Get a grip - Carpal Tunnel Syndrome

Some of the medical terms for problems can be so difficult to get into your head. Carpal tunnel syndrome is one of those. I have a friend who suffers from this - pins and needles and then pain in her index and middle fingers - and when I see her I can only ask how her wrist problem is; the name carpal tunnel just won’t stay in my memory.

But a great number of people need to get their tongues around this problem because carpal tunnel syndrome is surprisingly common; around one in 1000 people develop it every year, especially in women over 50.

The symptoms can be very mild and can come and go but for some the symptoms become so severe that treatment is required.

The problem is basically caused by pressure on a nerve in the wrist. The carpal are wrist bones and there are eight small carpal bones in the wrist. A ligament (called retinaculum) lies across the front of the wrist and between this ligament and the carpal bones is a little space called the carpal tunnel. This tunnel houses the tendons that pass from the forearm muscles to the fingers and a main nerve to the hand (the median nerve) also goes through this tunnel before then splitting into smaller nerves across the palm.

The median nerve gives the sense of feeling we have in our thumb, index and middle fingers and also half of the ring finger and it also influences movement at the base of the thumb.

It is thought a variety of conditions can lead to carpal tunnel syndrome. Inflammation in the tendon going through the carpal tunnel can cause swelling and therefore increase pressure on the nearby median nerve; arthritic conditions of the wrist such as rheumatoid arthritis can lead to carpal tunnel syndrome; oedema (water retention) and even genetic factors are all thought to be associated in some instances with the problem.

Whatever the cause, the results can be very painful and can lead to real problems in the normal functioning of the hand and fingers. In severe cases it can become impossible to make a proper grip and the pain can travel up the forearm. Symptoms can come and go and are often worse at night.

Because the condition is surprisingly common, doctors recognise it quickly. Painkillers can be used to ease the pain and other treatments include a wrist splint to keep the wrist still and stop any pressure on the nerve. Sometimes this can be worn just at night to rest the nerve but allow normal activities during the day. In many cases, a wrist splint can be very effective.

Other treatments can include steroids to reduce any inflammation in the area, although this can have limited success as the symptoms often return after a few months. Surgery is an option, when the ligament over the front of the wrist is cut to ease the pressure in the carpal tunnel, and this generally has good results.