Carpal Tunnel Syndrome (CTS)

The median nerve is one of the nerves that supplies the feeling to the hand. It runs down from the neck, and continues to travel down through the forearm and wrist, via a tunnel of bones called the carpal tunnel. The median nerve supplies the sensation to the thumb side of your hand in your palm (your thumb, index, middle and ring fingers) and to some of the smaller muscles in your hand.

Carpal tunnel syndrome is a condition in which extra pressure is put onto the nerve, squeezing it as it passes through the carpal tunnel in the wrist.

Symptoms

The usual symptoms of carpal tunnel syndrome are altered sensations in the thumb, index, middle and ring fingers of the hand. It can be described as tingling or pins and needles. Symptoms are usually worse at night time or first thing in the morning. They may wake you up from sleeping. Certain activities, such as gripping an object with the arm elevated (for example, holding a telephone), or repeated use of the wrist (for example, working on a production line or as a typist) may bring on the symptoms.

In the early stages, the symptoms may come and go and may be relieved by moving or shaking your hand. Symptoms may resolve or get better over time.

If however, the condition worsens, you may experience changes in sensation more regularly, with further loss of feeling (or numbness) in the fingers, and weakness or wasting (where the bulk of the muscle looks thinner) in the small muscles that move the thumb. You may experience pain in the forearm or find it more difficult to carry out pinching and gripping tasks. The hand may feel clumsier.

Causes

Carpal tunnel syndrome is a common problem. It is more common in middle aged women than in men, but it can also affect men. It can be caused by different factors:

Arthritis of the wrist or thumb
An injury to the bones in your wrist and hand may alter the shape of the carpal tunnel, and put pressure on the nerve
Repetitive work related activities may aggravate the tendons running through the carpal tunnel and put additional pressure on the nerve
Conditions such as rheumatoid arthritis, diabetes and pregnancy can affect the space in the carpal tunnel, putting extra pressure on the nerve
Sometimes there is no identifiable cause.

On occasion, problems with the neck or shoulder may cause symptoms that are similar to carpal tunnel syndrome, making it difficult to diagnose.

Diagnosis

Your healthcare practitioner will ask you questions about the nature of your symptoms. They may carry out some tests, such as tapping around the wrist, or bending your wrist to see if this brings on your symptoms. It may be necessary to send you for tests if more information is needed to decide if you have carpal tunnel syndrome or to see how severe it is. More information can be found on the Versus Arthritis website.

Treatment

The following advice may help you to manage your symptoms if they are mild. You should seek advice from your healthcare practitioner after six weeks if your symptoms persist or become more severe.

Lifestyle changes

Sometimes, avoiding activities that aggravate the nerve may help to resolve the condition. Try and avoid repetitive hand or wrist movements. By pacing, or changing the way you carry out tasks, you may find you can manage your symptoms yourself. Have a discussion with your manager to see whether adjustments could be made to how you work, or changes, for example, to your computer workstation may help. You should ensure that you are able to drive safely.

Managing your health

If your carpal tunnel syndrome is more likely to be related to an underlying health condition, seek advice from your GP on how to best manage this to reduce your symptoms.

Hand exercises

Exercises can help to improve the movement of your wrist and hand. Try the following exercises three to four times per day:

Exercises for the fingers, hands and wrists | Versus Arthritis

Splinting

Carpal Tunnel Wearing a splint that rests the wrist in a neutral (straight) position might help relieve the symptoms occurring at night. In the short term, if your symptoms are brought on by particular activities, wearing a splint may help to remind you to try and bring in changes to the way you work. A pharmacist, doctor or hand therapist can advise you on which splints would be suitable, or advice can be found online. Wrist splints can be purchased privately online. Here is an example of an appropriate splint – the metal insert should be removed so that the wrist sits in a neutral (straight) position.

Surgery

Surgery is not usually needed for patients with mild symptoms (for example, patients whose symptoms are occasional and do not interfere with their sleep).

Patients with persistent symptoms who have not responded to a self-management programme can be referred to a hand surgeon for management if their doctor feels this is appropriate. Patients with severe carpal tunnel syndrome (who are experiencing continuous numbness or pain and muscle weakness/wasting) should be referred to a hand surgeon more quickly to prevent any long-term issues.

If your symptoms persist, you may be offered a steroid injection into the carpal tunnel to help reduce inflammation (and reduce pressure on the nerve). Your healthcare practitioner will consider whether this is suitable for you. In some cases, this can help resolve or improve your symptoms.

Carpal tunnel surgery is usually completed as a day case. It involves the surgeon cutting through the tight ligament that crosses over the carpal tunnel to relieve the pressure on the nerve. More information on carpal tunnel syndrome is available on The British Society for Surgery of the Hand website.

NHS decision support tool

Decision support tools are designed to support shared decision making between people and a clinician. People may find they are useful before, during or between consultations depending on their care pathway.

This document is called a decision aid. It is designed to help you decide between treatment options. You should go through it and talk to your healthcare professional.

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