Carpal tunnel syndrome (CTS)

What is carpal tunnel syndrome?

Carpal tunnel syndrome is a type of arthritis that causes pain, tingling and weakness in your fingers and thumbs.

The carpal tunnel is the passageway in the hand made up of the median nerve (which runs from the elbow, through the forearm and wrist into the hand), tendons and the carpal bones.

Carpal tunnel syndrome can affect one or both hands and can affect people of all ages, however, it is more common in women.

What causes carpal tunnel syndrome?

Carpal tunnel syndrome occurs when the median nerve (at the point where it enters the wrist) is put under pressure (squeezed) by irritated, swollen tendons. It is this pressure that causes numbness and pain in the middle fingers. For many people the cause of carpal tunnel syndrome is never known. However, it may be caused by injury, such as wrist fractures or from work activities that require repetitive wrist or finger movements, such as typing, sewing or construction work. You may also be at risk of carpal tunnel syndrome if:

• You are overweight.
• You take the contraceptive pill.
• You have an underactive thyroid gland.
• You are pregnant.
• You suffer with diabetes.
• You have rheumatoid arthritis.

What are the symptoms of carpal tunnel syndrome?

The first symptoms are numbness, tingling (pins and needles) and a burning sensation in the hand. The symptoms are usually worse at night and can often awake the sufferer. As carpal syndrome progresses symptoms can be felt during the day and the pain may travel up your arm to the elbow or shoulder. If carpal tunnel syndrome progresses the affected hand may become weak, especially the muscles of the thumb, index and middle fingers, as a result you may find it hard to pick up and hold objects.

How is carpal tunnel syndrome diagnosed?

Your doctor will suspect carpal tunnel syndrome from your pattern of symptoms and medical history. To confirm the diagnosis a special electrical test, called a nerve conduction study may be carried out. In this painless test, small electrical currents are passed into the median nerve above the wrist, if the nerve is trapped, then the speed of the electrical impulse is slowed down.

To eliminate other forms of arthritis you may also have a blood test or an x-ray.

How is carpal tunnel syndrome treated?

The treatment of carpal tunnel syndrome depends on the severity of your symptoms. If symptoms are mild, you may only need painkillers, though your doctor will keep an eye on you to make sure your symptoms don’t progress. Painkillers should only offer short-term relief. Painkillers will not treat CTS and it is important not to rely on them.

If it is your job or hobby that has caused carpal tunnel syndrome to develop, you will need to rest between periods of performing the task and try to change how you do the certain task.

To relieve pain and discomfort you can try soaking your wrist in warm water (between 92-100 degrees) and gently bend and flex it. Do this 3-4 times a day.  Another option is to place an ice pack around the write or place your wrist in an ice bath for 10-15 minuets, once or twice an hour.

There are prescription drugs available for carpal tunnel syndrome to relieve pain and reduce inflammation. The main drugs used are non-steroidal anti-inflammatory drugs (N.S.A.I.D.s). You may also require a splint for a period of time to prevent movement and pressure on the nerve. These can be of great value if worn during the night.

If a wrist splint has not helped, your GP may recommend steroid injections. A steroid injection into the wrist will relieve symptoms by reducing swelling around the nerve.  This procedure isn’t always a cure and a further injection may be needed after a few months.

In severe cases, carpal tunnel syndrome might not respond to treatment, so you may require surgery. During surgery the roof of the carpal tunnel (carpal ligament) is cut to relieve pressure on the nerve in the wrist . The patient is usually allowed home the same day, although the wrist will need to be rested for at least a week and it can take a month after the operation to get back to normal activities.