Carpal tunnel syndrome

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Carpal tunnel syndrome occurs when the tissue inside the wrist swells, causing compression of the median nerve. Symptoms include pain, numbness and weakness of the hand.

Arthritis, joint, bone & muscle

Carpal tunnel syndrome may affect one or both hands, and is characterised by symptoms of:

Pain in the palm and fingers that may be described as burning, tingling or like an electric shock or pins and needles. Pain may also be referred into the arm and shoulder. The pain may be worse at night, and may wake the patient up.
Numbness in the palm, wrist and fingers. The little finger and half the ring finger remain unaffected. This is often the first symptom and may occur when driving or holding something small, such as a mobile phone.
Weakness of the hand and reduced ability to use the thumb may develop as the condition progresses, limiting the ability to hold small objects and interfering with every day activities such as buttoning clothes or tying laces. The muscles may become visibly wasted (reduced in size).

Without appropriate treatment permanent nerve damage may occur, however, with treatment, sufferers may regain normal use and functioning of their hands.

The carpal tunnel is a narrow passageway within the wrist surrounded by bones and ligaments. The median nerve and the tendons that move the fingers run through the carpal tunnel to the hand. Carpal tunnel syndrome is the result of compression of the median nerve, resulting in the classic symptoms of numbness, pain and weakness.

Carpal tunnel syndrome may be caused by any of a number of factors that reduce the space inside the carpal tunnel. These include:

Trauma or injury to the wrist.
Over-use of the hands (for example, participating in work or sporting activities that involve long periods of repetitive movements , such as computer work, assembly line work, construction work, gardening or golfing).
Fluid retention (for example, as a consequence of pregnancy).
Inflammation of the tissues (for example due to rheumatoid arthritis).

Low levels of vitamin B6 may also be associated with carpal tunnel syndrome.

Women are more likely to experience carpal tunnel syndrome than men, and are especially susceptible after menopause (due to hormonal changes) and during pregnancy (due to fluid retention).

Other risk factors associated with carpal tunnel syndrome include having a small carpal tunnel, having a family history of the condition, being obese, and suffering from diabetes, thyroid disorders or rheumatoid arthritis.

Without appropriate treatment, carpal tunnel syndrome may worsen, potentially leading to permanent damage to the median nerve . The following suggestions are recommended as supportive measures, and should not take the place of professional care and advice.
Splinting of the wrist is commonly used to minimise movement and decrease pressure on the nerve, and more than 80% of patients report that this leads to an improvement in symptoms. Don’t delay in asking your physiotherapist whether this is an appropriate option for you, as splinting appears to be most beneficial when commenced within 3 months of developing symptoms of carpal tunnel syndrome.
Performing stretching and strengthening exercises under the guidance of your physiotherapist may help to relieve your symptoms.
If you do repetitive work, take a break every 15-20 minutes to stretch and bend your wrists. Avoid bending the wrist excessively when working on a computer keyboard, or putting the wrists into any positions that worsen your symptoms.
Ask your physiotherapist about ergonomic aids that may be beneficial for your circumstances. For example, some computer operators find that ergonomically designed keyboards decrease the pressure on the wrists.
It may be helpful to keep your hands warm by wearing fingerless gloves. Some people also recommend immersing your hands into hot water for three minutes at a time, followed by 30 seconds of immersion in cold water. This is repeated 3-5 times, with the whole procedure performed once or twice daily.
Stop smoking, as it may delay your recovery.
If you have an underlying health problem that predisposes you to carpal tunnel syndrome (for example, hypothyroidism or rheumatoid arthritis), working with your healthcare professional to manage your condition may help to reduce your carpal tunnel syndrome symptoms at the same time.

Exercises that strengthen the hand and wrist can be useful in preventing over-use injuries. Warm up exercises before tackling your work will help - your physiotherapist can help with these.

Without treatment, carpal tunnel syndrome will worsen.
It is important to consult your healthcare professional if you are experiencing the symptoms discussed here.
Surgery may be required for some cases of carpal tunnel syndrome. Talk to your doctor for more information.