Do you wake in the night with pins and needles in your hand? If you do, you could be suffering from carpal tunnel syndrome.
Carpal tunnel syndrome is a relatively common condition caused by a pinched nerve in the wrist. The nerve compression leads to gradually increasing sensations of numbness, tingling and sometimes pain and weakness in the hand, particularly in the thumb, index and middle fingers.
Carpal tunnel syndrome can be uncomfortable but the good news is that for most people, proper treatment can relieve the pain and paraesthesia, keep your hand moving and help you sleep through the night.
What’s going on?
In carpal tunnel syndrome, the median nerve is being squashed as it travels through your wrist. The median nerve relays sensations, such as touch, to your brain and controls some of the movements of the hand. Any compression can interrupt these sensitive nerve signals, causing symptoms of numbness, tingling and a dull ache in the hand. Increasing, or longstanding pressure on the nerve can lead to weakness and decreased function, especially in the thumb.
It’s all about your anatomy. The carpal tunnel is a narrow passageway in the wrist. It contains the median nerve as well as blood vessels and tendons for the muscles. It helps protect the nerve but it’s also a very constricted area, so any swelling or narrowing of the tunnel can press on the nerve and lead to symptoms.
In many cases we simply don’t know why the nerve has become compressed but a number of factors can contribute. These include your individual anatomy, the way you use your hands, pregnancy and some health conditions.
- Family history: One in four people with carpal tunnel syndrome have a close relative with it too; so getting carpal tunnel may have been written into your DNA.
- Health conditions: Chronic diseases including diabetes, arthritis and hypothyroidism can all increase your risk of developing carpal tunnel syndrome.
- Obesity: Being overweight can make you more likely to develop carpal tunnel syndrome, this seems to be particularly the case in younger individuals and children.
- Anatomy: Some people are just born with a narrow carpal tunnel. Others may develop cysts, tumours or swellings in the structures that pass through the narrow passage.
- Pregnancy: For reasons that we don’t fully understand, carpal tunnel syndrome is common in pregnancy, affecting as many as fifty percent of women. There may be a hormonal link because carpal tunnel syndrome occurs more frequently in women going through the menopause too.
- Injury: Trauma, sprains and fractures can all lead to swelling in the area and put pressure on the median nerve.
- Activities: Activities than involve repetitive wrist movements, vibrating instruments or using a strong grip can trigger the development of carpal tunnel syndrome. So playing a musical instrument, working with a power drill or chainsaw or working on an assembly line could put you at risk.
Interestingly, the repetitive action of typing does not appear to predispose to getting CTS, with research so far showing that it’s actually less common in those who spend their days tapping on a keyboard.
What can I do?
Many people find that their carpal tunnel syndrome disappears without treatment, or by adopting simple self-care measures. However carpal tunnel syndrome is not just an irritation. Prolonged nerve compression can cause permanent nerve damage and impede your hand’s movement and function, so it needs to be sorted. If you have severe symptoms, which are regularly waking you at night, see your doctor for advice, or even try an Osteopath where treatment is often performed using deep tissue massage and mobilisation.
Watch and wait
Carpal tunnel syndrome in pregnant women usually gets better when the baby’s born the birth or within three months of the birth.
Ice and respite
If your CTS is down to repetitive movements, take regular breaks aiming for a five minute rest every hour. Ice the inside of the wrist twice a day with a cool pad or a packet of frozen peas for fifteen to twenty minutes to ease any inflammation and decrease swelling.
Modify your movements
If your work or hobbies have triggered your carpal tunnel syndrome, then see if changing your technique, taking time off or requesting a new role takes the pressure off your median nerve.
Splints and supports
A wrist splint can support the wrist, prevent it bending and keep it in a neutral position.
If it is properly fitted and worn regularly, you should start to notice an improvement in your symptoms within a month. Splints are widely available in pharmacies, online or ask your doctor to recommend a local source.
Treat the underlying condition
Gaining control of your disease will also help ease the symptoms of carpal tunnel syndrome. Ensure diabetes or thyroid function are well regulated, if you are obese see if you can lose some weight and see your rheumatologist or GP to manage any inflammatory arthritis.
Steroids are hormones that can act to reduce inflammation. They can be used as a medication to reduce the symptoms of carpal tunnel syndrome.
Although they can be taken orally, they are usually given as an injection straight into the wrist. If the symptoms recur then the treatment may be repeated.
If your carpal tunnel syndrome hasn’t responded to splints and self-help, or if there’s a danger of permanent nerve damage then it may need to be decompressed surgically.
The surgery is performed under local anaesthetic as an outpatient, so you will be awake throughout the procedure but the area will have been numbed with an injection.
The roof of the carpal tunnel is cut, which relieves the pressure on the median nerve. Sometimes this is done using keyhole surgery and sometimes through an open operation, your surgeon will talk through the best approach for you.
There is a small risk of bleeding, infection, recurrence and scarring with any surgery. However In most cases, carpal tunnel release will permanently cure your symptoms.
After surgery your hand will be bandaged and may be supported in a sling for the first couple of days. Keeping the hand raised will prevent fluid building up in your fingers and gentle exercise will stop any stiffness. Let the pain be your guide; light activities should be fine but avoid anything that causes discomfort until it has completely recovered, which may be a few weeks.