Carpal Tunnel Syndrome

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome (CTS) is pressure on a nerve in your wrist. It can cause tingling, numbness and pain in the patient’s hand and fingers. It can often be treated through self-care but it can take a few months to get better.

The symptoms of carpal tunnel syndrome include:

  • An ache or pain in your fingers, hand or arm
  • Numb hands
  • Tingling or pins and needles
  • A weak thumb or difficulty gripping.

These symptoms often start slowly and come and go. They are usually worse at night or when driving or holding a book, newspaper, or telephone. As the condition worsens, the altered feeling may become continuous, with numbness in the fingers and thumb together with weakness and wasting of the muscles at the base of the thumb.

Sufferers often describe a feeling of clumsiness and drop objects easily and may also suffer from associated pain in the wrist and forearm.

It has been found to be three times more common in women than in men and commonly affects women in middle age but can occur at any age in either sex. It can also be common in pregnancy and in patients with diabetes, thyroid problems and rheumatoid arthritis.

The main aim of treatments is to prevent the condition getting any worse. Non-surgical (conservative) treatments include changing your lifestyle, the use of splints (especially at night), and injection into the carpal tunnel or a combination of these.

Surgery involves opening the roof of the tunnel to reduce the pressure on the nerve. The surgery may be performed under local anaesthesia (injection in the area around the nerve to ensure the patient does not feel pain), regional anaesthesia (injected at the shoulder to numb the entire arm) or general anaesthesia (where the patient is unconscious during the procedure).

The type of anesthesia used for a surgical procedure is determined by several factors including type and length of the surgery, the patient’s health or age and the preference of the patient and clinician.

Patient eligibility criteria

Surgical treatment for carpal tunnel syndrome can be undertaken where the patient meets the following criteria:

  • Symptoms persisting longer than three months, despite trying conservative treatments (by injection and/or wrist splint)

AND EITHER:

  • The patient has had positive nerve conduction studies (NCS). NCS measures how fast an electrical impulse moves through your nerves and shows if the patient has nerve damage

OR

  • Positive clinical symptoms which have been reviewed by a hand surgeon and demonstrate the patient has carpal tunnel

OR the patient may proceed straight to decompression surgery as required

  • If the patient has constant loss of feeling in their hand or muscle wasting around the thumb, then the patient should be urgently reviewed by a hand surgeon.

The NHS website defines nerve condition studies as: a nerve conduction test (NCS) – where small metal wires called electrodes are placed on your skin which release tiny electric shocks that stimulate your nerves; the speed and strength of the nerve signal is measured.

Advice and further guidance

There are a number of things that you can do to yourself to help treat carpal tunnel syndrome. These include:

Wearing a wrist splint

A wrist splint is something the patient wears on their hand to keep their wrist straight. It helps to relieve pressure on the nerve. It can often take at least four weeks of wearing a splint before the patient may start to feel better.

Lifestyle changes

It may help if the patient stops or reduces movements that cause frequent bending of the wrist or actions that involve gripping hard, such as using vibrating tools for work or playing an instrument.

Painkillers

Painkillers like paracetamol or ibuprofen may offer short-term relief from carpal tunnel pain.

For more information visit www.nhs.uk and search for ‘Carpal Tunnel’.

Treatment policy for patients covered by NHS Birmingham and Solihull CCG