What is carpal tunnel syndrome?
It may sound like something you'd hear about on the traffic news, but the carpal tunnel is something you need to know about if you have pain or tingling in your hand. Read on!
What's the carpal tunnel?
On the back of your wrist are your wrist bones. Across the front is a tough, inflexible band of tissue called a ligament. In the 'tunnel' between them pass the attachments between the muscles in your forearms and your hand, and a nerve called the median nerve.
Your median nerve controls some of your thumb movements and the sensation of two thirds of your palm and fingers on the thumb side. If this nerve gets squashed in the narrow tunnel, both sensation and muscle strength of these parts of your hand can be affected.
What are the symptoms?
The symptoms of carpal tunnel syndrome occur in the parts of the hand supplied by the median nerve. They tend to come and go at first, often being worse when you've used your hand or at night. They include:
- Pins and needles (often over the index and middle fingers first and sometimes relieved by shaking your arm)
- Pain, which may be worse at night and relieved by dropping your arm down to the floor
- Numbness over your fingers or palm
- In more severe cases, weakness of some thumb movements.
Who gets carpal tunnel syndrome?
The most common time to get carpal tunnel syndrome is in your 40s or 50s, and women are two to three times more likely than men to suffer. People who use their wrists a lot (for scrubbing, etc) get it more commonly, which is why it can be mistaken for repetitive strain injury. It can run in families. If you're pregnant, overweight, have arthritis, diabetes or thyroid problems, you may also be more prone.
If you do get symptoms when you're pregnant, don't despair. You tend to retain fluid when you're pregnant, so the nerve is more likely to get squashed. That's why many women develop carpal tunnel syndrome in pregnancy, but get better after the baby is born. Being overweight before you get pregnant, or putting on a lot of weight during pregnancy, can increase the risk of carpal tunnel syndrome as well as other complications of pregnancy . Doctors often recommend a splint rather than surgery in the first instance (see below) since your symptoms may settle on their own once you've had your baby.
What can I do?
Firstly, could you rest your wrist? In mild cases, simply reducing the amount of work your wrist does can relieve symptoms. Actions like gripping and wringing should be particularly avoided - could this be an excuse to pass the washing and cleaning on to someone else in the family?
If you're overweight, losing weight may relieve the pressure inside the carpal tunnel. Some medicines and medical conditions cause fluid retention which can bring on symptoms, so do talk to your GP.
What are the treatments?
In about one in four people, symptoms settle within a few months on their own. If they don't or if you have persistent or more severe symptoms like muscle weakness, your doctor may recommend surgery. It's a minor operation, usually done under local anaesthetic, which involves cutting the ligament at the front of your wrist, and success rates are very high.
Other treatment options include:
- A wrist splint. In one study, a third of people didn't need more treatment than this. You may find a splint gets in the way of your everyday activities, but wearing it just at night may be enough to control your symptoms
- Steroid injection into the wrist. This relieves symptoms in the short term in up to three out of four people and in the long term in at about half of people.
All-a-tingle - what's amiss?
Your nervous system is a wonder of human engineering, controlling movement and sensation from the 'command centre' in your brain via a vast network of nerves. Pressure at any point along these nerves can either stop them working properly (causing weakness, numbness, etc) or stimulate them at the wrong time (causing pins and needles and stabbing nerve pain).
Pins and needles in a small patch of skin are most commonly due to pressure on a nerve nearby. If local symptoms persist, or if you get more widespread pins and needles, you should always check with your doctor. Causes include:
- Hyperventilation (over-breathing) caused by anxiety. This commonly causes pins and needles in the hands and feet and sometimes around your mouth.
- A problem with your spine, where the nerves attach to your spinal cord. Back pain is very common and often settles on its own, but pins and needles or numbness affecting your legs, and particularly around your bottom, can be a sign of a prolapsed disc. If you get numbness around your bottom or nether regions you should see a doctor urgently.
- Nerve damage due to conditions like diabetes or vitamin deficiencies.
With thanks to 'My Weekly' magazine where this article was originally published.