Carpal Tunnel Syndrome
What is carpal tunnel syndrome?
A major nerve (called the median nerve) travels down the upper limb and enters the hand through the carpal tunnel, a narrow passageway surrounded by ligaments and bones at the base of the hand. The median nerve controls sensation, movement and strength over the thumb, index finger, middle finger, and half of the ring finger. Factors such as tendon inflammation, fluid retention and ergonomic stressors can cause increased pressure in the carpal tunnel, resulting in compression of the median nerve – a condition called carpal tunnel syndrome.
In most cases of carpal tunnel syndrome, it is almost impossible to attribute it to a single, specific cause or risk factor. It is now a widely held view that some individuals simply have carpal tunnels that are smaller, predisposing them to nerve compression. Indeed, research studies found women to be three times more likely than men to develop carpal tunnel syndrome at some point in their lives. Individuals with pre-existing medical conditions such as diabetes mellitus, rheumatoid arthritis and hypothyroidism have been found to be at higher risk. Pregnancy, obesity, trauma, and ergonomic stressors found both at work and at home are also likely contributors to the development of carpal tunnel syndrome.
How do I know if I have carpal tunnel syndrome?
Signs and symptoms of carpal tunnel syndrome may include:
- Numbness, tingling and/or pain over the thumb, index finger, middle finger and ring finger (especially at night).
- Clumsiness when using their hands to perform daily activities.
- Muscle wasting over the small muscles of the thumb (located in the palm).
- Loss of strength and dexterity over the thumb and fingers, making it difficult to grasp and manipulate objects.
How is carpal tunnel syndrome diagnosed?
Your specialist Doctor will obtain your health history and perform a physical examination. Your Doctor may also order medical diagnostic tests (e.g. nerve conduction studies, electromyography studies, ultrasound scans, MRI scans) to help with the diagnosis.
How is carpal tunnel syndrome treated?
It is important to seek early treatment for carpal tunnel syndrome to prevent permanent damage to the nerve and corresponding small muscles of the thumb and hand. Treatment options for carpal tunnel syndrome depend on the severity and duration of the disease and include both surgical and non-surgical interventions.
Your specialist Doctor may refer you to our Hand Therapist, who will be able to provide the following services:
- Advice and education pertaining to your condition
- Wax therapy
- Ultrasound therapy
- Advice on lifestyle and activity modifications so as to eliminate or minimise daily activities or or upper limb postures which may further aggravate the condition
- Provide a customised wrist splint for night wear, so as to minimise the risk of poor wrist positioning during sleep. The splint can also be worn in the day when performing activities which tend to elicit or worsen symptoms.
- Nerve and tendon gliding exercises to help the median nerve move better within the carpal tunnel
- Personalised home exercise program
Your Doctor may suggest other non-surgical interventions such as oral medications (e.g. anti-inflammatory drugs, vitamin B supplements) to help reduce any existing inflammation and improve nerve function.
Surgical interventions to help relieve the pressure within the carpal tunnel may be recommended in the following situations:
- The symptoms of carpal tunnel syndrome do not improve over time with non-surgical interventions.
- Carpal tunnel syndrome has been persistent for prolonged periods of time (i.e. more than six months) and has been diagnosed to be severe in nature.
- The small muscles of the thumb and hand, which are controlled by the median nerve, show signs of wasting and hand weakness becomes more pronounced.
Recovery from carpal tunnel surgery can take anywhere from several weeks to several months. Hand therapy is often required after surgery to help regain the movement, strength and function of the affected hand and wrist.