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Carpal Tunnel Syndrome

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is a condition that is suffered by a substantial number of the population. It is generally more prolific in women, with around five in every 100 women affected during their life compared with three in every 100 men. The root cause of the issue is where pressure is applied to the nerves within the carpal tunnel.

Anatomy of the human hand and wrist

The human hand comprises of twenty-seven individual bones and these bones form the wrist, palm and fingers. A total of eight carpal bones form the wrist and it is the carpal tunnel where the median nerve along with a bundle of tendons reside. The tunnel itself is created where the eight bones are connected via tissue but anything compromising this region can have an effect on the hand itself.

The median nerve plays a vital role in relaying both physical sensation and nerve signal messaging allowing the brain to understand what is happening. Without this you may experience pain, numbness or a tingling sensation.

The palm of the hand is formed by metacarpal bones which links the wrist and the fingers through a variety of muscle attachments.

The fingers are created from three individual bones in the Distal, Middle and Proximal Phalanges whilst the thumb just has two bones in the Distal and Proximal Phalanges. The fingers are formed from ligaments and move in relation to the tension of the forearm muscles, though finer movements are controlled via hand muscles.

Bones of the Human Hand and Wrist

What are the symptoms?

The main symptoms of carpal tunnel syndrome, also known by the abbreviation CTS, are as a result of injury to the median nerve. This nerve passes through the tunnel in the wrist and is responsible for the control of the movement of the thumb, as well as providing the sensation to the thumb and the fingers to the side. CTS symptoms generally develop gradually, building up over time and sufferers feel these symptoms more acutely early in the morning, or at night.

Symptoms typically include pain, numbness and tingling and these sensations can occur in the half of the ring finger, the middle finger, index finger or thumb. It is possible that in the case of more severe CTS that tingling, pain and numbness will be felt beyond the localised areas. Symptoms can be present in a single hand or in both and generally will affect both hands after an extended period of time.

For more information on carpal tunnel syndrome Arthritis Research UK have put together a downloadable booklet with all the information you may need.

How the condition can worsen

Symptoms often worsen after using the affected hand, and a wrist support or brace may be needed to ease the pain. Repetitive actions may increase the severity of the symptoms, and although many sufferers initially believe that keeping the hand or arm in the same position for an extended period of time may reduce carpal tunnel syndrome, the opposite is in fact true. In severe cases pain may run all the way from your hand up your forearm and reaching your elbow.

Less common symptoms

In addition to the more common symptoms there are further symptoms that may indicate CTS, and these include the atrophy of muscles in the thumb, or weakness in this digit when a sufferer tries to bend it at a 90 degree angle away from the palm of the hand. Discomfort in the upper arm, forearm or the hand may be experienced and a dull ache may be frequently felt. Paraesthesia, a sensation similar to pins and needles may be felt in the hand or dry skin. Changes in the colour of the hand or swelling may also occur. Sufferers of CTS may become less sensitive to touch, a condition also known as hypoesthesia.

Those with the condition may find that their hands become weak and that they struggle to grip or hold on to certain objects. The dexterity of a hand may also be affected and impaired by carpal tunnel syndrome. Sufferers often struggle with basic tasks such as fastening buttons or typing and a wrist support may be needed to ensure that the hand is held in the correct place and the ailment treated or limb rested accordingly. CTS can be a minor or a major ailment, and if symptoms appear they are best addressed quickly in order to minimise the impact on a sufferer’s activities and daily life.

What causes the onset of the condition?

There are a host of reasons why you may experience an increased risk in the onset of CTS, whether this is injury based, linked to other health conditions or even as a result of something hereditary. In general however the medical professionals are unsure as to the root cause of the condition.

Injury to the wrist

Some injuries, such as crushing, fractures or sprains can cause swelling or structural changes to the hand and wrist. Where these compress the median nerve, CTS may develop.

Some health conditions

It is known that a number of health conditions, such as type 1 or type 2 diabetes, oedema, rheumatoid arthritis, gout, obesity and hyperthyroidism can contribute to the development of CTS.

More rarely, CTS can develop as a result of growths or cysts on the tendons and blood vessels within the carpal tunnel. It can also arise where there is an abnormal wrist structure.

Pregnancy and the menopause

For reasons that remain unclear to the medical profession, Carpal Tunnel Syndrome can be more common in pregnancy. Luckily, most cases will improve or completely resolve about six to twelve weeks following the birth of the baby.

In addition, CTS can occur more frequently during the menopause and among some women being treated for breast cancer.

Family history

Although scientists are unsure as to how or why CTS can be passed on, research has suggested a possible genetic link. Therefore, individuals with family members who have, or have had CTS may be at a slightly increased risk of developing the condition. Approximately 25 percent of sufferers report a parent, brother, sister or other close relative with Carpal Tunnel Syndrome.

Certain activities

Some activities may prompt CTS to develop. Typically those activities requiring repetitive movement, strenuous grip or exposure to prolonged vibration can trigger symptoms of CTS.

Depending upon the severity of the Carpal Tunnel Syndrome, as well as the length of time an individual is affected by it, it may be necessary to wear a wrist support. This can help to reduce pain and to maintain some function. Wearing a splint at night can keep the wrist straight, prevent additional pressure and relieve some of the symptoms.

Gaining a diagnosis for this can be as simple as seeing your GP. However, if they are unsure of the problem, there are other tests that they can use to determine the exact cause of the symptoms.

If you visit your GP with symptoms of carpal tunnel syndrome, there are a number of quick tests that they can perform to assess if this is the problem. They will look at your wrists and hands and discuss your symptoms. This will include the movement and strength you have in your hands, arms and wrists. They will make a note of any indications of weakness, especially concerning the muscles around your thumb. If they make a positive diagnosis, they might suggest some exercises to reduce the pain or advise you to wear a type of wrist support, particularly at night.

Diagnosing CTS

There are a number of ways in which CTS can be diagnosed but typically this can be done by your GP. He may conduct a number of physical tests as well as asking about the symptoms you are experiencing and how this might be affecting your mobility.

Physical Assessment

A GP's physical assessment will check for any tingling sensations or numbness around your fingers by tapping gently on your wrist. They might also ask you to perform certain movements and positions for one minute to see if this causes you any pain, tingling or numbness. This can involve keeping your wrist held over your head or moving your wrist around. If these tests prove to be positive, then a diagnosis of carpal tunnel syndrome can be easily made.

Other Tests

Generally, a physical examination by your GP is enough to diagnose carpal tunnel syndrome. However, there are other tests that can be used if your GP is not completely sure of the cause of your problems. These can be used to indicate or eliminate other conditions.

Blood Tests

By testing your blood, other conditions that are related to carpal tunnel syndrome can be diagnosed. These include rheumatoid arthritis, diabetes and an underactive thyroid.

Nerve Conduction Test

This test is used to show how quickly signals pass through the nerves. During the test, electrodes are attached to the wrist and hand and the nerves are stimulated by passing a current through them. This can indicate any damage that has occurred to the nerves.


An electromyography (EMG) can also be carried out to show up damage to the nerves. In this test, thin needles are put into the muscles and these will then show any electrical activity that occurs naturally in them. This type of test is not used very often in the UK, as a nerve conduction test is usually sufficient for a diagnosis.

Imaging Tests

If there is the possibility of fractures in the wrist or the presence of a condition such as rheumatoid arthritis, your GP might ask for an X-ray. They might also use an ultrasound scan to check the median nerve. Both of these produce images of what is inside your body. They can be used along with the other tests and examinations to determine if you have carpal tunnel syndrome. Following a diagnosis, you might need to wear a wrist support or do certain exercises and movements to help alleviate the symptoms.

What treatment options exist?

The treatment options available to you will be largely determined by the severity of the condition. Non-invasive treatments may be offered for mild to moderate symptoms in the form of a wrist support though at the same time medication or corticosteroid injections may also be offered. For serious cases of CTS then surgery may be offered to relieve pressure on the median nerve.

Mild to moderate symptoms

All but the most severe cases of carpal tunnel syndrome benefit from the use of a suitable wrist support. Choose a well-made wrist support that is comfortable enough to be worn through the night as this will help to keep the wrist still enough to avoid aggravating the median nerve and triggering pain. An improvement in the condition can often be felt within four weeks of using wrist support.

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are not particularly helpful in managing the pain of carpal tunnel syndrome and are usually rejected in favour of corticosteroid treatment. This can be given in tablet form but is more frequently delivered to the site of the problem through an injection. Sometimes further injections may be necessary to get the condition under control.

Severe carpal tunnel syndrome (CTS)

CTS is considered to be severe when symptoms have lasted for longer than six months and / or when other treatments have failed to make an impact on the disorder. Sometimes known as ‘decompression’ or ‘release’ surgery, this is undertaken under local anaesthetic and does not usually require a stay in hospital.

Surgery is undertaken either through the traditional form of open cut or occasionally as keyhole surgery accessed through the wrist and palm. Because it is less invasive with minimal scarring, keyhole surgery usually results in a quicker recovery time, but the long term prognosis for both types of surgery is the same.

After surgery the hand is bandaged and usually kept in a raised position in a sling for the first couple of days as this helps to relieve post-operative stiffness and swelling. You will be provided with exercises to aid healing which should be commenced after the operation or as advised by your medical practitioner.

All surgery carries a degree of risk and in the case of CTS surgery there are a number of potential complications which should be given due consideration before undergoing the operation to release the median nerve. These include failure to release the nerve successfully, possible nerve injury, post-operative bleeding and scarring.

An NHS survey into 6,000 patients who underwent CTS surgery indicated that 75% of respondents believed their symptoms had improved, with over half of the people in the study reporting that the operation had completely resolved the problem.

In many cases of carpal tunnel syndrome there will be no need for surgery, and many patients find that they can successfully bring the annoying and painful symptoms under control with the use of gentle exercise and appropriate wrist support.

Surgery can be an extremely effective way of treating CTS but it is important to manage your recovery well to ensure that it is as quick and effective as possible.

This rehabilitation after a carpal tunnel syndrome operation can include doing exercises to improve movement, reduce stiffness and regain strength, and wearing a wrist support to protect the area from further damage and aid recovery.

Tips for recovery

You can start doing small exercises on the day of your surgery simply by bending and extending your fingers regularly and moving your shoulders and elbow, although it is advisable to keep your arm elevated for the first 48-hours after your operation. This will help reduce swelling and is particularly important at night.

A wrist support can ease pain and discomfort during your recovery and will help you carry out day-to-day tasks by offering added strength and protection. It is still not advisable to lift heavy objects, however, until your hand has healed completely. You will have to wear a dressing after your operation for at least a couple of days and you should also avoid getting this wet.

Recovery times

How long it will take you to fully recover after carpal tunnel surgery will largely depend on the type of operation you have had. You may recover slightly quicker from keyhole surgery, for example, than you will from open release surgery. Both methods have been proven to be just as effective for treating carpal tunnel syndrome, but there can be several weeks' difference in recovery times.

It will probably take around six weeks for your hand to heal after open release surgery. When you can return to work will depend on your own recovery and the type of work you do. If your job involves a lot of repetitive movements with your affected hand, you may need to have the whole six weeks off. If your work does not put too much pressure on your injured hand, however, you may be able to return in as little as a fortnight. A wrist brace or support may be useful in these circumstances to prevent against accidental stresses and to help your hand heal as quickly as possible.

If you had keyhole surgery on the hand that is not your dominant one and you do not do a job that requires repetitive movements, you may be able to get back to work after just a day. Conversely, if you have to do repeated movements with your affected hand, you may have to stay away from your job for around four weeks.


If you do not want a recurrence of the syndrome in either your affected hand or in the other one, you may want to consider wearing a wrist brace or support. This is particularly important if you do a job involving repetitive activities.

If you do suffer from carpal tunnel syndrome symptoms, wearing a wrist support or splint can reduce the effects by stopping the wrist from bending and putting pressure on your median nerve. This treatment can see benefits within just four weeks.

You may also wish to consider lifestyle changes to help alleviate the issues seen with CTS, whether this is in eating healthy, looking at exercises like yoga which work on stretching and strengthening or if it is a workplace related source, simply speak with your line manager.

The BUPA website has a number of FAQs in relation to suffering from carpal tunnel syndrome. To view them click here.

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