Carpal Tunnel syndrome (CTS) occurs when there is an increased pressure on the Median nerve. The Median nerve is responsible for carrying sensory signals from the hand to the brain and it is particularly responsible for the sensation of the thumb, index, middle and part of the ring finger, in addition to innervation of small hand muscles. This pressure occurs at the Carpal ligament (a band of tissue in which Median nerve passes under) which is located under the palmer side near the wrist. As a result, the signal being sent to the brain is disrupted and often results in pain, pins & needles feeling and, eventually, weakness of the hand muscles.
Can Carpal Tunnel Syndrome Cause Severe Pain?
The pain can be significant enough to disrupt sleep, and in some cases, can cause symptoms while performing daily activities such as driving, reading a book or holding a phone. Symptoms are usually intermittent (i.e. come and go) but in some people, or in its late stages, they can become persistent.
The pain is described as a dull ache or discomfort in the fingers, hand, wrist and/or forearm. Altered sensation and clumsiness are also frequently reported by patients. Keeping the hand in certain or fixed positions can start the symptoms and shaking or altering the position of the hand relieve the symptoms.
Who is More Likely to Get Carpal Tunnel Syndrome?
Some people are more likely to develop CTS than others. Pregnancy is a known contributing cause of CTS and most of the time this resolves after delivery. It is believed that the increase in fluid volume in the body is the cause of the excessive pressure in the carpal ligament. Once the delivery takes place and fluid volume returns to normal, the pressure is eased. Occasionally the symptoms may persist after delivery and further management is required.
People who perform repetitive forceful movements for work are also at high risk for developing CTS, as the carpal ligament is more likely to become irritated with abnormal forces. Using a computer mouse or keyboard in unusual postures has been linked to CTS and adapted equipment are available to help facilitate these postures and may help some people. Some medical conditions such as Diabetes and Rheumatoid Arthritis, are also linked to an increased risk of developing CTS.
How Is Carpal Tunnel Syndrome Diagnosed?
CTS is diagnosed by your doctor after a careful examination of the wrist, hand and fingers. Performing certain clinical tests during the examination in addition to a detailed history guides to the diagnosis. If further management is warranted (e.g. surgery) then your doctor may request a nerve conduction study, which is a painless test using electrodes placed over the skin along the course of the Median Nerve. Other tests such as Ultrasound scan or MRI may be helpful if your doctor believes there may be other underlying reasons for your symptoms (e.g cysts). Occasionally, CTS symptoms can be mistaken for symptoms arising form cervical radiculopathy, which is a nerve impingement in the neck. Your doctor will be able to distinguish the source of the pain by performing various tests of your upper limb and neck.
How is Carpal Tunnel Syndrome Managed?
Initial management for mild to moderate symptoms is usually non-surgical. Patients may find relief with splintage which avoids the wrist from flexing and providing some structural support. Pain can also be managed with appropriate painkillers which can be discussed with your clinician. A steroid injection in the Carpal Tunnel may also be beneficial and may provide effective relief for some time. There is a possibility to repeat these injections if appropriate. It is important to discuss these options with your doctor. A more definitive treatment for CTS is a surgical procedure called Carpal Tunnel Decompression usually performed under local anaesthetic with excellent results.
Take Home Message
Most patients can positively respond to non-surgical methods of managing mild-moderate CTS such as splinting, medications or injections. Surgery produces excellent results. All surgeries carry risks and these should be discussed with your doctor.
If you are experiencing symptoms of Carpal Tunnel Syndrome and would like to discuss management options, contact ACTIVATE for a detailed assessment and comprehensive range of non-surgical treatments.
About the Author: Dr. Mustafa Alnaib MBChB, MRCS, MSc, FEBOT is an orthopaedic surgeon, musculoskeletal doctor and Clinic Director at ACTIVATE Musculoskeletal Clinic in Kent.