Carpal Tunnel Syndrome

The classic Carpal Tunnel Syndrome (lets call it CTS!) is when you get pins and needles in the thumb, index and middle fingers particularly at night and you end up waggling your hand over the side of the bed to make it go away. Sound familiar?

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My symptoms aren’t really like that – more pain really – but my GP says its CTS. Is it?

CTS can present it quite a wide variety of ways and pain can be a bigger issue than parasthesia (pins and needles). It can be located more in the wrist than the hand and it can radiate up the forearm. These are what we call ‘atypical CTS’ but it is still the same condition.

What causes it then?

What is happening is that the Median Nerve – the nerve supplying sensation to the thumb side half of the hand and fingers – is being squeezed in the ‘carpal tunnel’. That is a tunnel in the wrist made up of bone on the floor and walls and a thick band (retinaculum) of tissue making up the roof. Either the nerve gets too big (fluid retention, diabetes, obesity, hypothyroidism and heavy manual work or vibrating tools) or the tunnel gets too small (arthritis) but either way it is squeezed and that causes the symptoms of pain and parasthesia.

I have got some muscle wasting as well – is that bad?

Its certainly not good and really you should have had something done about it way before the muscles started wasting. The Median Nerve doesn’t just carry sensation from the hand to the brain but also sends signals from the brain to the hand muscles. The sensation bit is affected first and if the muscle is affected then the damage is quite severe and may not recover even after surgery.

 

Wasting of the Thenar Eminence

Wasting of the Thenar Eminence

 

I was sent to a Rheumatologist who gave me a steroid injection and night splints and that seems to have done the trick.

Thats excellent news and hopefully the benefit will be long standing. The splints can be very effective because they stop you bending the wrist and it is that position that squeezes the nerve the most. They can be a bit of a pain though and if you get fed up wearing them and the symptoms come back then an operation might be needed.

 

NIght Splint

NIght Splint

 

How can you tell if I have CTS?

If it is a very straight forward presentation then I don’t need to do any special tests. I can usually bring on your symptoms simply by bending your wrist and squeezing it and within 10 – 15 seconds you will get the numbness you recognise.

If I’m not so sure because you have an atypical presentation, then I may send you off for Nerve Conduction Studies (NCS) which is a test done by a specialist doctor called a Neurophysiologist. This test looks at the speed of the nerve signals going down the nerve and can tell if it is being compressed and where.

Do I need an operation?

If the symptoms are worsening or permanent and especially if there is any muscle wasting then yes you do and you can read about the operation in the ‘Operations’ section.