Carpal tunnel syndrome

Carpal tunnel syndrome is a common condition that affects the median nerve as it passes through a narrow tunnel in the wrist.

The carpal tunnel is formed by the bones of your wrist, called carpals, and a thick ligament. Inside it run the tendons that bend your fingers and thumb, along with the median nerve.

Sometimes the nerve gets squashed. When that happens you may feel pain, numbness, burning or tingling in your thumb, index and middle fingers and part of the ring finger.

Symptoms are often worse at night or first thing in the morning. They can also become a problem when you hold something like a phone, a book or a steering wheel, because your wrist is bent forwards and your fingers are curled into a fist position.

The result can be a feeling of weakness and clumsiness in the hand, with reduced sensation and reduced grip strength.

Carpal tunnel syndrome can appear for no clear reason. Still, your risk goes up if you have any of the following:

• a job that involves repetitive activity involving your hand
• diabetes (Type 1 and 2)
• inflammation of the tendons
• fracture at the wrist
• rheumatoid arthritis in your wrist joint
• pregnancy
• menopause
• thyroid problems

Doctors diagnose carpal tunnel syndrome mainly by examining your wrist and hand. The symptoms look a lot like those of other conditions, so the doctor may also check other parts of your body, especially your neck.

Nerve conduction studies can be done too, but you don't need them to confirm the diagnosis.

Sometimes blood tests are taken as well, to find out whether another condition is adding to the problem.

If you have a wrist problem like carpal tunnel syndrome, it's important to stay active and keep your pain under control.

Try to vary what you do during the day, so you aren't squeezing, gripping or wringing again and again. Swap between heavier and lighter tasks to reduce strain. You can also look for another way of doing a task that puts less strain on the wrist, or take more rest between such activities.

Padded handles can help if you cycle, garden or play golf.

Be aware of how you hold your wrist. Try not to keep it bent in either direction for a long time.

For carpal tunnel syndrome, a doctor will often advise a wrist splint as the first treatment. The splint keeps your wrist straight at night. It shouldn't stop you from moving your wrist freely during the day.

You wear it at night so that you can't bend your wrist while you sleep, because that position can squash the median nerve.

Sometimes you may need the splint in the daytime too, when you're doing repetitive activities. But it's not advised to wear it all the time. You may only need it for a few weeks to settle the symptoms.

If you have carpal tunnel syndrome, targeted wrist exercises can help. They encourage movement, stretching and strengthening, and they can improve your wrist and hand movement and your pain.

Read about exercises for wrist, hand and finger problems.

Pain medicine can help you move more comfortably, and that in turn can help ease the symptoms of carpal tunnel syndrome.

More about taking painkillers

If painkillers aren't controlling the pain from carpal tunnel syndrome, your doctor may talk to you about a corticosteroid injection into the carpal tunnel. Corticosteroids are medicines that help reduce pain and inflammation, and they may be given together with a local anaesthetic.

An injection may not cure the condition. It's used to help with the pain.

Surgery for carpal tunnel syndrome may be an option if you've already tried every other treatment. The operation is called a carpal tunnel decompression. The surgeon opens the roof of the carpal tunnel, which takes the pressure off the nerve.

Sometimes carpal tunnel syndrome means you need to take some time off work so you can recover. How long you stay off depends on your condition and on what your job involves.

You don't have to be free of symptoms before you think about going back. Carrying on with work, or returning as soon as you can manage it, will help your recovery.

Getting back to your normal daily activities bit by bit can also build up your strength and stamina.