Carpal Tunnel Syndrome
What is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome describes the condition where compression of a nerve (the median nerve) in an area of your wrist termed the ‘carpal tunnel‘ causes a painful burning sensation in the palm of your hand with tingling and numbness of the fingertips.
Often the patient experiences pins and needles in the thumb, index, middle and radial side of the ring finger.
The patient may get up several times during the night to vigorously shake their hands to ease the symptoms
Symptoms of Carpal Tunnel Syndrome include:
- Pain in The hand
- Numbness in the hand
- Pins and needles or tingling in the hand/fingers
- A loss of power in your hand or dropping objects or a reduction in manual dexterity and precision of the hand/fingers
- Wasting of Hand Muscles on the Palm
These symptoms often occur at night and you may find they are often relieved by shaking your wrist vigorously for 15 to 30 seconds
You may find that your symptoms are worse when you fall asleep. Your sleep may even be disturbed by the pain and pins and needles causing you to wake and shake your hands vigorously to ease the symptoms
When you wake up in the morning you may still have numbness and tingling in your hands that spreads all the way up to the forearms and to the shoulder.
In the daytime your symptoms may flare when you are bending your wrist during driving or working at a keyboard or vibrating machinery.
As carpal tunnel syndrome gets progressively worse you will notice a weakness in grip strength, more pain and your forearm muscles cramping.
How is Carpal Tunnel Syndrome diagnosed?
Carpal tunnel syndrome is usually diagnosed from a careful history and examination.
The neck, shoulder and elbow are also examined to make sure the nerve compression is not occurring in a different region.
The median nerve compression test is a very useful test. To perform this test the clinician taps or applies pressure on the area where the median nerve is located to replicate the symptoms the patient experiences. If the symptoms are replicated it is a positive test. This is the Tinel’s Sign
Another test is the Phalens test. Here the patient flexes the wrist in a ‘reverse prayer’ manoeuvre. Again replication of symptoms of pain and pins and needles in the medican nerve distribution is a positive sign
Conditions such as pronator syndrome or a prolapsed disc affecting the C6 nerve in the neck region can present as carpal tunnel syndrome so an in-depth examination is essential
You may undergo nerve conduction studies but even in approximately 5-10% of cases, Carpal Tunnel syndrome these may be normal. They are however positive in the vast majority of cases.
Here at MyMSK clinic we also use an ultrasound scanning machine to help make an accurate diagnosis
Causes of Carpal Tunnel Syndrome
Carpal tunnel syndrome is caused by any factor which causes compression or swelling of the median nerve at the wrist or causes narrowing of the carpal tunnel. There are several causes of carpal tunnel syndrome
Often no single cause of carpal tunnel is is identified and it may be due to a combination of factors
Risk factors
Treatment of carpal tunnel syndrome
Although carpal tunnel syndrome often comes on gradually, it is important to treat it early to prevent long term disability and potentially irreversible muscle damage.
If diagnosed and treated early when the symptoms may be mild, surgery may be avoided.
A non surgical approach is recommended:
- Wrist splint: Wearing a splint at night works by preventing flexion of the wrist. This in turn reduces the pressure on the median nerve in the carpal tunnel. It may also be useful to wear the Splint during the day when doing activities which may bring on carpal tunnel syndrome
- NSAIDS: Non-Steroidal Anti Inflammatory Medications i.e Ibuprofen or Naproxen often these can help relieve pain and inflammation
- Nerve flossing exercises: Occasionally patients may benefit from specific exercises that help the median nerve glide more freely within the carpal tunnel
- Activity modification: This involves being able to identify certain activities or wrist movements in your job or hobby which make carpal tunnel syndrome worse. Altering or modifying these can help slow or stop the progression. You may need ergonomic input to alter things such as the workstation setup or tools being used at work if you work with machinery
- Cortisone injection: These are powerful anti inflammatory medications that can be directed into the carpal tunnel. These injections can often relieve painful symptoms and help to control flare ups. A good response to the injection also helps your doctor in diagnosing carpal tunnel syndrome
We here at MyMSK clinic tend to use an Ultrasound guided injection to help release or create for the median nerve.
An Ultrasound guided injection really adds precision to the procedure and makes a successful outcome more likely. It also helps avoid complications such as damage to the median nerve. Sometimes more than one injection is required to adequately control symptoms
Surgery
Surgical procedure
The surgical procedure performed for carpal tunnel syndrome is termed carpal tunnel release. Often carpal tunnel surgeries are done as an outpatient procedure under local Anaesthesia.
The procedure involves cutting the ligament that forms the roof of the tunnel. This ligament is called a flexor retinaculum. By cutting this the aim of surgery is to relieve the pressure within the carpal tunnel and an easing of symptoms
Treatments
Osteopath
Osteopathy is a type of alternative medicine that invloves manual therapy and focuses on improving muscle and bone health
Read More
Cortisone Injections
A Cortisone Injection (termed steroid injection in the UK) is an anti inflammatory injection for the joints or body tissue to relieve pain.
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