What is Hand Pain?

Pain in the hand is a very common problem, with causes ranging from trapped nerves, to wear and tear and osteoarthritis. One of the most common forms of hand pain is Carpal Tunnel Syndrome (CTS). About one in 1,000 people develop this syndrome each year.

What is Carpal Tunnel Syndrome (CTS)?

The carpal tunnel is a canal formed between the small bones of the wrist called carpal bones and a ligament that lies across the front of the wrist. A large nerve, called the median, along with the tendons that attach the forearm muscles to the fingers, pass through this canal.

In Carpal Tunnel Syndrome the nerve becomes compressed within the canal. In most cases it is not clear why it occurs, although increase in pressure is thought to compress and restrict the blood supply to the median nerve.

What are the symptoms of CTS?

  • Pins and needles. This is tingling or burning in the parts of the hand supplied by the median nerve. This is typically the first symptom to develop. The index and middle fingers are usually first to be affected.
  • Dryness of the skin may develop in the same fingers.
  • Morning Symptoms: People often find the symptoms worse in the morning or wake them during the night
  • Pain in the same fingers may then develop. The pain may travel up the forearm. Numbness of the same finger(s), or in part of the palm, may develop if the condition becomes worse.
  • Weakness of some muscles in the fingers and/or thumb occurs in severe cases. This may cause poor grip and eventually lead to withering of muscles at the base of the thumb.

What causes CTS?

In most cases it is not clear why it occurs. Increase in pressure is thought to compress and restrict the blood supply to the median nerve. CTS is more common in manual workers, especially with jobs using a lot of wrist movement such as scrubbing or wringing. So, overuse of the hand may be a factor in some cases to trigger the changes in the structures in the carpal tunnel, leading to this condition developing.

How is it diagnosed?

In many cases the symptoms are classical and so the diagnosis can be made with the need for special tests. A scoring questionnaire has been developed which is very sensitive at picking up cases. This on the website and also attached at the end of this leaflet. If the diagnosis is not clear then a test to measure nerve impulses (nerve conduction test) can be performed.

How can my CTS be treated?

  • General measures

If there has been a specific trigger such as a work related or sporting activity then modification of this activity can help settle symptoms. Avoiding over-use of your wrist by excessive squeezing, gripping, wringing, etc. is important. Losing weight may be helpful if you are overweight. Simple painkillers may be used to ease the pain e.g. paracetamol or co-codamol. There is no evidence that antiinflammatories such as ibuprofen are of any benefit. If the condition is part of a more general medical condition (such as arthritis) you’re your GP can advise which medicines may be best.

  • Not treating may be an option

In up to 1 in 4 cases the symptoms go without treatment within a year or so. (In about 2 in 3 cases that develop during pregnancy the symptoms go after the baby is born.) This may be suitable if the symptoms are only mild.

  • Wrist splints

aimed at keeping the wrist in a neutral position are the usual first step in treatment. Worn for 2-3 months (usually overnight) many patients get a good improvement or full resolution of symptoms if used for a few weeks.

  • Steroid injections

Injection of cortisone (steroid) into the carpal tunnel around the nerve can be beneficial in some patients.

  • Surgery

A small operation can cut the ligament over the front of the wrist and ease the pressure in the carpal tunnel. This usually cures the problem. It is usually done under local anaesthetic. You will not be able to use your hand for work for a few weeks after the operation. A small scar on the front of the wrist will remain. There is a small risk of complications from surgery. For example, following surgery there is a small risk of infection and damage to the nerve or blood vessels

What should I avoid?

  • Avoid over-use of your wrist by excessive squeezing, gripping or wringing.
  • If Carpal Tunnel Syndrome was caused by a work-related or sporting activity then reducing or modifying these can help settle symptoms. Losing weight may also be helpful if you are overweight.
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