Carpal tunnel syndrome: What is it, what are the symptoms, and what's the cure?
DR CATHY STEPHENSON
Last updated 05:00, January 14 2016
Women are more at risk of developing carpal tunnel syndrome, and repetitive wrist movements are another risk factor.
A reader, Diane, writes: "I wake up every night with pain in my hands. If I shake them, it seems to get better. It doesn't bother me during the day at all. Is this something I need to worry about, or will it just go away on its own?"
Although it is hard to be certain without seeing Diane in person, I suspect the cause of her symptoms is a condition known as carpal tunnel syndrome. It is common and may go away on its own, but I would recommend seeing a doctor to get a definitive diagnosis and ruling out anything more serious.
Carpal tunnel syndrome (CTS) is actually quite common, especially among women in the 30-60 age group. It occurs when the median nerve gets compressed as it travels through the wrist. The median nerve supplies sensation and power to part of the hand, thumb and fingers. When the nerve gets compressed or squeezed, it can cause symptoms much as Diane describes.
The median nerve is responsible for sensation to the palmar surface of the thumb, index and middle fingers. In some people it also supplies sensation to all or part of the ring finger. The nerve travels through the wrist via a narrow passageway known as the carpal tunnel, which it shares with nine tendons. Any condition that causes swelling around this area can result in compression of the nerve, and CTS.
* Carpal Tunnel Syndrome or The Creepy Dead Hand
* Dealing with the internal acid attack
* How to quit smoking
Carpal tunnel syndrome is caused by swelling which compresses the median nerve travelling through the carpal tunnel.
Common risk factors for developing CTS include:
* Being female.
* Being obese or overweight, as this will increase pressure on the wrist area.
* Pregnancy – extra weight and fluid retention associated with pregnancy can cause compression of the median nerve; this usually resolves after the baby is born.
* Certain medical conditions such as diabetes, rheumatoid arthritis, hypothyroidism.
* Injury to the wrist, eg, a serious sprain on fracture
* A family history of CTS
* Occupation or hobbies that involve lots of repetitive wrist movements.
Often CTS presents exactly as Diane describes it, with pain typically occurring at night. The pain is often described as being burning or prickly in nature, and patients will often talk about having to shake their hands vigorously to relieve it, or even place their hands in cold water or the fridge to ease their symptoms. It tends to be much better during the day. Other symptoms can occur as well, and may include:
* Loss of sensation or tingling in the thumb and first three fingers – the little finger should not be involved, and if it is the diagnosis is not CTS.
* Loss of power in the hand, especially a weakened grip.
* Wasting of the hand muscles, especially around the base of the thumb if the CTS has been present for a long time.
* A feeling of stiffness in the hands, especially in the mornings.
Diagnosis is usually quite straightforward – in CTS, putting pressure on the median nerve through a series of short exercises will reproduce the symptoms. However, if your doctor is not sure what is going on they may suggest further testing such as nerve conduction studies which need to be done by a specialist. They may also want to exclude other underlying medical conditions, so may recommend blood tests for diabetes and thyroid disorder.
For many people with CTS, treatment can be quite simple. Addressing the underlying risk factors is the first step – especially altering activities to reduce strain on the wrist and losing any excess weight.
Anti-inflammatory drugs such as ibuprofen can be useful for the pain, but cannot be used in pregnancy. If night-pain is still an issue, a hand therapist or physio will be able to fit you with a splint to wear in bed. This takes the pressure off the carpal tunnel, relieving any compression on the median nerve.
Occasionally, your doctor may suggest a steroid injection to try to settle things down, but I wouldn't recommend this until you have tried the other options.
As a last resort, if your symptoms are severe or long-standing, surgery is highly successful. It involves release of the carpal tunnel through an incision at the wrist, and can usually be done as a day case, without the need for general anaesthetic.
I hope this advice is helpful, Diane. For more information, you could visit familydoctor.co.nz.
Cathy Stephenson is a general practitioner and medical forensic examiner.