Carpal Tunnel Syndrome

What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome (CTS) is a common condition that can cause tingling, numbness, aches or pains in the hand and wrist.

The carpal tunnel itself is narrow and formed by the wrist bones and a thick ligament which branches across them. 

The symptoms are caused by pressure on the median nerve as it passes through the carpal tunnel. This nerve controls muscles that move your thumb and supplies the sensation to your thumb and first two fingers which is where the symptoms are usually felt.

What are the symptoms?

All symptoms can vary in intensity and may come and go:

• Altered sensation such as tingling or numbness and aches/pains felt in the thumb, index finger, middle finger and the thumb side of the ring finger
• Symptoms are often worse at night and can disturb sleep 
• Symptoms may affect one or both hands and may spread up into the wrists and forearm
• You may also experience some reduction in your grip strength and feel a little clumsy when using your hands to do things like fastening up buttons

What are the causes?

The exact cause is not always known, but anything that increases pressure on the nerve can lead to symptoms, such as;

• Repetitive hand or wrist actions such as gardening, assembly line work or forceful gripping actions
• Obesity 
• Peri-menopausal women. It is three times more likely in women than men 
• Hormonal changes such as during pregnancy
• Osteoarthritis & Rheumatoid arthritis effecting the wrist and hand
• Vibration - such as from operating machinery 
• Diabetes
• Thyroid issues
• Direct injury to the wrist such as a fall
• Excessive alcohol consumption 

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How long will it last?

Everyone's pain is different and full recovery can depend on multiple factors, but most people will make a full recovery. Most people will see some improvement following 6-12 weeks of lifestyle changes, advice, and an exercise program. Nerve healing can be a slow process and can take up to 18-24 months to fully resolve in some cases.

What can I do to help myself?

Do I need an x-ray or a scan?

In most cases, no. A good history and physical examination of your hand alone provides enough information to diagnose your problem. Scans and x-rays are not always useful for diagnosing carpal tunnel syndrome. While a scan or x-ray may provide information it rarely alters the treatment plan. 

Imaging findings are very poorly linked with pain and often people with no pain have very similar findings on their scans/x-rays to those that do. X-rays and scans can help for a small number of people in certain situations and will be recommended by a healthcare professional if required.

What about a steroid injection?

A steroid injection may be considered to help control the pain in some circumstances. The risks and benefits would be discussed with your Physiotherapist or GP and is not always an appropriate option for all patients.