Carpal Tunnel Syndrome
Carpal Tunnel Syndrome is an extremely common disorder that can cause a tingling sensation, numbness and in some cases pain in the hands and fingers – most notably the index finger, middle finger and thumb.
What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is something that most people have heard of but a lot of people are not clear on exactly what it is.
So what is carpal tunnel syndrome? Carpal tunnel syndrome is when the nerve that runs from your wrist up to your arm, called the median nerve, gets compressed. This results in the movement in your thumb and fingers being restricted as well as pain in your arm and hand.
What is the cause of Carpal Tunnel Syndrome?
There is no clear consensus on the precise cause of Carpal Tunnel Syndrome, although there are certain factors that are known to increase your chances of developing it. These include:
- Carpal Tunnel Syndrome runs in your family
- Wrist injuries
- Doing repetitive work with your hands
Of course not everyone who fits this profile will get Carpal Tunnel Syndrome but it does mean there is an increased chance of it. For example, up to 50% of pregnant women will develop Carpal Tunnel Syndrome.
Symptoms of Carpal Tunnel syndrome
It is useful to know what the symptoms of Carpal Tunnel Syndrome are so that you can get a carpal tunnel test if you suspect you have it.
Some of the Carpal Tunnel Syndrome symptoms include:
- Tingling in the hands and fingers
- Dull aching in the arm or hand
- Weakness in the thumb
- Pins and needles
Displaying these symptoms does not always mean that you have Carpal Tunnel Syndrome, so you should certainly visit your GP to discuss things before looking for treatments.
How is Carpal Tunnel Syndrome diagnosed?
There are two main tests that are used for diagnosing Carpal Tunnel Syndrome. They are called the Tinel and Phalen Manoeuvres.
The Tinel test involves tapping on the palm side of the wrist. If positive, the test will produce a tingling sensation in the fingers.
The Phalen Manoeuvre involves manipulating the wrist into a flexed position. Again, the tingling sensation indicates a positive test.
In cases that have progressed, an electromyogram test and nerve conduction studies may be undertaken to establish the extent of nerve damage. Electromyograms measure electrical activity in nerves and muscles whilst nerve conduction studies measure the ability of nerves to transmit electrical impulses.
However, nerve damage may not show up on these tests until the nerve damage is significant. It’s also been found that the severity of symptoms doesn’t necessarily relate to the extent of nerve damage revealed on electromyograms and nerve conduction studies.
Although many cases of Carpal Tunnel Syndrome go away on their own after a number of weeks or months, many cases require further treatment.
If you’re experiencing the symptoms of Carpal Tunnel Syndrome, you should seek medical assistance. If caught early, some cases of Carpal Tunnel Syndrome may be successfully treated with exercises and lifestyle changes and surgery may be avoided.
Treatments for Carpal Tunnel Syndrome
In approximately 25% of cases, the symptoms of Carpal Tunnel Syndrome will subside on their own within a few months. If you find that your symptoms persist or are more severe then you can have minor surgery to correct the problem.
The surgery for Carpal Tunnel Syndrome is very minor and is carried out under local anaesthetic in most cases. The surgery has a very high success rate and will usually clear up all symptoms of Carpal Tunnel Syndrome.
If you don’t like the sound of surgery then there are a couple of alternative treatments available, firstly a wrist splint. This can be a very effective form of treatment for some people although it can hinder everyday activities, which is why many people will only wear it at night.
Another alternative treatment is steroid injections into the wrist. This treatment has proven to be very effective, especially in the short-term, with three out of four people who get steroid injections reporting that it completely disappeared. However, this number falls to around half of people when it comes to long term relief.
Carpal Tunnel Syndrome exercises
Carpal Tunnel Syndrome (also known as CTS) is a condition commonly experienced among musicians and people who do a lot of typing on a day to day basis.
However, anyone can suffer from carpal tunnel syndrome, and certain people can be prone to the condition if they; are pregnant, are related to people who have CTS, have a wrist injury, have arthritis or diabetes or use their hands and wrists a lot in their job.
Carpal Tunnel Syndrome occurs when the median nerve in the hands is compressed and causes a wide range of symptoms in sufferers including; tingling in the hands and fingers, numbness in the hand and fingers, pain in the hand and fingers, pins and needles, weakness of the hand and wrist and a constant ache in the affected area.
Sufferers will often find the symptoms get worse throughout the day and peak at night.
Sometimes CTS symptoms will stop independently, or certain workplace changes will alleviate the problem. In other cases medicine is injected into the wrist or wrist splints are used in order to treat symptoms. In the most extreme cases surgery may be required to release the affected nerve.
If you believe that you have CTS or have been diagnosed with CTS, the first course of action you should take is adjusting the job or hobby that is causing the condition. In the workplace your employer should have a suitable plan to help you which includes; regular breaks from using your hands and wrists and wrist supports.
You can also perform regular carpal tunnel exercises to help alleviate pain.
Here are some of the best Carpal Tunnel Exercises:
Stand next to your desk or a table and place your arms straight down onto the table surface, palms flat with your fingers facing you. If you don’t feel an immediate stretch try lowering your chest a little until you can feel the exercise working. You can do this exercise as many times as necessary throughout the day.
Stand up and put both of your arms straight out in front of you at shoulder height, then put both hands into a ‘stop’ position for around 10 seconds. Then straighten out your wrists and let your fingers relax. Whilst in this position squeeze your fingers into a fist and hold for 10 seconds then bend your fists down and hold for 10 seconds. After this is complete, relax your wrists and fingers for a few seconds then repeat the process a few times.
Make a tight fist, hold for ten seconds then slowly extend your fingers until your hand is flat. Repeat several times.
Make a tight fist, hold for ten seconds and then slowly extend your fingers spreading them out, spreading them as far apart as possible, hold for ten seconds then relax. Repeat several times.
Standing up, raise your arm up so your hand is at shoulder height, palm facing forward (arm will be bent). Then push your four fingers together and stretch your thumb away from the fingers. Hold for 10 seconds then relax and let you arm hand by your side. Repeat several times.
Sitting down or standing up, curl the parts of your fingers (from your middle knuckles down) towards your palm. You should end up holding your hand in a position that looks a bit like a thumbs up but without the tips of the fingers tucked in. Hold for ten seconds then relax. Repeat several times.
Put your entire hand into a fist, leaving out your thumb, and clench tightly for ten seconds. Relax and repeat several times.
Place your arm out in front of you with your elbow facing down, palm facing up. Use your other hand to bend your fingers and wrist down towards the floor until you can feel a good stretch. Hold for 10 seconds then let your wrist and fingers relax. Repeat several times.
These carpal tunnel exercises should not cause you any pain. If you are in pain from CTS or these exercises cause you pain, seek medical advice as soon as possible.
Exercise guide after Carpal Tunnel surgery
Surgery to relieve Carpal Tunnel Syndrome consists of an incision made to the wrist at the base of palm. The ligament that forms the top of the carpal tunnel is cut which allows it to expand thus alleviating pressure on the median nerve. If thickening around the tendons is present, this can also be cut away, allowing the median nerve more room within the carpal tunnel.
After surgery, a dressing will be applied to the hand and wrist. The dressing will be deliberately large and bulky to try to keep your wrist in a neutral position. If you’re allowed home the same day, your nurse or healthcare professional will advise you when you can reduce the size of the dressing. You will have sutures, which will be taken out around ten to fourteen days after surgery.
To speed your recovery, it’s advisable to elevate your hand as much as possible. When you go to bed, try to place your hand on a pillow to keep it raised. This will minimise swelling.
After your wound is completely healed and your dressing and sutures have been removed, you can work on minimising the appearance of scarring. Massage the scar and surrounding skin with non-perfumed hand cream. This will decrease sensitivity in the area and soften the scar tissue, accelerating the healing of the skin.
- Gently bend your wrist backwards and forwards, slowly and gently being careful not to jerk or strain.
- Touch your thumb to the tip of each finger. Immediately after surgery, you may only be able to reach one or two of your fingers. Don’t force anything. In time, you will able to touch each finger.
For best results, perform these exercises two or three times a day, repeating each movement ten to fifteen times each. To begin with, these exercises may be a little bit uncomfortable, but if you experience significant pain then you should stop immediately.
Resuming activity after surgery
Once the pain from the surgery begins to subside, you can begin using your hand again for less challenging daily activities such as eating or getting dressed – provided it doesn’t cause pain.
Gradually, you’ll be able to use your hand more and more and by around two weeks after surgery, you’ll be able to engage in most of your normal daily activities. Don’t resume driving until you’re confident that you can maintain control of the vehicle.
Although it’s important to engage in gentle activity to rehabilitate your hand and wrist post-surgery, you must be careful not to overuse your affected hand. If you do so, you risk prolonging your healing time. Watch out for increased pain, redness or swelling and cut back on your exercises and activities until your hand recovers.
In more severe cases of Carpal Tunnel Syndrome, it can take up to sixth months for your hand to recover. In some extremely severe cases, you may not entirely regain the same level of strength in your hand and wrist that you used to have.
Wrist splint for Carpal Tunnel Syndrome
With Carpal Tunnel Syndrome, it’s important to manage the symptoms to reduce pain.
Often, it is recommended that you wear a hand brace to help keep your wrist in a neutral position, which will help relieve the pain and tingling sensation that arises from the irritation of the median nerve as it passes through the carpal tunnel.
Wearing wrist supports, splints or braces may help relieve some of the symptoms. If you are seeing a health care professional, they may provide you with custom splints which are created by physical therapists. These will be tailored to fit the dimensions of your hand and wrist and should be comfortable as well as supportive.
However, it is also possible to buy wrist splints over the counter at chemists or online. These braces often come in different sizes, so it’s advisable to go to a physical shop or chemist to find out your size by trying braces on before you buy one.
If you’re wearing a hand and wrist brace all the time, you may want to choose a soft brace, as this will allow you more movement without causing discomfort. However, try to wear a rigid brace overnight to keep your wrist in a neutral position. This will soothe the median nerve and should help to alleviate some of the symptoms.
It may take some trial and error before finding the right hand brace for you. The one you choose should be comfortable, but firm enough to hold your wrist in a neutral position. You should also notice a reduction in symptoms once you’ve started wearing the brace.
Can Carpal Tunnel Syndrome cause shoulder pain?
When Carpal Tunnel Syndrome first develops, people notice that their fingers become numb at night. The reason symptoms often first manifest at night is because the wrist is usually held in a flexed position in bed. This causes fluid to accumulate around the wrist joint, exerting pressure on the median nerve which runs through the carpal tunnel, located in the wrist.
Although Carpal Tunnel Syndrome is typically associated with hand and wrist pain, many sufferers experience a burning, searing or numbness running up the centre of the forearm and into the shoulder. Some cases of Carpal Tunnel Syndrome resolve themselves, but others worsen over time and may require surgery.
What causes Carpal Tunnel Syndrome?
Certain medical conditions may predispose you to developing Carpal Tunnel Syndrome. For example, diabetes, arthritis, hypothyroidism and obesity can all make you more likely to develop the condition. Almost half of all pregnant women report symptoms consistent with Carpal Tunnel Syndrome, which often disappear after birth. Some people are born with smaller carpal tunnels than others making them more susceptible.
Some occupations increase the risk of Carpal Tunnel Syndrome, including hairdressing, factory and assembly line work and seamstressing.
How Can Carpal Tunnel Syndrome be prevented?
- Carpal Tunnel Syndrome can be triggered by working long hours at workstations that cause you to hold your wrists in an uncomfortable position. If the place you work has a human resources or occupational health department, ask about having your workstation ergonomically assessed. It’s possible to buy wrist-rests and specialist keyboards which help to prevent Carpal Tunnel Syndrome.
- Try to remember to sleep with your wrists straight.
- Avoid activities which require you to flex and extend your wrists repeatedly.
- Perform wrist strengthening exercises.