You may well know someone who has or has had carpal tunnel syndrome. And it may be that that person has had it for a long time and it has got worse and worse. Carpal tunnel syndrome is characterised by pain and tingling in the hand, particularly in the thumb, the index and middle fingers. This condition is caused by compression of the median nerve as it enters the wrist, and it is the most common peripheral nerve compression. The median nerve passes through the carpal tunnel, a space beneath a band of connective tissue, known as the transverse carpal ligament. It is swelling and thickening of this ligament which causes the nerve compression.
However similar symptoms may occur for other reasons, usually because of a problem in the neck. In this case, treating the carpal tunnel will not help and may make things worse if surgery is involved. So it is important to make sure that you have the correct diagnosis.
The pain of CTS is often worse at night and may be relieved by hanging your arm off the edge of the bed. As the condition progresses the pain may start to extend up the forearm towards the elbow and it may become more apparent during the day. There are often specific activities which provoke the pain, such as typing, writing or housework. You may also develop weakness in the thumb and become prone to dropping things.
The causes of CTS are varied and include:
- any form of arthritis in the wrist (including rheumatoid and osteoarthritis), where there is swelling of the wrist joint or the tendons that pass through the carpal tunnel
- hormonal changes during pregnancy – these sometimes affect connective tissues, thus putting pressure on the median nerve
- an underactive thyroid gland
- fracture of the wrist
The risk of developing carpal tunnel syndrome is greater if your job involves repetitive hand movements or the use of vibrating tools.
Treatment and management of carpal tunnel syndrome
The suitability of different treatments depends on how bad the condition is. In the early stages, rest and the use of a splint may be helpful. It is important to address any underlying conditions, for instance diabetes or underactive thyroid. Your GP should be the first port of call and will refer you to the appropriate specialist.
Osteopathy may be useful in managing CTS. Specifically, osteopathic treatment may be used to stretch soft tissues, improve the mobility of bones of the wrist and hand, increase the length of the transverse carpal ligament to enlarge the carpal tunnel and reduce the compression of the median nerve, reduce swelling, and strengthen muscles(1). The osteopath may also recommend a nerve glide to help with healing of the median nerve. You can check out an example here:
If your job involves tasks which appear to be causing or aggravating CTS, it is important to contact your employer’s occupational health officer, as they will be able to recommend suitable adjustments to your workstation and equipment. In some cases, people who have been disabled by work-related CTS may be eligible for Industrial Injuries Disablement Benefit. For more information see the guide from the Department for Work and Pensions, DB1 – a guide to Industrial Injuries Disablement Benefits.
Steroid injections and surgery
A steroid injection can be helpful, although the effect may wear off after weeks or months. A small quantity of steroid is injected into the carpal tunnel, which helps to reduce swelling. If you have arthritis in the wrist, you may be offered a steroid injection into the wrist joint itself.
In more severe cases where the pain, numbness and/or weakness has not improved with other treatments, patients may be offered surgery. Carpal tunnel release surgery relieves pain by reducing the pressure on the median nerve. Surgery is usually carried out under a local anaesthetic and recovery should take less than a month.
Unfortunately people who have had carpal tunnel syndrome for a long time, especially where there is muscle-wasting or loss of sensation, may not recover fully after surgery. Although these patients should experience a reduction in pain, for some there is no improvement and in a small minority (up to 8%) the patient may develop chronic regional pain syndrome following surgery(2). This is a condition which can develop in the hand and arm, following carpal tunnel syndrome or an injury such as a wrist fracture. It results in persistent severe pain, swelling, loss of the ability to use the muscles and discolouration of the skin. I will be discussing CRPS in the my next blog post.
1. Siu G. et al., Osteopathic manipulative medicine for carpal tunnel syndrome. J Am Osteopath Assoc. 2012 Mar;112(3):127-39.
2. Da Costa et al., Incidence of regional pain syndrome after carpal tunnel release. Is there a correlation with the anesthetic technique? Rev Bras Anestesiol. 2011 Jul-Aug;61(4):425-33
Sorrel Pindar, Registered Osteopath