Carpal tunnel syndrome explained
Each year doctors undertake thousands of operations a year to tackle carpal tunnel syndrome - a condition in which the wrist nerve becomes trapped or compressed.
In this latest health article also featured in the January edition of the West Essex LIfe Magazine, Mr Nick Saw, Consultant Orthopaedic Surgeon at The Holly Private Hospital talks about this common condition.
What is carpal tunnel syndrome?
Carpal tunnel syndrome is a common condition that can affect the hand and arm. There are three nerves that go to the hand. One of them, the median nerve, runs from the forearm into the palm in the middle of the hand. As it enters the palm, it goes under a ligament along with the tendons that move the fingers in a space called the carpal tunnel. The ligament is a bit like felt and cannot stretch, so sometimes the nerve can be squashed against it. This causes the pain and pins and needles we can carpal tunnel syndrome.
What are the symptoms?
There can be a whole range of symptoms. Classically it causes pins and needles affecting the thumb, index and middle fingers of the hand. It can wake the person at night, and is often relieved by hanging the hand down and shaking it.
Some people feel pain rather than tingling and it can be noticeable when the hand in held in a position for a while as in driving, reading, holding the phone or texting. Doing fine things such as earring and buttons can become tricky. The symptoms start intermittently but over time can become more frequent and last longer. In severe cases there may be permanent numbness and muscle wasting.
What causes carpal tunnel syndrome?
We still don’t know why most people get carpal tunnel syndrome. We do know that is it more common in women, usually in middle age but it can affect almost anyone. The symptoms may be brought on by something else going on that can cause swelling such as an injury or the normal changes associated with pregnancy, conditions that cause inflammation such as rheumatoid arthritis or chronic diseases such as diabetes.
There may also a family trait of carpal tunnel syndrome. Research has shown there's a genetic link to carpal tunnel syndrome. About one in four people with carpal tunnel syndrome have a close relative, such as a parent, brother or sister, who also has the condition but it’s not fully understood how and why the condition is passed on through families.
For most people however there is no cause for it.
How is carpal tunnel diagnosed?
For the majority of people the story of the symptoms leads to the diagnosis. A physical examination may find numbness and muscle wasting but this tends to be late on in the condition. Early on there may be nothing to find, although what we call provocative testing - putting the hand in positions that may worsen the compression- can trigger the symptoms.
It is important in the examination to make sure there are no other signs of inflammation or injury. Occasionally nerve tests may be needed to assess the nerves, particularly if the story is unclear or there may be other causes of nerve irritation such as neck problems or diabetes.
What treatments are there for carpal tunnel?
For some people the symptoms of carpal tunnel syndrome get better on their own quite quickly. When the symptoms first appear, simple things may help. Try to avoid or minimise anything that may bring on the symptoms such as hand position at work or holding the phone for a long time. Rest breaks, frequent changes in position and stretching exercises may help. If the night symptoms are intrusive a splint at night that holds the wrist in position can improve the situation. If the symptoms don’t improve or worsen an anti-inflammatory steroid injection can be considered.
If the symptoms are not improving or are worsening, then surgery should be considered. The idea of the surgery is to divide the ligament over the median nerve to allow more space. This takes the pressure off the nerve, improving the symptoms and stops the nerve being damaged further. It can be done under local or general anaesthetic as a day case operation. The success rate of the surgery at stopping the night pain and tingling is high, but if the nerve has been squashed badly or for a long time the numbness may not get completely better. It is better to have the surgery before any muscle wasting or permanent numbness have set in.
Mr Saw has clinics at The Holly Private Hospital on Wednesday mornings and alternate Friday mornings.
To book an appointment call our friendly appointments team on 020 8936 1201.