What causes Carpal Tunnel Syndrome?

The Median Nerve is very sensitive to pressure, and in most cases there isn’t an obvious cause. Some of the possible causes include:

• Any form of arthritis in the wrist if there’s swelling of the wrist joint or the tendons that run through the carpal tunnel.

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• Hormonal changes during pregnancy – these can sometime affect connective tissues and so put pressure on the nerve

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• An Underactive Thyroid Gland

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• Diabetes

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• Fracture of the wrist

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• Occasionally, some medications, particularly exemestane and anastrazole (treatments for Breast Cancer).

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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.

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What are the Symptoms

Carpal Tunnel Syndrome causes pain, aching, tingling or numbness in either one, or both, of your hands. It tends to come on gradually, over a period of weeks. The symptoms are usually worse in the thumb, index and middle fingers, but sometimes it may feel like your whole hand is affected. You may also have an ache extending up the arm to your shoulder or neck.

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The symptoms tend to be worse at night and may disturb your sleep but you could also notice it most when you wake up in the morning. Hanging your hand out of bed or shaking it around will often relieve the pain and tingling.

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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 your fingers numb, or both. You may find that you drop things more often and that activities which require fine finger movements, like writing or fastening buttons, become more difficult.

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How is Carpal Tunnel Syndrome diagnosed?

There are a number of ways in which Carpal Tunnel Syndrome can be diagnosed, including examination and testing.

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Examination of the wrist: Mr Khan will examine your hand and wrist to try to confirm the diagnosis and to assess how severe it is. If your wrist is swollen due to arthritis or an inflamed tendon, 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 a pin prick.

 

Mr Khan may also:

• tap over the Median Nerve on the palm side of your wrist (Tinel’s test)

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• ask you to bend your palm towards your forearm for up to a minute (Phalen’s test)

 

These tests can help to confirm Carpal Tunnel Syndrome, though they aren't fully reliable so you may also have one of the tests described below. 

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Tests: Sometimes the condition is mistaken for something else. For example, pressure on nerves in the neck due to disc problems or arthritis can cause similar symptoms. A nerve conduction test may help if there’s any doubt about the diagnosis or to see how severe the compression of the nerve is. These test can be done in several ways but one common measurement is made by stimulating a finger with a small electric current while recording the response of the Median Nerve at the wrist with a pair of electrodes attached to the skin. When the nerve is impaired, the speed of conduction between the finger and the wrist is slower.

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What is the Treatment for Carpal Tunnel Syndrome?

Many different treatments have been suggested for Carpal Tunnel Syndrome but only a few have been proven to work. Not all cases are progressive and some may improve without any medical treatment. Importantly, if there’s a particular cause for your problem then your symptoms may improve simply by treating this.

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Mr Khan will advise you which treatments are available, and they will help to decide which is most appropriate for you. The decision is usually affected by how severe the compression of the nerve is. If it’s severe and your hand muscles are weak, then it’s important to get treatment quickly, and you’ll normally be advised to have surgery.

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Simple treatments can often help, including:

• a resting splint for your wrist – particularly if your symptoms are worse at night.

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• a working splint – if your symptoms are brought on by particular activities. This should hold your wrist slightly extended (bent back).

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An Occupational Therapist or Physiotherapist will be able to advise you about the different types of splint. Similarly, some therapists recommend certain exercises at the wrist which might help prevent the Median Nerve becoming stuck to nearby tendons.

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Drugs

A Steroid Injection can be helpful, although the effect may wear off after weeks or months. A small quantity of steroid is injected into the carpal tunnel, which helps to reduce any swelling. The injection may rarely be uncomfortable, but it can be very effective. A Steroid Injection into the wrist joint itself may help if you have arthritis in your wrist.

 

Surgery

You may need surgery if there’s severe compression of the Median Nerve or if the numbness and pain doesn’t improve with other treatments.

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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.

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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, but, as with all surgical treatments, some people will have complications.