Carpal tunnel syndrome (CTS) is a relatively common condition that causes pain, numbness and a burning or tingling sensation in the hand and fingers. Symptoms of CTS can range from mild to severe.
The carpal tunnel is a small tunnel that runs from the bottom of the wrist to the lower palm. Several tendons that help to move the fingers pass through the carpal tunnel.
So does the median nerve, which controls sensation and movement of your hand. On the inner side of the wrist, the carpal tunnel is enclosed within tissue called the transverse carpal ligament.
In cases of CTS, the space inside the tunnel is made smaller by the increased tissue pressure and a build-up of fluid in the tissue (edema). This places pressure on the median nerve.
The pressure is increased further when the wrist and fingers are bent (flexion). Compression of the median nerve causes the symptoms of pain and numbness.
How common is CTS?
It is more common in women than in men. In Ireland each year, around 60 to 120 women out of every 100,000 are affected by the condition compared with 35 to 60 men out of every 100,000. The two most common age-ranges for developing CTS are between 50 to 54 and 75 to 84.
In addition, CTS is also a common condition during pregnancy, affecting up to 50% of pregnant women. It is thought that this may be due to the fluid retention that often occurs during pregnancy, which places additional pressure on the carpal tunnel and causes symptoms.
Cause
The compression of the median nerve can disrupt the nerve signals, affecting your sense of touch and hand movements. The median nerve can become compressed if the tendons that run through the carpal tunnel are swollen and inflamed.
Symptoms
The symptoms of carpal tunnel syndrome (CTS) affect the median nerve, which passes through the carpal tunnel in the wrist and controls the movement of the hand. In most cases, the symptoms of carpal tunnel syndrome begin gradually without a specific injury.
Many patients find that their symptoms come and go at first. However, as the condition worsens, symptoms may occur more frequently or may persist for longer periods of time.
- – Tingling
- – Numbness
- – Pain
These symptoms occur in:
- – The thumb
- – The index finger
- – The middle finger
- – Half of the ring finger
Risk Factors
The exact cause of CTS is often unknown, a number of risk factors for the condition have been identified. These include:
- Family history: research has shown that there may be a genetic link to CTS. This means you may have an increased risk of developing CTS if other members of your family have the condition or have had it in the past.
- Certain health conditions:
- 1- Type 1 diabetes and type 2 diabetes – a chronic (long-term) condition that is caused by having too much sugar (glucose) in the blood.
- 2- Rheumatoid arthritis – a condition where the joints become painful and inflamed as a result of the immune system attacking the body.
- 3- Gout – a common type of arthritis that causes pain and swelling in one or more joints.
- 4- Hypothyroidism – an underactive thyroid gland.
- 5- Obesity – particularly in young people. 6- Edema – an excess build-up of fluid in the body’s tissue.
- 6- Pregnancy: CTS is common during pregnancy. This is due to fluid retention (edema), where a build-up of fluid that often occurs in the hands and arms (as well as in the legs, ankles, and feet) causes swelling in these areas. Edema can occur during pregnancy, resulting in pressure being placed on the median nerve.
- Certain injuries: CTS can sometimes occur following a hand injury.
- Injuries, such as sprains (a stretched, twisted or torn ligament), a fracture (a break or crack in the bone) and crush injuries (where an external force causes an injury to a body part) can cause swelling and place pressure on the median nerve.
- Certain activities: It has been suggested that certain activities that involve repeated flexion (bending) of the wrist may cause the median nerve to become inflamed and may, therefore, be a risk factor for CTS.
- Examples of activities that may lead to CTS include: Playing a musical instrument – Assembly packing – Using a computer keyboard – Craftwork (making decorative items by hand) – Work that involves manual labor.
Management
Non-surgical treatments
In mild to moderate cases of carpal tunnel syndrome (CTS), non-surgical treatments such as wrist splints and daily activity modification, and Corticosteroids are often recommended.
Wrist splints
A wrist splint is worn at night to support the wrist and keep it in the same position. The splint prevents the wrist from bending, which can place pressure on the median nerve and aggravate your symptoms.
You should begin to notice an improvement in your symptoms within eight weeks of wearing the wrist splint. Wrist splints are usually available from larger pharmacies or your GP may be able to recommend a suitable supplier.
Activity Modification
Reduce repetitive use of fingers, hand and wrist; avoid gripping (e.g., tools); avoid jewelry/watches that apply pressure or constrict anterior wrist; avoid striking palm (e.g., stapler); discontinue use of vibratory tool or repetitive use of handled tools (e.g., hammer); avoid weight lifting and cycling; discontinue repetitive, extremes, or sustained wrist flexion, extension or ulnar deviation.
Corticosteroids
Corticosteroids are a type of medication that contains steroids. Steroids are hormones, which are powerful chemicals that have a wide range of effects on the body, including helping to reduce inflammation.
It may be recommended to treat CTS if using a wrist splint does not ease your symptoms. The medication will help to relieve the pressure on your median nerve and reduce inflammation of the tendon.
In addition, Corticosteroids can be taken as tablets, although for CTS it is likely that you will have a corticosteroid injection directly into your wrist.
One injection is usually recommended and it must only be given by a suitably trained healthcare professional, such as your GP or a hand surgeon.
There is a lack of evidence to support the use of non-steroidal anti-inflammatory drugs (NSAIDs) for treating CTS and diuretics to help relieve fluid retention.
Surgery
Surgery is usually only recommended for severe cases of CTS when the symptoms last for more than six months or if other non-surgical treatment options have not been effective in relieving your symptoms.
Surgery for CTS is known as a carpal tunnel decompression surgery. This type of surgery is performed on an outpatient basis, which means that you will not have to stay in hospital overnight.
Our Approach
Dublin Sports Injury Clinic is a Physical Therapy Clinic based in Pearse Street, Dublin 2. We have a holistic approach to our assessment and treatment. The initial assessment helps us to explore the cause of your injury and help you to get pain free shortly and stop any further injuries. We will design a customized training program for you to start with, and we coach you and monitor your progress closely. We prescribe relative rest or modified activities as required. Depending on the individual requirement, we apply manual therapy accompanied by stretching to restore tissue elasticity and reduce the strain in the muscle-tendon unit with joint motion.
Next step
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Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. You can contact us if you would like to book an appointment or get some advice from our therapist.