The typical first symptoms of carpal tunnel syndrome will be tingling or pins and needles
extending down into the hand. It's often first an issue at nights and may wake the person
up with numbness and tingling or could occur when they're driving. Driving along, the hand
and will go numb and they have to take their hand off the wheel to shake it to get the
life back into it or can occur when someone's just sitting still. For example, sitting reading
the paper, and typically the little finger is least affected.
When a patient comes to see me, I ask them the history and they often will recount symptoms
of tingling and pins and needles in their hand. To examine them, the first thing is
I look at the hand. If it's a severe case, then they may have wasting of the muscles
in the pad of the palm at the base of the thumb I look for any evidence of an old injury
to the wrist that it might look misshapen which could increase the likelihood of carpal
tunnel. I then assess the feeling of their skin. This will start with just brushing the
skin to see if they feel that that's normal compared with what they'd expect and then
more specifically to measure whether there's a loss of sensation, you can do a test called
a two-point discrimination.
When I'm examining somebody with carpal tunnel, there's special tests that we do as part of
the examination. The first one is called Tinel's test where the examining surgeon will tap
on the front of the wrist and if somebody has carpal tunnel, then they may well experience
a tingling sensation going down in the fingers or going up the arm or even that if it's unpleasant
and electric shock type sensation. Two other provocative tests we do called Tinel's test
where the wrist is bent forwards and held in this position for up to a minute and this
may bring on the sensation of numbness and pins and needles in the fingers or Reverse
Phalen's tests where the wrists are bent backwards. The tests that I find probably most sensitive
would be a combination of Phalen's tests and something called Durkan's tests where I'd
bend the wrist forward and then apply pressure to the front of the carpal tunnel and if that
brings on the symptoms in the fingers, then that to me is quite suggestive of carpal tunnel
syndrome. For some patients if from the history and examining them, there's doubt as to whether
the diagnosis is carpal tunnel syndrome or not, then they can be referred for what's
called a nerve conduction test; which is an electrical test where a neurophysiologist
records the conduction of electricity across the carpal tunnel and then can work out whether
there is slowing of the conduction consistent with the diagnosis of carpal tunnel syndrome.
If somebody is concerned that they might have carpal tunnel syndrome, the most important
thing is to make a mental note of when they get the symptoms and also what they can do
to relieve it. So if for example they've been woken up in night with numbness and tingling
in the hand, then often shaking it around or hanging it over the sides of the bed and
that relieving the symptoms would be suggestive of carpal tunnel. One of the treatments that
is always worth trying is to wear a splint on the front of the wrist that stops the wrist
moving, and if someone is concerned, they might have carpal tunnel syndrome, then obtaining
one of these splints and wearing it at night. If that then gives them a better night's sleep,
then that might suggest that the diagnosis is carpal tunnel syndrome.
The condition can result spontaneously. So I think when someone first presents with symptoms,
it's not unreasonable to give it a bit of time to see if it settles down. If the splint
controls the symptoms, then this is a perfectly good way to manage the symptoms and if for
example the lady who's pregnant has developed carpal tunnel syndrome during her pregnancy,
then managing the symptoms with a splint is often all that's required so that once she's
had her baby, in the majority of cases, the symptoms will then settle. Another treatment
that can be offered is a cortisone injection into the carpal tunnel and this will often
relieve the symptoms, but in many cases, this will just be temporary relief. But how long
they get the benefit for is quite unpredictable and variable. If somebody has persisting symptoms,
they've tried these more conservative measures and they're still very troubled by them, then
at that point surgery may well become appropriate. The other group of patients where we would
recommend surgery is if the severity is such that they've actually got permanent numbness
of the fingertips or if the muscle in the hand is getting weak or wasting away, and
in that situation then a surgical release of the nerve is the only treatment which is
likely to reverse the changes.