Carpal Tunnel Syndrome

The Median nerve gives feeling to the skin on the palm of the hand and fingers, as well as innervating several muscles in the hand and arm.

The Median nerve passes through the carpal tunnel into the hand.

Carpal Tunnel Syndrome is a commonly occurring disorder which is caused by compression of the Median Nerve as it passes through the carpal tunnel.

Carpal Tunnel Syndrome is characterised by pins and needles or numbness in the thumb and fingers which is usually worst at night, and frequently cause waking.

Associated symptoms can include wrist pain and thumb weakness.

The most common causes of Carpal Tunnel Syndrome are:

Pregnancy: Temporary hand swelling associated with pregnancy causes a (usually) temporary case of CTS

Tendonitis: Tendons which share the tunnel with the Median nerve can become swollen due to overuse, and this will cause compression of the Median nerve.

Ageing: Tendons can become thickened with increasing age and this also causes compression of the median nerve

Arthritis: Inflammation associated with arthritis can cause swelling in the wrist leading to pressure on the Median nerve.

Mechanical causes: Vibration, prolonged highly repetitive work and traction can also cause Carpal Tunnel Syndrome

Naturally Occurring: Carpal Tunnel Syndrome is naturally occurring in (up to) 10% of the population, often in women with small wrists.

Traumatic Injuries such as a wrist fracture can reduce the amount of space in the carpal tunnel.

Diagnosis of Carpal Tunnel

Carpal Tunnel Syndrome is diagnosed with a thorough clinical examination and may require a nerve conduction study.

An accurate diagnosis is required to ensure the most appropriate treatment is implemented.

Symptoms such as pins and needles in the hand can have many different causes all requiring specific treatments.

Treatment of Carpal Tunnel

Carpal Tunnel Syndrome requires treatment as it will not resolve by itself, unless it is pregnancy related. Pregnancy related CTS will normally reduce by 50% in the first two weeks after birth. If symptoms persist for any length of time beyond those first few postpartum weeks, treatment is required.

Conservative treatment of Carpal Tunnel Syndrome

Conservative treatment refers to the non surgical treatments available for Carpal Tunnel Syndrome.

The following treatments have been proven to be effective;

Splinting- The wrist must be splinted in an exact position to maximise the size of the carpal tunnel for three weeks.

Exercises- Specific tendon gliding exercises are done once per day

Education- Certain wrist positions and activities need to be avoided as much as possible during the treatment period.

30% of patients with CTS have successful treatment with conservative measures when their symptoms are mild to moderate and the symptoms have been present for less than three months.

Surgery

Carpal Tunnel Release is the most frequently performed elective surgical procedure in the hand.

The surgery can be done by keyhole surgery or through an incision at the wrist.

In a majority of patients, surgery is the most effective and appropriate choice of treatment.

In some cases of CTS a single steroid injection is considered appropriate as a treatment.

Following Carpal Tunnel Release, you may be referred to a hand therapist for splinting, massage, advice and exercises to help your return to sport, work or other activities.

References

1.Levine et. al. A Self-Administered Questionnaire for the Assessment of Severity of Symptoms and Functional Status in Carpal Tunnel Syndrome. J.Bone Joint Surg.Am. 1993 Nov:75-A(11):1585-1591.
2.Sevim et.al. Long-term effectiveness of steroid injections and splinting in mild and moderate carpal tunnel syndrome. Neurol.Sci.(2004)25:48-52
3.Graham et.al. A prospective Study to Assess the Outcomes of Steroid Injections and Wrist splinting for the Treatment of Carpal Tunnel Syndrome. Plast. Reconstr. Surg. 2004 Feb:113(2):550-6
4.Gerritsen et.al. Splinting vs Surgery in the Treatment of Carpal Tunnel Syndrome. A Randomized Controlled Trial. JAMA.2002 Sep 11:288(10):1245-51
5.Rozmaryn et.al. Nerve and Tendon Gliding Exercises and the Conservative Management of Carpal Tunnel Syndrome. J. Hand Ther. 1998 Jul-Sep:11(3):171-9
6.Gelbeman et.al. Carpal-Tunnel Syndrome. Results of a prospective trial of steroid injection and splinting. J. Bone Joint Surg. (Am). 1980 Oct:62(7):1181-4
7.Akalin et.al. Treatment of Carpal Tunnel Syndrome with Nerve and Tendon Gliding Exercises. Am. J. Phys. Med. Rehabil. 2002 Feb:81(2):108-13
8.Celiker et.al. Corticosteroid Injection vs. Nonsteroidal Antiinflammatory Drug and Splinting in Carpal Tunnel Syndrome. Am. J. Phys. Rehabil. 2002 Mar:81(3):182-6

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