A form of arthritis that typically causes pain, weakness and tingling in your thumbs and fingers is referred to as Carpal tunnel syndrome (CTS).
- CTS is more often seen in women than men.
- In the UK, 3% of men and 5% of women may experience CTS is their lifetime.
- Although Carpal Tunnel Syndrome becomes more common as you get older, it can affect people of any age.
The Carpal tunnel serves as a passageway in the hand. Carried within it are the median nerve (extends from the elbow, forearm and wrist to the hand), tendons and bones of the carpal.
Women are more susceptible to Carpal tunnel syndrome, however it impacts people regardless of sex and age, affecting one or both hands.
What Causes Carpal Tunnel Syndrome?
Carpal tunnel syndrome occurs when the median nerve (at the point of entry into the wrist) is placed under tension or pressure (clasped) by irritated and swollen tendons. The numbness and pain felt in the middle fingers are as a result of the pressure the median nerve is subjected to.
In many cases, the exact cause of CTS is unknown. Factors that can increase pressure on the median nerve and tendons within the carpal tunnel include:
- Repetitive hand motions, especially forceful grasping or pinching
- Weight gain, which can increase swelling
- Fluid retention during pregnancy or menopause
- Wrist injuries that cause swelling/inflammation
- Certain health conditions like rheumatoid arthritis or diabetes
Risk Factors
Individuals with the following conditions are susceptible to carpal tunnel syndrome:
- Overweight
- Use contraceptive pills
- Suffer from an underactive thyroid gland
- Pregnant
- Diabetic
- Suffer from rheumatoid arthritis
You may have an increased risk if:
- You are between 40 and 60 years old
- You work in an occupation with repetitive hand motions (typing, assembly line work, etc.)
- You have a family history of CTS
- You are female (CTS is 3x more common in women)
Symptoms
A burning sensation in the hand, numbness, or tingling (also referred to as pins and needles) are early symptoms that indicate the onset of the syndrome. During the night the symptoms worsen and can even deprive the sufferer of sleep. As time goes by the symptoms become more noticeable by day and the pain may extend to other areas of the body such as the arm, elbow or shoulder. If not treated, the affected hand weakens. The muscles of the thumb, index and middle fingers are mostly impacted, once this occurs the victim finds it difficult to hold and pick up objects.
Diagnosis
After looking at the pattern of symptoms and your medical history, carpal tunnel syndrome can be diagnosis by your doctor. A unique electrical test referred to as nerve conduction study may be performed to confirm the diagnosis. Nerve conduction study involves the passage of small electrical charges into the median nerve which is directly above the wrist. When tension or pressure is placed on the nerve then the rate at which electrical impulse is transmitted declines.
Carrying out a blood test or an x-ray may also happen in an attempt to get rid of other forms of arthritis.
If carpal tunnel syndrome is suspected, your doctor will take a full medical history and conduct a physical exam of the hands and wrists. They will check for areas of tenderness, swelling, warmth and limited range of motion.
Your doctor may also recommend the following tests to aid diagnosis:
Nerve conduction studies: Small metal electrodes are placed on the hand and wrist. Minor electric shocks are used to stimulate the median nerve. Slowed nerve conduction indicates nerve compression.
Ultrasound imaging: Sound waves create images of the tissues and bones in the wrist. This allows your doctor to look for enlarged tissues putting pressure on the nerve.
Blood tests: These can help rule out medical conditions with similar symptoms, like rheumatoid arthritis or hypothyroidism.
Treatment
The severity of your symptoms will determine what kind of treatment you receive. Painkillers will be enough for mild symptoms, but your physician still needs to place you under observation to ensure the symptoms do not get worse.
If the cause of the syndrome is your job or hobby, it is often a good idea to take breaks on the job and try to devise other means of performing such activities.
In mild cases, carpal tunnel syndrome symptoms can often be relieved with rest, ice packs, over-the-counter anti-inflammatory medication and wrist splints worn at night. If these conservative treatments fail, your doctor may try corticosteroid injections to reduce inflammation and swelling around the nerve.
Carpal tunnel syndrome symptoms such as pain and inflammation can be reduced by the use of prescription drugs. Non-steroidal anti-inflammatory drugs (N.S.A.I.D.s) are majorly effective. It is a wise choice to wear a splint until you recover so as to prevent movement and avoid putting the nerve under pressure. The splint should also be worn to bed.
Sometimes sufferers may need surgery when the CTS does not respond to treatment. The process involves opening up the carpal tunnel and cutting the ligament just below the wrist, this helps alleviate the pressure on the nerve. The patient is discharged the same day, but it is advised that you rest the wrist for a week.
For moderate to severe cases that interfere with daily activities, carpal tunnel release surgery may be recommended. This procedure involves cutting the ligament pressing on the nerve to relieve the compression. Though recovery takes several weeks, most people experience significant symptom improvement after surgery.
Prevention
While some risk factors like genetics can’t be changed, managing other risk factors can help prevent carpal tunnel syndrome progression or recurrence after treatment:
- Losing weight to reduce compression in the wrist area
- Avoiding repetitive hand motions and resting hands frequently
- Managing chronic health conditions like diabetes or arthritis
- Doing exercises to strengthen the hand and wrist muscles
- Making adjustments at work, such as using ergonomic equipment
Further Information
You can learn more about Carpal tunnel syndrome by going to the Arthritis Research UK website. This resource offers some excellent advice and information on this disease. Carpal-Tunnel.net is another excellent source of information. Maintained by a doctor with a longstanding research interest in CTS, this website also offers a handy, self-diagnosis questionnaire.
Photo by Milada Vigerova on Unsplash
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