Carpal Tunnel Syndrome - Patient Information Trial

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What is carpal tunnel syndrome?

Carpal tunnel syndrome (CTS) is condition caused by pressing (compression) of one of the nerves in your wrist — the median nerve — where it passes through your wrist in the carpal tunnel. Symptoms such as pain, tingling, numbness, weakness and clumsiness in your hand are most common.

What causes carpal tunnel syndrome?

CTS happens when a nerve is pressed at the wrist, in an area called the carpal tunnel. This is on the palm side of your hand, next to your wrist joint. Pressure on this nerve can cause you to feel pain or other ‘funny feelings’ in the skin of your hand, or make your hand weak and clumsy. This pressure can happen for different reasons including diseases of the joint like arthritis, wrist damage, being overweight, being pregnant, and too much water in your body.

The carpal tunnel is formed by an row of small bones of your hand (called the carpal bones) and a ligament (called the flexor retinaculum) which makes a roof over this row, creating a tunnel. A nerve (called the median nerve) and a number of tendons for hand movements run through this tunnel.

The median nerve controls the some of the muscles which move your thumb, and provides sensation to your thumb, index, middle and half the ring finger. This means that when it is compressed the symptoms you get relate to this — predominantly pain and altered sensation in the area supplied by the median nerve. Compression can also lead to weakness of the muscles that move your thumb, and they may become atrophied (reduce in size).

What are the treatment options?

Simple treatments/Watch and wait:

  • No treatment is needed for some people as the problems can get better on their own, although we recommend reducing activities that make your symptoms worse

  • In others wrist splints (a support for the wrist) can help. A wrist splint worn at night may improve symptoms by keeping the wrist at an angle that reduces the compression. This tends to be most successful in those who have not had symptoms for long, or those whose symptoms come and go

  • If your carpal tunnel syndrome is part of another medical condition, the symptoms may get better when the other condition changes. For example, if you are pregnant the symptoms will often get better once the baby is born, and if you are overweight then losing weight can also help

Medicines:

  • Medicines (painkillers, injections) can reduce pain in some people where problems are not too bad

  • Steroid injections can also be very effective in those with moderate symptoms, improving symptoms for about 3 in 4 patients

Surgery:

  • Operations may be needed when your problems are bad or not getting better with other treatment

  • An operation, normally under local anaesthetic, can be used to treat those where other options have failed or when symptoms are severe. This can either be an open or a keyhole operation, where the ligament over the carpal tunnel is cut to release the pressure and give more space.

When do I need to see a specialist?

You will normally see a specialist if your GP thinks your problems are caused by CTS and simple treatments are not working (e.g. reducing actions that make your pain worse).

What happens when I see a specialist?

When you see a specialist, they will ask you to tell them what your problems are with your hands and wrists, how long you have had the problems, and how this affects your life and work. After this they will examine your hands (look at them, watch you move them, and do some simple tests) and then can talk to you about how best to treat the problem.

The examination will assess the nerve and its functioning. They will then discuss the different treatment options with you according to how severe your symptoms are.

Sometimes more information is needed to make a diagnosis or decide on the best treatment. The specialist may arrange for extra tests (such as nerve conduction studies) or ask another specialist to see you (such as a spine surgeon) for their opinion.

How long will it be before I am better?

This will depend on how bad your problems are – about 3 in 4 people get better in 6 months without surgery, and most people who do have surgery can do their normal work 3 weeks after the operation. Normally this is not a problem that will affect you for life.

If your symptoms are mild (especially if they are only on one side, you have not had them for long, or you are under 30 years old) then typically symptoms will resolve within 6 months. This happens in around a quarter of patients. Steroid injections can give permanent relief, and tend to be effective within a month, but approximately three quarters of patients will still require surgery within a year. Surgery will usually give permanent improvement, although there can be adverse effects including pain and weakness following the surgery, and the complications posed by any operation. However, typically patients are able to return to modified work within 2 weeks, and to normal duties within 3 weeks. Long term it is uncommon for CTS to be recurrent or persistent.

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