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Carpal Tunnel Syndrome

(Median nerve entrapment)

Carpal tunnel syndrome is a common problem that affects hand function. It is caused by compression of a major nerve, the median nerve, in the wrist leading to symptoms of pain, numbness and weakness in the affected hand. It is the most common nerve entrapment syndrome estimated to affect around 5% of all adults.

If you think you might have carpal tunnel syndrome, here are some ways to prevent it and treat it if it does occur.

What is nerve entrapment syndrome?

Nerves are like broadband cables carrying signals to body parts telling them what to do and receiving information from these areas sending them back to the centre. Just like cables, there can be information bottlenecks caused by areas of entrapment, but instead of slow download speeds, video lag during a Zoom meeting or when playing a video game, you experience symptoms like muscle weakness, pins and needles, numbness etc. depending on what area the nerve is supplying.

These areas of nerve entrapment typically occur where a nerve crosses a joint and is bordered by bone, at least on one side. Compression of the median nerve in the carpal tunnel accounts for 90% of all nerve compression syndromes.

What is Carpal Tunnel Syndrome (CTS)?

The carpal tunnel (carpus = wrist (Latin)) is a narrow passageway that runs along the front of your wrist. It is formed by the wrist bones and a tight transverse carpal ligament that holds down the tendons that bend your fingers. It also contains the median nerve that supplies muscles and sensation to areas in the hand.

Carpal tunnel syndrome occurs when pressure builds up on the median nerve inside the carpal tunnel because of swelling or inflammation of the nerve or surrounding structures. This can cause numbness, tingling, pain, weakness, and sometimes even loss of feeling in some of the fingers.

CTS usually affects people who do repetitive tasks with their hands for long periods of time. For example computer keyboard users, musicians, assembly line workers, etc. Symptoms may be mild at first but worsen over time.

Who is at risk of developing carpal tunnel syndrome?

Anyone can develop carpal tunnel syndrome but some people have a higher risk. These include:

  • Age 50+.
  • Women.
  • People who have had a previous break or surgery on the wrist.
  • Those who work with vibrating equipment.
  • Individuals who spend hours using keyboards every day. That's including video gamers.

Common symptoms of Carpal Tunnel Syndrome?

Common signs and symptoms include:

  • Numbness or tingling in one or more fingertips.
  • Weakness of grip strength - you may struggle to open a jam jar.
  • Painful burning sensations along the course of the median nerve (thumb, index and middle finger).
  • Difficulty using tools such as scissors, knives, forks, toothpicks, writing utensils, etc.
  • Waking at night with hand symptoms that want you to shake it out.


What are the causes of carpal tunnel syndrome?

There are many factors that contribute to the development of carpal tunnel syndrome including:

  • Repetitive motion
  • Overuse injuries
  • Obesity
  • Diabetes
  • Rheumatoid arthritis
  • Osteoarthritis
  • Hyperthyroidism
  • Hypothyroidism
  • Vitamin deficiency
  • Alcohol abuse
  • Smoking
  • Excessive caffeine intake
  • Medications like steroids, anti-depressants, blood thinners, diuretics

How do you diagnose Carpal Tunnel Syndrome?

Diagnosis begins by taking a thorough medical history. You will be asked about any recent injury or illness, medications taken, family health history, occupation, hobbies and other risk factors that may be associated with your symptoms.

A thorough physical examination is done looking for evidence of CTS and how established it is. A test you can do at home to check for CTS is the Phalen's manoeuvre or wrist-flexion test:

Press the back of your hands and fingers together with your wrists flexed fully and your fingers pointing down. Stay in this position for at least one or two minutes. If your fingers develop a tingle or get numb, then you likely have carpal tunnel syndrome and you should arrange to see a specialist. Click here to schedule your appointment.

Nerve conduction study testing sensory function and motor function of the nerves of the hand help determine whether the problem lies within the nerves, the muscles surrounding them or coming from a different site altogether. They also help determine how severe your CTS is. This test is only requested when necessary because it can be uncomfortable to undergo.

Several medical conditions can first present with symptoms of carpal tunnel syndrome, espescially when both sides are affected.

What treatments are available for carpal tunnel syndrome?

Treatment options vary depending on the severity of your symptoms:

Mild cases will often respond to rest from activities that cause the symptoms. If you must continue you can modify your activity: e.g. take frequent breaks, use a wrist rest if you use a keyboard.

Wearing a wrist splint or trialling a short course of non-steroidal anti-inflammatory drugs (NSAIDs), if appropriate, can help alleviate symptoms in mild cases.

Hand therapy is another option for those suffering mild symptoms.

Steroid injection into the area around the median nerve is effective in cases where there may be a reversible cause.

For more severe cases, surgical intervention may be required. This involves decompression of the carpal tunnel by dividing the transverse carpal ligament either through an open or key-hole/endoscopic procedure. The procedure is straightforward with excellent results (recurrence rate less than 5%) if done at the right time. 

Having undergone surgical training Dr Ade has, ahem, first-hand experience surgically managing CTS and knows when you will be best served with surgery over conservative treatment.

Carpal tunnel syndrome is a completely reversible condition if addressed early, but if there is delay in attending to it the eventual nerve damage can be irreversible.

I can meet you in Central London or Hertfordshire or via a Zoom video consultation

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