows the longer you're off work the less likely you are to return.