Carpal Tunnel Syndrome is very common, affecting around 6% of western populations.
As a Consultant in Clinical Neurophysiology, I have seen thousands of patients with this
condition.
I’m going to explain to you what it is, the evidence based treatments that can cure
it and some of the misinformation to avoid.
First up – it’s really about a nerve in the wrist called the Median Nerve.
At this level, it provides sensation to these 3 and a half fingers and power to just a couple
of muscles in the hand.
Because it passes through the wrist at the carpal tunnel, the syndrome has been given
its name.
The tunnel is formed by the 8 carpal bones and a hood called the transverse carpal ligament,
also known as the flexor retinaculum.
Inside this space the nerve is surrounded by 8 flexor tendons which pull your fingers
in towards the palm.
As it’s a tight and crowded space, the nerve, which is delicate, can be squashed against
the surrounding tendons.
This can happen for a number of reasons.
By far the commonest cause, is the accumulation of minor trauma leading to thickening of these
tendons, usually as a result of overuse.
It is not caused by muscle imbalances in the forearm as some might have you believe.
The overall shape of the canal can also be a factor.
Patients with particularly narrow canals are more at risk of this and so there can be genetic,
as well as social factors when it runs in the family.
Distortion of the canal following fractures can be an acute cause.
Many women develop carpal tunnel syndrome during pregnancy.
This is due to fluid building up in the canal, as a result of the hormonal changes of pregnancy.
Fortunately, for most women, this fluid dissipates afterwards and so it self resolves.
Nerve fragility is also an important cause especially in Diabetic Patients.
You can see more information about the mechanisms underlying this by following the i-card above.
There are some much rarer causes too where extra materials can deposit in this space
such as in Amyloidosis and Hunter’s Syndromes.
Whilst there are many ways to diagnose this condition, it is a clinical diagnosis reached
by your treating health care provider.
A variety of supportive tests can be used which can include nerve conduction tests.
For the record, in the hands of an expert, they are very quick and are not as painful
as some would have you believe.
You can see a demo of how fast and painless these are, as well as some of the theory behind
it by following the i-cards above.
Let’s talk about treatment, and let me firstly save you time and money.
Of the thousands of patients I have seen, I have never seen a case caused by vitamin
or health supplement deficiency.
There are some people out there trying to make money from your discomfort and will try
and sell you these, as supposed cures.
I’m sorry to say that there are absolutely no 24 hour cures.
Not even surgery which is a definitive treatment can achieve this as actual nerve recovery
takes months.
Pain itself can be rapidly relieved by surgery in this time frame as the ischaemic effects
of compression on the nerve is relieved.
For mild through to moderate compression there are 3 evidence based effective conservative
treatments.
Wrist splints, Physiotherapy and Steroid Injections.
The actual choice is down to you and your healthcare provider and sometimes these can
be used in combination.
The one thing I would like to say is that if these are not effective after 6 weeks,
please go back for reassessment as the choice of treatment should be reviewed as per the
Royal College of Surgeons Guidance – link in the box below.
They also provide some great information which can help stratify severity.
Whilst surgery can be performed at any stage, it tends to reserved for moderate and more
severe cases.
It is very simple surgery with excellent success rates, which is usually done with a local
anaesthetic and takes around 10 minutes.
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