Carpal Tunnel Syndrome

 

Carpal tunnel syndrome is due to compression of the median nerve in the wrist. The nerve runs in a tight tunnel along with tendons and any swelling in the tunnel puts pressure on the nerve. This causes tingling in the thumb and fingers (typically sparing the little finger) often at night, pain, and it can lead to weakness in the hand. This is often presents itself as clumsiness or a tendency to drop things.

 

Causes include:

Tenosynovitis (swelling of the lining around the tendons)

Arthritis

Injuries

Pregnancy

Diabetes

Hypothyroidism

 

Diagnosis:

Is based on history, examination and in some cases, nerve conduction studies to locate the area of compression (as it is occasionally at the neck level).

 

Treatment:

Activity modification

Splinting the wrist straight whilst sleeping

Steroid injection into the carpal tunnel is sometimes considered

Surgery, if conservative management fails, or the compression is severe. Pins and needles often resolve instantly and symptoms will continue to improve over a 2 – 3 year period. If the compression was prolonged and severe, sensation and strength will not recover fully.

 

Postoperative risks and complications:

Swelling and stiffness – keep your hand raised and exercise your fingers to prevent this

Scar – will be firm and lumpy initially, and sometimes sensitive, but with regular scar massage will fade and soften with time

Pillar pain – a deep ache in the heel of the hand when pressure is applied. This may continue for several months but it does no harm and will improve.

Incomplete return of sensation and strength (depending on severity of compression)

Complex Regional Pain Syndrome (CRPS) – a complication of any upper limb surgery (<5%), which is unpredictable and causes swelling, stiffness and pain. This is treated with different Hand Therapy techniques.

 

More information:

http://www.bssh.ac.uk/patients/conditions/21/carpal_tunnel_syndrome