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Pain and numbness in the hands – Carpal Tunnel

Ongoing tingling sensations or numbness in your hands or arms could be a sign of carpal tunnel syndrome (CTS).

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Carpal tunnel syndrome (CTS) is caused by a combination of factors: the structure of your wrist, health issues and repetitive actions (like typing on a keyboard).

The carpal tunnel is a narrow passage that protects the median nerve and blood vessels that run from your wrist into your hand. Increased pressure in this area can cause CTS – a potentially painful and disruptive condition that can worsen over time.

Causes of Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is caused by increased pressure due to your wrist swelling (e.g., after an injury) or swelling in the nerves, blood vessels or tendons in the carpal tunnel. People who are pregnant or who have issues with fluid retention are also more likely to get CTS symptoms.

A pain in the neck

The median nerve can be compressed (or entrapped) anywhere along its length, leading to an increased risk of CTS.

What causes nerve compression?

Nerves need nutrients to stay healthy, and these are carried along the nerve by axoplasmic fluid. A certain amount of pressure is needed to keep this fluid moving, but any squashing of the nerve can disrupt this flow and cause CTS symptoms.

A key moment in CTS treatment is identifying the exact site of the nerve compression – otherwise any surgery may focus on the wrong part of your body and fail to provide any relief. It is essential to confirm the site of your nerve compression.

Nerve compression can be caused anywhere along the median nerve, including by injuries (especially to your lower back), scar tissue, tight muscles, hormonal imbalances, repetitive motions or excessive or long-term use of vibrating power tools.

Symptoms of Carpal Tunnel Syndrome

Typically, the symptoms are quite mild at first but tend to become worse over time if not addressed. The main symptom is tingling or numbness in your hand or fingers – it may even feel like a mild electric shock.

These feelings can move from your wrist up your arm. Over time, they could become constant and may interfere with your sleep. You’re most likely to notice them when holding or manipulating an object.

CTS can also result in weakness or a reduced ability to grip objects – if you find that you often drop things unintentionally, this could be a red flag.

Diagnosis of Carpal Tunnel Syndrome

As with many conditions, early diagnosis and treatment lead to the best outcomes. Ignoring potential CTS symptoms can lead to permanent nerve damage.

Diagnosing CTS involves reviewing your symptom history, and a physical examination. This will involve a thorough look at your lower neck and upper back joints, plus your neurodynamics or nerve tissue mobility.

X-rays are unlikely to help with diagnosing CTS, but a more specialist test known as electromyography can help to identify the condition by measuring the tiny electrical discharges produced by your muscles. Along with nerve conduction studies, this can be used to diagnose CTS and/or rule out other possible causes of your symptoms.

Treatment of Carpal Tunnel Syndrome

Mild CTS symptoms can often be eased through lifestyle changes or medication:

  • Take stretch/ wiggle breaks from repetitive tasks at regular intervals to improve blood flow.
  • Use wrist splints to relieve the pressure on your median nerve. This can be especially effective in the evenings before the onset of nocturnal symptoms, or during the day if you have to carry out repetitive tasks.
  • Take it easy – grip objects with less force, or use less force when typing.
  • Avoid flexing your wrists to hard
  • Keep your hands warm with fingerless gloves or hand warmers.
  • Do wrist stretches and exercises regularly.
  • Lift your hands and wrists above your head.
  • Elevate your hands and wrists whenever possible – This home remedy is particularly effective if your CTS is caused by pregnancy, fractures, or other issues with fluid retention.
  • Take anti-inflammatories for pain relief or to reduce inflammation around your median nerve.

If none of these techniques help, then you should consider consulting a Physiotherapist, especially for mild to moderate cases.

Physiotherapy treatment for CTS could involve any combination of the following:

  • Carpal bone mobilisation and stretching exercises to open the carpal tunnel.
  • Nerve and tendon gliding exercises
  • Muscle and soft tissue extension
  • Spinal correction exercises
  • Strengthening exercises focused on your grip, pinch, thumb and forearm
  • Arm, wrist and hand strengthening and endurance exercises.
  • Posture, fine motor and hand dexterity exercises.
  • Ultrasound, acupuncture or massage can also help

Other approaches to treatment

  • Ergonomic assessment of your workplace and daily activities to identify risk factors and avoid repetition
  • Prescription medication including corticosteroid injections
  • Surgery, but only a last resort and typically only if at last 6 months of conventional treatment has been unsuccessful in relieving or abating your symptoms

In cases of “double crush syndrome” – where the nerve is compressed in a different location – treatment of the whole median nerve path will be required.

What does surgery involve?

One or two small incisions are made in the affected area to cut the ligament, release the nerve and increase the space around it. The ligament will grow back, allowing more space for your nerve than previously. Surgery may not completely resolve severe CTS symptoms but can provide relief and prevent deterioration.

What is my prognosis if I have CTS?

Mild to moderate CTS can generally be relieved with physiotherapy and other treatments – especially in the early stages of CTS. In more serious cases, surgery is likely to be required.


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