What is carpal tunnel syndrome (CTS)?
CTS is a condition caused by the compression of the median nerve as it passes through the wrist. The carpal tunnel is formed by the wrist bones on one side and a thick ligament on the other side.
The median nerve is responsible for supplying the sensation to the thumb, index, middle and a portion of the ring finger. These are the most affected most affected although sometimes the whole hand and on occasion the forearm can also be affected. CTS affects more women than men and is most common in those aged between 40 and 65.
What are the symptoms of carpal tunnel syndrome?
CTS can have one or both hands and cause a variety of symptoms, including tingling / numbness and sometimes pain into the area which the median nerve supplies. You may also experience a feeling of swelling or clumsiness to the hand. Symptoms are often worse at night, feeling like you need to shake the hand or hang the hand, out the bed. They may also occur through the day, particularly with activities such as writing, typing, DIY and housework.
It can affect either just one or both hands.
In the later stages of CTS, you may notice weakness to the fingers and thumb, gripping objects, or problems with fine finger movements such as fastening buttons. In these cases, you may notice wasting on the muscles around the thumb.
What causes Carpal Tunnel Syndrome?
Any condition that reduces the amount of space within the carpal tunnel can cause CTS. The median nerve is very sensitive to pressure. The following is a list of things that can increase your risk of developing CTS (but not limited to):
- Metabolic conditions i.e., Diabetes, Thyroid gland imbalance
- A wrist fracture
- Inflammation, and conditions related i.e., rheumatoid arthritis
- Fluid retention (for this reason CTS can occur in pregnancy)
- Hormonal changes associated with the menopause
- Your genes
- Obesity
- Occupation or sports that places heavy demand on your wrist - using vibration tools / repetitive gripping
- Occasionally some medications may cause it
What treatments are there for carpal tunnel syndrome?
Not all cases will cause long term symptoms and for some people you may find it improves without any medical treatment. Likewise, if there is a particular cause for your problem such as under active thyroid gland or arthritis, treating the cause, may improve the CTS symptoms.
However, there are different treatments that can help reduce or prevent the symptoms of CTS, which we will discuss in more detail.
Splints
Wearing a splint whilst you are sleeping may reduce the severity of your symptoms, by allowing inflamed areas to rest. Also, the positioning of the wrist is important to reduce the pressure within the carpal tunnel. The carpal tunnel is under its least amount of pressure when the wrist is straight.
It can take several weeks before you start to notice an improvement in your symptoms, therefore if tolerated it is sensible to trial splints for at least 8-12 weeks. Splints are to be worn at night. They are to keep the wrist in a straightened position. The splint straps should be firm but not too tight, so that circulation is not affected. Please seek advice if you feel any skin irritation, colour changes to the skin, increased swelling, rubbing, increased pain or pins and needles in the hand /wrist /forearm.
Splints Hygiene – splints can be washed in cold soapy water, remove the metal bar before doing so. Also splint liners can be considered for comfort and to enable you to wash more regularly.
Altering your activities
Some activities may increase the severity of your symptoms and altering these, where you are able, may reduce your symptoms:
- Avoiding extreme positions of the wrist; this may involve reviewing your workplace set up and consider use of aids.
- Modify your environment; for example, using wider grip tools/ cutlery, or handles for equipment.
- Posture: The nerves begin at the neck and travel the length of the arm; therefore your overall spinal and upper limb posture should be considered. (See figures below as good examples)
- Reduce the duration or frequency of aggravating activities, taking regular breaks, altering grip.
Injections
A steroid injection may be offered following a thorough assessment by your clinician. This is where a small amount of steroid is injected into the carpal tunnel, to aiming to reduce any inflammation. This may be helpful; however, responses cannot be guaranteed, and symptoms may return.
What actions can I take to improve my health?
Evidence tells us that making healthy lifestyle choices can have a big impact on influencing problems with your muscles and bones and can play a major role in your overall health. Some of the most effective areas to address are below:
Maintaining a healthy weight:
Link: www.nhs.uk/live-well/healthy-weight/
Increasing levels of physical activity
Link: www.nhs.uk/live-well/exercise/
Avoiding poor sleep patterns
Link: www.nhs.uk/live-well/sleep-and- tiredness/how-to-get-to-sleep/
Reducing alcohol consumption
Link: www.nhs.uk/live-well/alcohol- support/calculating-alcohol-units/
Stopping smoking
Link: www.nhs.uk/live-well/quit-smoking/
Maintaining a healthy mind
Link: www.nhs.uk/conditions/stress-anxiety-depression/
The good news is that you are able to influence lots of these by modifying your lifestyle. Therefore it is important that you consider addressing these areas alongside your current treatment.
You may wish to discuss any of these factors with your treating clinician who will be able to work with you and guide your long term management and support you to improve your wellbeing.
There will be information about the local services that exist within the waiting areas of the physiotherapy department and your treating clinician will be able to help signpost you to appropriate services.
The websites listed below give more information on local services available:
• Blackburn and Darwen - https://refreshbwd.com/
• East Lancashire - http://www.upandactive.co.uk/
If your symptoms fail to improve within 6 weeks with this regime you should contact your doctor for a physiotherapy referral.
