Introduction
Carpal tunnel syndrome is a condition causing numbness, tingling, pain and weakness in the hand. It is caused by compression of the median nerve (one of the major nerves) at the level of the wrist.
The Carpal tunnel is an opening within the wrist where the median nerve and finger tendons pass. This passageway is bordered by bones of the wrist at the base and the roof of it is formed by the thick transverse carpal ligament.
Carpal tunnel syndrome affects 3-10% of population. It is most common after 40 years of age. Females are more affected than males.
Causes
MOST cases of carpal tunnel syndrome don't have an obvious cause.
Other common causes include:
- Injury – e.g.: broken wrist.
- Jobs requiring repetitive wrist motion.
- Pregnancy.
- Diabetes.
- Obesity.
- Rheumatoid Arthritis.
- Gout.
- Hypothyroidism.
Signs and Symptoms
Diagnosis is based on patient symptoms, examination findings and specific tests.
Tingling / numbness
This usually occurs in the thumb, index finger and middle finger. It may be worse at night and is sometimes relieved by using/shaking the hand.
Pain
Pain may occur in the hand and can sometimes involve the forearm
Weakness
There will be difficulty gripping onto objects for long periods of time. E.g.: holding onto steering wheel of car.
Clumsiness
Dropping objects e.g.: coffee cups.
Tests
Nerve Conduction Test and EMG
This test is usually conducted by a Neurologist (nerve specialist). It is used to determine the conduction speed and signal strength of the Nerve. However, some patients with symptoms and signs of carpal tunnel syndrome may still have a normal test result.
Ultrasound / MRI
These can show compression and flattening of the nerve in the carpal tunnel.
Non-surgical treatment
Activity Modification
Avoiding activities which cause the symptoms. This may involve changing jobs or changing roles at work.
Wrist Splint / Brace
This can be worn at night or during the day at work. It stops your wrist from bending and will reduce the pressure on the nerve.
Pain Killers / Anti-inflammatory Medications
These assist with pain only.
Massage
Massage therapy may assist with pain.
Injection
Corticosteroid / Cortisone injection can be used as a temporary measure to relieve symptoms.