Carpal Tunnel Syndrome (CTS) is a common condition were one of the nerves in your hand becomes irritated or gets compressed at the wrist. This nerve, which is called the Median nerve, provides sensation to the tip of the thumb, index, middle and half of the ring finger.

What is a nerve?

A nerve provides sensation to a designated area. It also stimulates a muscle to contract to produce movement. The median nerve in the hand travels through a tunnel alongside the fingers' flexor tendons. This nerve supplies the small muscles of the thumb, index and middle finger.

What are the signs and symptoms of CTS?

  • discomfort at night
  • pins and needles
  • numbness or even pain over tips of fingers
  • pain around the wrist
  • hand feels clumsy
  • fingers feel swollen
  • grip strength decreases
  • if symptoms persist inability to carry out day to day function

As symptoms progress

The tingling sensation and numbness will become present during the day, the grip strength will start to decrease quite significantly and limitation in Hand function will start to develop. Dropping of objects can result due to the lack of sensation over the tips of the fingers.

What happens if symptoms are not treated?

If symptoms are not managed well the following can result:

  • Muscle wasting over the thumb muscles
  • Persistent numbness over the tips of the thumb, index, middle or half of the ring finger

What causes CTS?

Symptoms can occur due to many factors. The following is a list of predisposing factors which can cause CTS to develop:

  • wrist or thumb OA
  • tendonitis
  • rheumatoid arthritis
  • diabetes mellitus
  • hypothyroidism
  • hormonal imbalance
  • pregnancy
  • trauma to the wrist
  • kidney disease
  • hereditary predisposition
  • hypermobility
  • postural
  • any activity which requires repetitive movement of the wrist

Conservative management

Keeping the wrist in a straight position particularly at night time is an important aspect in managing the night time symptoms. Keeping the wrist in a straight position helps to relieve the symptoms at night time. This can be achieved by using a support at night time.

Mobilise the nerve in the wrist by carrying out the following exercises.

Use of corticosteroids

A corticosteroid (steroid) injection can assist to manage the carpal tunnel symptoms. The main objective for using a steroid injection is to relieve the pain and settle down the symptoms. At times cortisone injections can have a very short-term affect. Once symptoms start to recur following a cortisone injection, it is recommended to contact the service who injected your wrist to discuss further management.

Surgical decompression

If symptoms continue to persist and all conservative management fail to relieve the symptoms, surgery might be required. The main reason for a surgical procedure is to relieve the pressure inside the carpal tunnel. You will need to discuss this with a clinician who will assess your symptoms. The clinician will assist you to take a decision on how to manage your symptoms.

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