What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is a condition where the nerves in the hand become compressed as it travels through the wrist. An estimated 195000 Australians will see the GP with carpal tunnel syndrome each year [1]. Women and those between 45-64 years of age are the most vulnerable population living with this condition. Carpal tunnel syndrome is the most common nerve compression injury around the world. Those diagnosed will face problems, such as numbness and weakness of the hand. If left untreated, these symptoms could progressively worsen over time.
 
Carpal Tunnel Anatomy
The carpal tunnel is a passageway at the front of the wrist, allowing tendons and nerves to travel from the forearm to the hand. Both the carpal bones (i.e. the small bones of the wrist) and carpal ligament form the borders of the passageway. As the tunnel is narrow, these structures can easily become compressed, especially with repetitive straining. Notably, the median nerve is a crucial structure that moves and provides sensation down the hand. Any compression of this nerve can result in carpal tunnel syndrome.
 
The compression of the median nerve as it travels through the hand SOURCE
 
Carpal Tunnel Syndrome Symptoms
Symptoms associated with carpal tunnel syndrome are usually distinct and consistent person-to-person. These include:
- Tingling, pins and needles and numbness in the hand and fingers, particularly along the median nerve distribution (e.g. the front of the thumb, index, middle and ring finger).
- Loss of fine finger and hand control. This can impair the ability to perform daily activities, such as picking up coins or typing.
- Numbness and tingling of the arm at night time.
- Travelling pain and discomfort from the hand to the shoulder.
- Wrist pain
- Swollen fingers and hand
- Reduced grip strength
 
Carpal Tunnel Syndrome Causes
Usually, there is no single cause of carpal tunnel syndrome. A range of factors can contribute to the compression of the median nerve [2]. Repetitive stress and strain of the forearm structures can cause swelling and inflammation. As a result, this can lead to a build up of pressure within the carpal tunnel, which can jam the median nerve and surrounding structures.
Examples of factors that can increase the chance of developing carpal tunnel syndrome include [3]:
- Abnormalities of the wrist, such as the shape and size of the surrounding bones.
- Underlying medical conditions, including arthritis, diabetes and tenosynovitis.
- Pregnancy which can lead to fluid retention in certain areas of the body.
- Certain occupations which require repetitive bending of the wrist, such as construction and cooking.
- Computer work for more than 20 hours a week.
- Exposure to constant vibration, such as working with heavy duty or construction equipment (e.g. drills, jackhammers, etc.)
 
Carpal Tunnel Syndrome Tests and Diagnosis
A formal diagnosis can be provided after thorough medical questioning, a physical examination and further testing. Early detection of carpal tunnel syndrome is crucial for seeking treatment promptly and improving the likelihood of a positive outcome. Tests that may be used to diagnose this condition includes:
Physical Hand Examination
There are specific physical tests that GPs may use to identify any impairments and assist in diagnosing carpal tunnel syndrome [3]. They may use special equipment or perform movements that show any signs that the median nerve is being compressed. These tests are potential indicators of carpal tunnel syndrome and will not lead to a definite diagnosis. Additional assessments may be recommended by your GP for confirmation. Common tests include:
- Grip strength using a hand dynamometer
- Tinel’s Test – Your doctor will repetitively and gently tap over the front of the wrist to reproduce symptoms
- Phalen’s test – You will be required to rest your elbow on the table, flex both your wrists and apply pressure with the back of your hands.
Nerve Conduction Studies
A nerve conduction study or electroneuromyography assessment helps diagnose nerve-related conditions. Electrodes are applied over the skin to detect the activity of the nerve(s) being investigated. For carpal tunnel syndrome, the rate of the median nerve activity can help confirm a diagnosis [3].
Imaging
Imaging investigations, such as MRIs, x-rays, CT scans and ultrasounds may also be conducted to help diagnose carpal tunnel syndrome and/or any other potential conditions [3]. Information interpreted from these tests can provide information about any structural abnormalities.
 
Carpal Tunnel Syndrome Treatment
If detected early on, carpal tunnel syndrome can be managed through simple and conservative treatments. If you have any of these symptoms, consulting a GP is essential for preventing more invasive treatment such as surgery. The treatments below are frequently recommended to help ease symptoms.
Lifestyle Changes
Specific wrist positions or activities often trigger carpal tunnel syndrome (e.g. repetitive wrist movement, vibrational tools, etc.). Making an effort to change or stop these types of activities can prevent constant aggravation of symptoms. For example, changing the ergonomics of the office environment can help reduce stress and strain through the wrist.
Carpal Tunnel Exercises and Rehabilitation
Performing specific wrist movements and stretches can help reduce symptoms. Your GP may recommend a physiotherapist or hand therapist to assist you with your recovery.
Carpal Tunnel Wrist Splint
Wearing a wrist splint can prevent unnecessary movement and strain through the arm. This can be worn as required or during the nighttime to help avoid further median nerve irritation.
Medication
Medications, such as anti-inflammatories, can be prescribed by GPs to relieve pain, symptoms and inflammation.
Carpal Tunnel Surgery
If the condition is severe or not responding to these treatments, a carpal tunnel release may be required. During this procedure, the carpal tunnel space is enlarged to decrease the compression through the median nerve. One standard method is to cut open the carpal ligament to open the carpal tunnel [4]. A hand surgeon will be required to perform this procedure either under local or less commonly general anaesthetic.
 
Recovery
Generally, those who seek an early diagnosis and treatment will be more likely to recover from the symptoms. However, those with persisting and/or severe symptoms may opt for surgery. Approximately 75-90% of surgical candidates will report that their symptoms have improved or completely disappeared within a few years [5].
 
Complications
If the appropriate treatment is not sought, there could be long-term complications, including muscle wastage, permanent nerve damage and loss of movement [6]. However, more invasive treatments, such as surgery, can also lead to complications. Between 3-5% of candidates will experience issues, such as ongoing pain and problems with scarring. Approximately 1% of candidates may face more severe issues, such as numbness and pain. Selecting an experienced and skillful surgeon is essential for reducing the risk of complications.
 
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References
- https://www.racgp.org.au/afp/2009/september/carpal-tunnel-syndrome/
- Sevy JO, Varacallo M. Carpal Tunnel Syndrome. [Updated 2021 Jul 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448179/
- Chammas, M., Boretto, J., Burmann, L. M., Ramos, R. M., Santos Neto, F. C. D., & Silva, J. B. (2014). Carpal tunnel syndrome-Part I (anatomy, physiology, etiology and diagnosis). Revista brasileira de ortopedia, 49, 429-436.
- https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/carpal-tunnel-release
- InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Carpal tunnel syndrome: When is surgery considered or needed? 2014 Nov 5 [Updated 2017 Nov 16]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279597/
- https://www.health.harvard.edu/diseases-and-conditions/dont-delay-treatment-for-carpal-tunnel-syndrome
