Carpal Tunnel Syndrome

Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

Carpal tunnel syndrome is a condition that causes pain, numbness, and tingling in the thumb, index finger, middle finger and sometimes the ring finger (but not the little finger). It is caused by pressure on the median nerve, which runs through the carpal tunnel, a narrow tunnel in the palmar side of the central wrist. The median nerve provides sensation to the thumb, index finger, middle finger, and half of the ring finger. It also controls the muscles that move the thumb, for example the muscles used to make a tight ring between the thumb and little finger.

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Carpal Tunnel Syndrome Affected

Who is affected by carpal tunnel syndrome?

Carpal tunnel syndrome can affect people of all ages, but it is most common in adults over the age of 50. It is also more common in women than in men. People who are at increased risk of developing carpal tunnel syndrome include those who:

  • Participate in activities that involve repetitive hand movements, such as typing, using a computer mouse, using vibrating tools such as a pneumatic hammer, or playing musical instruments

  • Have diabetes

  • Are pregnant

  • Have a history of wrist injuries

  • Have certain medical conditions, such as rheumatoid arthritis or hypothyroidism

What are the main symptoms of carpal tunnel syndrome?


The main symptoms of carpal tunnel syndrome are:

Symptoms of Carpal Tunnel Syndrome
  • Pain, numbness, and tingling in the hand and fingers, especially the thumb, index finger, middle finger, and sometimes the ring finger
  • Weakness in the hand and fingers
  • Difficulty gripping objects
  • Dropping objects
  • Burning or aching pain in the hand and fingers that may wake you up at night, causing you to shake the hand to settle the symptoms

The symptoms of carpal tunnel syndrome may be worse at night or when the wrist is bent for long periods of time.

Carpal Tunnel Syndrome Diagnosed

How is carpal tunnel syndrome diagnosed?

Carpal tunnel syndrome is usually diagnosed based on a physical exam and the patient's medical history. The doctor will ask about the patient's symptoms and activities. The doctor will also examine the hand and wrist for pain, numbness, weakness and range of motion limitations. In extreme cases it may be possible to see wasting of the muscles around the thumb. Nerve conduction studies and electromyography (EMG) may be ordered to confirm the diagnosis. These tests measure the electrical activity of the median nerve and the muscles it controls. Under ultrasound assessment the doctor can clearly see the median nerve and using the ultrasound probe to apply pressure to the nerve, the clinician can try to reproduce the tingling and pain into the hand which provides further evidence of a Carpal Tunnel Syndrome diagnosis.

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How is carpal tunnel syndrome treated?


Treatment for carpal tunnel syndrome depends on the severity of the condition. Non-surgical treatments are often effective. Non-surgical treatments may include:

Carpal Tunnel Syndrome Treatment
  • Rest:

    Avoiding activities that aggravate the symptoms.
  • Splinting:

    Wearing a splint at night can help to keep the wrist straight and reduce pressure on the median nerve.
  • Over-the-counter pain relievers:

    Over-the-counter pain relievers, such as ibuprofen or naproxen, can help to relieve pain and inflammation.
  • Physiotherapy:

    Physiotherapy can help to improve range of motion and strengthen the muscles around the wrist and fingers.
  • Lifestyle modifications:

    Changing lifestyle habits, such as losing weight and avoiding smoking, can help to improve symptoms in some people.
  • Corticosteroid injections:

    Corticosteroid injections can be used to reduce inflammation and pain in the carpal tunnel.
Carpal Tunnel Syndrome Splinting Treatment

Corticosteroid injections can be a highly effective way of reducing inflammation and pain as a result of median nerve irritation with carpal tunnel syndrome. At The Joint Injection Clinic, corticosteroid injections are performed after a thorough consent process, whereby the risk and benefits of the procedure are discussed in detail with your doctor.  The experienced medical doctor will then place you in a seated position with the wrist palm up, resting on the couch.  The palm side of the wrist is cleaned using a cleaning solution to ensure that the procedure is performed under sterile conditions.  The median nerve injection is performed with a small dose of steroid, targeting the area surrounding the nerve (perineural tissue), being careful to avoid injecting into the nerve itself. 

The injection itself is normally completed within 30-60 seconds, after which a plaster is applied and post-injection advice is given.  The patient is advised to look out for any signs of infection, specifically to check whether the local area becomes red, hot, tender, swollen or if they develop a fever.  If this occurs then the patient is asked to contact the clinic immediately at which time a formal reassessment will occur and if needed oral antibiotics can be prescribed.  The patient is also warned that following any injection they may notice a short-term worsening or flare in their symptoms after the local anaesthetic has worn off (4-5 hours).  This may last for 3-5 days and the patient is advised to consider icing of the area using an ice pack for 10-15 minutes every hour as required.

If non-surgical treatments are not effective, surgery may be an option. Surgery for carpal tunnel syndrome is a minimally invasive procedure that involves cutting the ligament that forms the roof of the carpal tunnel and widening the tunnel to create more space for the nerve.

Additional tips for managing carpal tunnel syndrome pain:

  • Take frequent breaks from activities that involve repetitive hand movements.
  • Stretch your hands and wrists regularly.
  • Avoid sleeping on your wrists, using a splint at night as required.
  • Use ergonomic tools, such as a keyboard wrist rest and mouse pad, to reduce strain on the wrist.

If you are experiencing pain, numbness, or tingling in your hand and fingers, it is important to see a doctor to get a diagnosis and discuss treatment options. With early diagnosis and treatment, most people with carpal tunnel syndrome can manage their symptoms and maintain a good quality of life.