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Carpel Tunnel Syndrome

Carpal tunnel syndrome is a collection of symptoms including pain, tingling and loss of sensation in the hand, caused by pressure on a nerve in the wrist as it passes through a 'tunnel' into the hand. Fortunately, it can be treated a number of ways and usually responds to treatment.

What is the carpal tunnel?

In each wrist is a protective channel for several tendons and an important nerve called the median nerve. The tendons are the connections between the fingers and the muscles that enable them to curl - there are nine of them. The median nerve connects the fingers to the spinal cord. It gives feeling to the thumb, index finger, middle finger and half of the ring finger. It also controls the movement of the small muscles at the base of the thumb.These tendons and the median nerve all pass through the carpal tunnel, located deep in the wrist. It is a confined space, which is why any inflammation of the tendons can cause pressure on the median nerve.

What is carpal tunnel syndrome?

If the tendons that pass through the carpal tunnel become irritated, which can be caused by a number of conditions, their lining becomes swollen. This puts pressure on the median nerve, reducing its blood supply.The symptoms of this pressure are varied and can include pain, tingling, pins-and-needles (paraesthesia), numbness and swelling of the thumb, index, middle and ring fingers, and dryness of the skin in those fingers. You may also notice some clumsiness or weakness in the affected fingers. It is a fairly common syndrome which can affect as many as 0.1 per cent of the population.

It's usual for the symptoms to be most noticeable during or after sleep, when fluid pressure can build up while the hand is rest. You may notice the symptoms are reduced when you use your hand normally, as it encourages the swelling in the carpal tunnel to disperse. However, if the causes of the swelling are not addressed, symptoms can start to occur during waking hours, which may indicate possible scar tissue and damage to the nerve.

What causes carpal tunnel syndrome?

Some people are more susceptible to swelling around the tendons and joints than others. This tendency is strongly related to incidence of carpal tunnel syndrome. Activities that involve strenuous or repetitive use of the fingers and thumb may play a significant role in promoting inflammation.

Related problems, such as trigger finger, rheumatoid arthritis or effects of a wrist fracture may aggravate or bring on carpal tunnel syndrome.Carpal tunnel syndrome is common in mid to later life but it can occur at any age. It affects far women more than men, particularly during pregnancy.

Treatment for carpal tunnel syndrome

There are wide and varied treatments. The first you might consider is to identify any activities that aggravate the condition: for example, tasks that involve repeated gripping, squeezing or twisting. Even just monitoring the symptoms can be helpful as the condition is known to subside after a while for many patients.

If carpal tunnel syndrome is mild or just beginning, stretching exercises designed to relieve pressure within the carpal tunnel may deliver some improvement. Some over-the-counter painkilling medications, such as paracetamol or ibuprofen, can also help; doctors also sometimes prescribe stronger anti-inflammatory medication. A wrist splint or brace worn at night is often sufficient to relieve symptoms, since it helps keep the wrist at a neutral angle that avoids pressurising the nerve. Another non-surgical option is a steroid injection into the carpal tunnel, which can provide long term relief for many patients.

There are surgical techniques available that can relieve carpal tunnel syndrome if required. The aim of this surgery is to provide more space for the nerve and tendons so they are not as vulnerable to pressure caused by swelling. The incision is made on the underside of the wrist under local anaesthetic and some of the thick band of ligament is split to open up the carpal tunnel. This is carried out under local anaesthetic. Depending on the technique used and the extent of the problem to begin with, recovery can be around 4 to 8 weeks. Most people return to driving after approximately 2 weeks.

Contact us and make an appointment

The key to deciding what treatment will be best should be assessed by a hand and wrist expert. Please get in touch if you believe you are suffering from carpal tunnel syndrome to make an appointment for an initial discussion.