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Carpal tunnel syndrome
What is carpal tunnel syndrome?
Carpal tunnel syndrome (CTS) is a relatively common condition that causes pain, numbness and a tingling sensation in the hand and fingers. Usually, these sensations develop gradually and start off being worse during the night. They tend to affect the thumb, index finger, middle finger and half of the ring finger. It is caused by compression of one of the nerves that controls sensation and movement in the hands, called the median nerve. The carpal tunnel is a narrow passage in your wrist made up of small bones and a tough band of tissue, and this is where the median nerve becomes compressed for a variety of reasons.
How do we treat carpal tunnel syndrome at the Mansfield Clinic?
The first thing that needs to be established is whether there is an identifiable cause for the carpal tunnel syndrome. Very often there is not, and in these cases, treatment involves the use of a special wrist splint that is worn for a short while.
If this is not sufficient to solve the problem, Dr Allfree may suggest a cortisone injection into the wrist.
In more severe cases, especially if the nerve is in danger of being damaged, surgery may be required, and in this case Dr Allfree will arrange for a surgical referral.
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What causes carpal tunnel syndrome?
Carpal tunnel syndrome is caused by compression of one of the nerves that controls sensation and movement in the hands. This nerve is called the median nerve. The carpal tunnel is a narrow passage in the front of the wrist made up of small bones and a tough band of tissue. It acts as a pulley for the tendons that bend the fingers.
In most cases it is not known why the median nerve gets pinched in the carpal tunnel, although certain things are thought to increase the risk of CTS developing, such as:
- a family history of CTS
- pregnancy – up to about 50% of pregnant women develop CTS
- injuries to the wrist such as a fracture of one of the bones
- underlying health conditions, such as diabetes ands rheumatoid arthritis
- repetitive work with the hand
Treating carpal tunnel syndrome
In some cases CTS will disappear without treatment, or simple self-care measures will reduce the symptoms.
CTS in pregnant women often gets better within three months of the baby being born. However, in some women, symptoms can continue for more than a year and will need treatment.
Non-surgical treatments
In mild to moderate cases of carpal tunnel syndrome (CTS), treatments such as wrist splints and corticosteroid injections are often recommended.
There is no evidence to support the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for treating CTS, or for diuretics to help relieve fluid retention.
Wrist splints
A wrist splint is worn at night to support the wrist and keep it in the same position. The splint prevents the wrist from bending, which can increase pressure on the median nerve and aggravate the symptoms of CTS.
You should begin to notice an improvement in your symptoms within four weeks of wearing a wrist splint. Dr Allfree will be able to obtain a suitable splint for you.
Corticosteroid injections
Corticosteroids are a type of steroid medication. They are powerful chemicals that can help reduce inflammation.
If a wrist splint does not work, corticosteroid injections into your wrist may be recommended. One injection is usually recommended to begin with. If the condition responds well to one injection but then recurs, the treatment may be repeated.
Injections into the wrist sound painful, but Dr Allfree has had a lot of experience in performing this injection, and patients tolerate it well.
Surgery
In more severe cases of CTS, surgery is usually required to reduce the pressure on the median nerve. Surgery relieves the symptoms of CTS instantly, but it can take a while to recover. Depending on which hand was operated on and what your job involves, you will usually be able to return to work within a few weeks of surgery. If you need a surgical opinion, Dr Allfree will be able to help you with the arrangements.