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GP, Alice Fitzgibbon explores a condition that many tradespeople will be familiar with
This month we cover more about carpal tunnel syndrome (CTS). We touched on this topic last month when it was mentioned along with the symptoms of hand-arm vibration syndrome. Carpal tunnel syndrome is a condition of its own with various different causes.
So, what exactly is it? Let’s start with the name. The carpal tunnel is the name given to an area in the wrist. It is a tunnel-like space with bones for walls and a floor and a ligament as the roof. There are tendons and a nerve called the median nerve that run through the carpal tunnel. If the tunnel becomes narrowed, there is no room for it to expand so there can be extra pressure put on the median nerve and its blood supply may be reduced. The nerve being compressed is what causes the symptoms of CTS.
The symptoms of CTS can start gradually and come and go before getting worse and happening more frequently. Symptoms often happen at night if the hand has been a particular position for a long period of time during sleep. The symptoms include:
- Pain, tingling and numbness in the hand – mainly in the thumb and index, middle, and ring fingers.
- Occasional shock-like sensations that radiate to the fingers
- Pain or tingling that may travel up the forearm toward the shoulder
- Hand weakness and clumsiness – this may make it difficult to perform fine movements such as buttoning your clothes
- Dropping things – due to weakness, numbness, or a loss of proprioception (awareness of where your hand is in space)
Symptoms at night are very common. People may often wake from sleep with pain which then settles when the hand is moved and the pressure on the nerve is relieved. During the day, symptoms may occur on holding something for a prolonged period of time with a bent wrist, such as when using a phone, driving, or reading a book.
Certain conditions or activities increase the risk of developing carpal tunnel syndrome. These include:
- being overweight
- doing work or hobbies where you repeatedly bend your wrist or grip hard, such as using vibrating tools
- having another illness, such as arthritis, thyroid problems or diabetes
- having a family history of CTS
- previous wrist injuries
Carpal tunnel is seen commonly in general practice. It is often diagnosed by the patient’s symptoms and an examination of the hand and wrist. If it is unclear if the symptoms are coming from CTS or another cause of nerve pain, nerve conduction studies may be needed to confirm the diagnosis. This is specialised test and there may be a long waiting list!
Treatment for CTS is all about relieving the pressure on the nerve. If there is an obvious activity a sufferer is doing to cause the symptoms then reducing or stopping the activity is the first thing to do. Simple painkillers especially non-steroidal anti-inflammatories might help on a short-term basis if they are suitable for you to take (if you are concerned or on other medication then check with your pharmacist). Use of wrist splints worn at night can treat CTS. They keep the wrist in position so it doesn’t bend during sleep and cause compression. These need to be worn consistently for at least 4 to 8 weeks as it takes time to improve the symptoms. Wrist splints can be ordered online or bought via a pharmacy. A self-physiotherapy exercise plan may also be recommended to help.
If the simple steps above don’t help the symptoms of CTS, or they are getting worse, further interventions may be needed. The next step may be a steroid injection into the wrist to try and reduce the swelling around the nerve. This doesn’t always help or may need to be repeated. Physiotherapists or trained GPs may offer this service in primary care. In severe cases of carpal tunnel syndrome, surgery may be needed to cure it. In this case, a specialist hand surgeon performs a minor operation to cut open the carpal tunnel and release the pressure.
There is more information and help available on carpal tunnel syndrome (CTS) on the NHS website: Carpal tunnel syndrome – NHS (www.nhs.uk).