Carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is a relatively common condition that can cause tingling, numbness, pain and weakness in your hand and fingers.

What is carpal tunnel syndrome?

The carpal tunnel is a narrow passageway that passes over the wrist joint. The tunnel is formed by the carpal bones and the flexor retinaculum (see diagram). The tunnel contains flexor tendons that bend your fingers and the median nerve. The median nerve supplies feeling to your thumb, index, middle and half of your ring finger and controls some muscles of your thumb (thenar muscles). Anything that reduces this space or increases pressure in the carpal tunnel can cause CTS.

Causes

In most cases, there is not an obvious cause. However, possible causes include trauma, pregnancy, any form of arthritis affecting the wrist and diabetes.

Symptoms

An ache or pain in your fingers, hand or arm.
Numb hands.
Tingling or pins and needles in your hand.
A weak thumb or difficulty gripping.

These symptoms usually start slowly and come and go. They are often worse at night.

Diagnosis

Diagnosis is usually clear after a thorough clinical assessment. You may have a special assessment called a nerve conduction test. This assessment will measure the speed of nerve impulses across the elbow and wrist.

What can I do to help my symptoms?

General adaptations

Avoid repetitive actions or activities that bring on the symptoms. If CTS is a result of an underlying health condition, treating the condition may help improve your symptoms.

Median Nerve Gliding Exercises

Complete 10 repetitions x 3 a day – if symptoms worsen with the exercise reduce the amount of wrist movement in the exercise.

Hand exercises

Complete x 5 sets of the below sequence 3-4 x day.

Splinting

Wearing a removable splint at night that keeps the wrist straight may relieve symptoms. This reduces the pressure over the carpal tunnel and rests the median nerve. If your symptoms increase with certain activities, you can wear the splint during this function to keep your wrist in a better position.

If symptoms aren’t settling:

Steroid Injection

A steroid injection into the carpal tunnel can be helpful as it reduces inflammation although the effect may wear off after several weeks or months.

Surgery

If you have severe symptoms or have not responded to any other treatments you may need referred to a hand surgeon for a surgical intervention. The surgical procedure involves dividing the flexor retinaculum that forms the roof of the carpal tunnel. This should relieve the pressure on your median nerve.

What about work?

Maintaining all normal activities including work improves your chance of recovery by keeping you moving. This helps you keep your ‘work fitness’ and prevents your hand and wrist getting weak, which can prolong your pain.

Remember: You do not have to be pain free to return to or remain at work.

It may be necessary to do temporary lighter or modified duties. This should be discussed with your line manager initially. If further clarification is needed your Occupational Health advisor can identify more specific role modifications.

What should I do if I am still experiencing problems?

If you are unable to agree on restricted roles with you manager or you are still having problems (despite following this advice): your Occupational Health team can help. The Occupational Health team can advise you on how to bridge the gap to help you return to normal activities. You can also gain access to the Occupational Health physiotherapy team by:

Self-referral

The Occupational Health Physiotherapy team can assist in the management of musculoskeletal problems that affect your ability to work. Staff are able to self-refer to physiotherapy via the trusts Occupational health internet page.

Management referral

If you feel your symptoms are having a significant effect on your ability to carry out your role, discuss this with your manager and request a referral to the Occupational Health Service.