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Description:

The carpal tunnel is found underneath the wrist.  Carpal tunnel syndrome is caused by the median nerve becoming entrapped. It is a small tunnel that is found at the base of the wrist and runs to the palm of the hand.  The wrist comprises of 8 small bones (carpals).  Support is given to the wrist by The Retinaculum ligament, a fibrous band which crosses the front of the wrist.  The carpal tunnel is the space formed between this ligament and the carpals. The tendons and nerves (in particular, the median nerve) travel through this space and are responsible for controlling movement and sensation in the hand.  The median nerve branches out into smaller nerves in the hand.

Carpal Tunnel Syndrome occurs when fluid builds up in the tissues of the carpal tunnel, and causes the tunnel to become smaller. This leads to a build-up of pressure on the median nerve, which results in numbness, tingling and a burning sensation in the wrist and hand.  It can lead to muscle damage and wastage.
Carpal tunnel syndrome is more typical in women and is most common in those aged between 50-54 and 75-84.




Causes:

Carpal tunnel syndrome is caused by pressure on the median nerve.  It is difficult to diagnose the specific cause of the syndrome.  Many factors can potentially cause carpal tunnel syndrome including obesity, an underactive thyroid, trauma, diabetes, oral contraceptive and arthritis.
Pregnancy can cause carpal tunnel syndrome because of the susceptibility to fluid retention. This usually improves 3 months post pregnancy but can last up to a year.
Carpal tunnel syndrome can be genetic.

Diagnosis:

A nerve conduction test can be carried out to diagnose carpal tunnel syndrome.  This measures the speed in which the nerve impulse travels through the carpal tunnel.

Symptoms can vary from moderate to severe, and are worse when the hand and wrist are bent.  As carpal tunnel syndrome becomes more severe the symptoms are continuous rather than intermittent (at intervals).

The most common symptom is numbness, while tingling or burning sensation can be felt in the hand and wrist, and in particular the thumb, index, long and radial half of the wedding finger.  The sensation can feel like pins and needles.
Numbness is often felt at night because during sleep limbs (including the wrist) tend to relax and flex (bend).

Pain is in the form of numbness and can be so extreme that it can wake the person up when asleep. Pain can be felt in the hand, the wrist and can travel up the forearm.
Dryness can occur in the affected fingers or thumb.
A weakness in the muscles can occur; which leads to a loss of strength in the hand, and the inability to grip properly.
Pain can be alleviated if the hand or wrists are elevated.  However in severe cases of carpal tunnel syndrome the pain can be constant.

Treatment:

Rest:  it is important to avoid actions that involve gripping, wringing or squeezing.  Try to avoid an action that forces the wrist to become bent/flexed.  When the wrist is flexed it restricts the space of the carpal tunnel, and applies pressure on the median nerve.

Ice treatment:  Ice, can be applied for 10-15 minutes, every 2-3 hours in the acute and sub- acute stage (frequency can be reduced according to recovery, and can be continued for as long as deemed necessary).  In the sub-acute stage (3days – 3 weeks) heat therapy can be applied.

A wrist support splint is proven to be an effective form of treatment.  A support brace can offer support to the wrist and prevent the carpal tunnel from becoming compressed.

Elevation: Raising the wrist and hand up can alleviate symptoms, by reducing the swelling.

Carpal Tunnel Syndrome Treatment:

A wrist support splint is proven to be an effective form of treatment.  A support brace can offer support to the wrist and prevent the carpal tunnel from becoming compressed.

NSAIDS (anti-inflammatories) and paracetamol can be taken to aid pain relief.  Medical advice should be sought, in case of possible side effects.
Steroid injections can be effective, but should only be given on the advice of an appropriately qualified medical professional (for example, a doctor).

Kinesology tape may prove effective in relieving pain and contributing to drainage of the affected area.

A doctor or physiotherapist might recommend an MRI scan to assess the pressure on the medial nerve.
A physiotherapist might prescribe ultrasound treatment, sound waves; which speeds up the repair process, by breaking down tissues and stretching them.  It can also help alleviate pain.

Massage can help aid recovery, and improve joint mobility and range of movement in the wrist. It should not be administered during the acute stage. If there is any underlying medical condition, such as a heart condition, it is important to seek medical advice before receiving massage.

A physiotherapist or sports massage therapist can recommend Carpal Tunnel Syndrome treatment exercises for strengthening and flexibility. Exercises should focus on strengthening, and increasing range of movement in the wrist and hand.  The intensity of the exercises should be increased gradually and in a controlled way.
Surgery can help alleviate pressure on the medial nerve, and alleviate the symptoms of carpal tunnel syndrome.  If muscle wastage starts to occur in the hand as a result of inaction then surgery might be required to allow movement again.

Sophia Cross, BA (Hons) MA