Carpal Tunnel Syndrome

Carpal Tunnel Syndrome

Are you waking during the night with tingling, pins and needles, numbness or pain in your hand? Do these symptoms persist on waking? Do the symptoms ease if you shake your hand. If so, you may be suffering from Carpal Tunnel Syndrome (CTS).

What is Carpal Tunnel Syndrome?

In the medical history books CTS was first described as long ago as 1854! It still remains a puzzling and disabling condition present in about 4% of the general population. In the medical world it is known as a compressive neuropathy of the median nerve at the wrist. In essence this means that the median nerve which travels from the neck down the arm into the hand is compressed as it passes over the bones and soft tissue around the palm surface of the wrist. This then causes tingling, pins and needles, numbness and pain in the hand.

It is more common in females than males. It can occur in all age groups but most commonly seen between 40 to 60 years. There are certain risk factors which make individuals more likely to develop this condition which includes prolonged postures with the wrist a bent position, repetitive use of the wrist muscles and exposure to vibratory machinery. Conditions that alter the fluid balance in the body like pregnancy, menopause, use of oral contraceptive, obesity, renal failure, hypothyroidism, renal failure, congestive heart failure can lead to symptoms developing.  Diabetic patients have a higher tendency to develop CTS due to a reduced threshold for nerve injury.

What do CTS signs and symptoms look like?

CTS can be classified into three stages.

Stage 1: Frequently awakening during the night and first thing in the morning with a sensation of a swollen, tingling, numb hand. They may report severe pain that irradiates from the wrist to the shoulder, and an annoying tingling in their hand and fingers. Hand shaking (the flick sign) relieves the symptoms. During the morning, a sensation of hand stiffness usually persists.

Stage 2: The symptoms are present also during the day, mostly when the person remains in the same position for a long time, or performs repeated movements with their hand and wrist. They may report clumsiness or difficulty with tasks that involve a lot of fine finger movements

Stage 3: They may notice that the muscle around the thumb on the palm surface of the hand is getting smaller compared the opposite.

Some people present with more unusual symptoms of CTS such as “writers cramp” or fatigue in the hand, cold sensitivity in the fingers, forearm pain, or numbness in the third finger only. There are also a small percentage of individuals who get symptoms with rigorous activity usually work-related. These cases usually do well with some small changes to work duties.

Diagnosis

When you attend your Chartered Physiotherapist, GP or Orthopaedic Specialist with the possibility of having CTS they will first ask a lot of different questions to rule out other causes of the symptoms. They will complete some clinical tests that may reproduce your symptoms. They may even refer you for further investigations including nerve conduction tests which is the main test but sometimes ultrasound or even an MRI in the case of a more unusual presentation.

 

Treatment

Once CTS has been confirmed by your health care professional there are both conservative and surgical options available. Individuals with mild to moderate symptoms are generally offered conservative treatment.  This includes use of wrist splints to keep the hand in a neutral position at night to prevent compression of the nerve at the wrist. For a lot of individuals this can be a very effective way to manage symptoms. Also addressing any work or sport related postures that may be putting a lot of compression on the wrist anatomy should be modified. Other options include nonsteroidal anti-inflammatories drugs from your GP, corticosteroid injections provided by an Orthopaedic specialist, soft tissue techniques and joint mobilisations performed by a Chartered Physiotherapist. If there is no improvement in symptoms with conservative options or the symptoms are particularly severe then the surgical option of a carpal tunnel release is considered. This has been proven to have a good long-term outcome in 70-90% of suffers.