Carpal Tunnel Syndrome

Carpal tunnel syndrome is a common condition that causes tingling, numbness, and pain in your hand and fingers. It occurs when your median nerve becomes pressed or squeezed in the narrow wrist passage, called your carpal tunnel.

What is carpal tunnel syndrome? 

Carpal tunnel syndrome (CTS) is the compression of one of the main nerves in your hand, called the median nerve. The median nerve provides sensation to all your fingers (except your little finger) and the palm side of the thumb. It also creates signals to move the muscles at the base of your thumb. 

This major nerve travels from your forearm to the palm of your hand and can become compressed at a narrow passageway of the carpal tunnel in your wrist. This pressure on your median nerve causes your CTS symptoms such as tingling, numbness, and pain.

How common is carpal tunnel syndrome? 

Carpal tunnel syndrome is fairly common in the UK, with around 7-16% of adults suffering from it.

What causes carpal tunnel syndrome? 

Anything that squeezes or irritates the median nerve in the carpal tunnel space may lead to carpal tunnel syndrome. It’s more likely to happen with certain risk factors, such as:

• Being overweight or obese

• Wrist fracture or dislocation

• Doing repeated activities with your wrist in an unnatural position, either very flexed or extended

• A cyst or tumour in your carpal tunnel that presses on or narrows your median nerve

• Pregnancy or menopause – fluid retention often increases pressure on the median nerve

• Having a parent or sibling with CTS

Certain medical conditions can also increase your risk of carpal tunnel syndrome, such as:

• Joint or bone diseases including rheumatoid arthritis, gout, arthritis, and osteoarthritis

• Diabetes 

• Thyroid disorders, kidney failure and lymphedema

Workplace factors, such as working on an assembly line, with hand tools, or typing for long periods of time can also increase your risk of carpal tunnel syndrome. 

Carpal tunnel syndrome symptoms

The effects of carpal tunnel syndrome often start slowly and may come and go. At first, your symptoms might be minor, but gradually worsen over time. For some, the pain will cause disturbed sleep. 

Carpal tunnel syndrome symptoms include:

• Pain in your hand, finger, or arm 

• Numbness in your hand

• Tingly thumb and fingers

• Weak thumb

• Hand clumsiness, difficulty gripping, and a loss of your manual dexterity

What does carpal tunnel feel like?

If you have carpal tunnel syndrome, your hands may feel numb like they are asleep, or you may get a tingling sensation like little pin pricks. You may feel it in your thumb, index, middle and ring fingers, but not your little finger. 

Many people shake out their hands to try and get rid of the symptoms.

If you have carpal tunnel syndrome in one of your wrists, you may feel like it’s weaker and not able to do day-to-day activities as well. This could be simple things like pouring a kettle or driving. 

Carpal tunnel diagnosis

Your doctor usually diagnoses CTS by asking about your symptoms, general health, medical history, and by physically examining your hand. They may also X-ray your wrist or check it with an ultrasound. 

Make sure you tell them when you first noticed your symptoms and if they have become worse over time. 

How to test for carpal tunnel syndrome

Your doctor may test for carpal tunnel syndrome by:

• Pressing down or tapping along your median nerve on the palm side of your wrist and hand to see if it causes tingling in your fingers (Tinel’s sign)

• Flexing and holding your wrists to see if you feel numbness or tingling in your hands (wrist flexion or Phalen test)

• Lightly touching your fingertips with a special instrument with your eyes closed to test their sensitivity

• Checking for muscle weakness around the base of your thumb

• Looking for smaller muscles (atrophy) around the base of your thumb 

Alongside a physical exam, your doctor may also do the following tests: 

X-ray/MRI: You won’t get a diagnosis of carpal tunnel syndrome from an X-ray or MRI, but it will help exclude other causes of wrist pain like a fracture or arthritis. 

Ultrasound: Your doctor may use an ultrasound to look at the nerves and tendons to see if the median nerve is being compressed. 

Electromyography: This measures the tiny electrical discharges in your muscles using a thin-needle electrode inserted into your muscle. Your doctor may use this to look for damage to muscles controlled by the median nerve.

What happens if carpal tunnel isn’t diagnosed? 

If carpal tunnel syndrome isn’t diagnosed and treated, the symptoms can worsen. This can even lead to permanent damage to your median nerve. In time, it may become difficult, or even impossible, to move your hand.

Preventing carpal tunnel

Carpal tunnel syndrome prevention methods include:

• Keeping your wrists straight as much as possible, when working, sleeping, doing repetitive activities, and using tools. If you’re typing for long periods, hit the keys softly and keep your wrists in a relaxed middle position parallel to the floor

• Relaxing your grasp, reducing forceful pinching, and avoiding flexing and extending your wrists
  

• Taking frequent breaks from repetitive activities. When you take a break, gently stretch and bend your hands. It also helps to alternate tasks, to reduce the pressure on your wrists

• Performing stretching exercises before and after activities 
  

• Keeping your hands warm and flexible. If you work in a cold environment, your hands are more likely to become stiff and painful. Fingerless gloves can help too

• Improving your posture and avoiding rolling your shoulders forward, shortening your neck and shoulder muscles will help with carpal tunnel. It’s also a good idea to adjusting your computer screen and keyboard to the correct height.

Can I treat carpal tunnel on my own?

You should treat CTS early. Conservative treatments are more likely to help if you have mild to moderate symptoms.

Initially, you can try to:

• Rest your hands more

• Avoid activities that worsen your symptoms 

• Apply cold packs to reduce swelling

Nonsurgical treatments that your doctor may prescribe to help improve carpal tunnel syndrome, include:

• Wrist splinting – to hold your wrist still, usually at night to help relieve night-time tingling and numbness symptoms and also daytime symptoms. Splinting is often used if you are pregnant.

• Nonsteroidal anti-inflammatory drugs (NSAIDs) - such as ibuprofen can offer short-term pain relief.

• Corticosteroids – may be injected into your carpal tunnel to relieve pain, inflammation, and swelling.

Carpal tunnel surgery

Your health care provider will determine the best treatment for you based on several factors. These include your age, health and medical history, the symptoms of your CTS, and your tolerance and preferences for medications and procedures.

They may recommend non-surgical options if the syndrome is mild, or they may suggest surgery if other options are providing little relief.

If you decide to have surgery, it can be performed by open or keyhole surgery. Keyhole surgery is often the preferred choice if possible as it offers fast outpatient treatment with a quicker and less painful recovery compared to open surgery.

What happens during carpal tunnel syndrome surgery?

Carpal tunnel release surgery, also known as carpal tunnel decompression, is one of the most common hand surgeries. It is typically an outpatient procedure performed in 20 minutes under local anaesthetic.

What happens during surgery will depend on the CTS surgery you have:

Open surgery - a single cut approximately 5cm long is made in the front of your wrist at the base of your palm. The carpal ligament in your carpal tunnel is then cut to relieve the pressure on the median nerve in your wrist.

Keyhole surgery – a smaller cut of about 2cm long is made in your forearm just above your wrist, or in your palm. Your hand and wrist surgeon will pass a thin, flexible telescope, called an endoscope through the incision to see inside your wrist. The carpal ligament is then cut using tiny instruments to relieve the pressure on your median nerve as it passes through your carpal tunnel passage.

What conditions may lead to needing carpal tunnel surgery? 

If you have carpal tunnel syndrome and non-surgical treatments haven’t been successful then carpal tunnel surgery may be recommended. If there is a chance of permanent nerve damage from your carpal tunnel syndrome, then your hand and wrist surgeon will recommend surgery.

What is the recovery time?

This procedure is usually performed on an outpatient basis so you will usually go home the same day of your surgery.

Initially, you’ll use your hand for light tasks such as holding a glass, gradually building up to more strenuous tasks. Your grip should return to normal after six to twelve weeks following your procedure.

You can drive again when you’re able to grip and control the steering wheel properly and perform an emergency stop.

Your consultant may advise you to wear a carpal tunnel splint to keep your wrist from moving around and to lessen pressure on your nerves. The carpal tunnel brace will allow your wrist to be straight and less pressure on your wrist.

When you return to work will depend on your job and its requirements.

It’s best to follow your surgeon’s advice regarding your recovery and timings.

What are the risks or complications?

Most patients have no complications after carpal tunnel release surgery 

However, there are potential risks to all types of surgery including CTS surgery, such as infection, pain, scarring, and nerve and blood vessel damage.

Pillar pain is a complication related to CTS surgery. It is an aching pain and tenderness in the fleshy part at your thumb base and little finger. It is often temporary and resolves within months. 

Other risks of CTS surgery include:

• Loss of grip strength and hand dexterity

• Incision tenderness

• Scar tissue development

• Palmar cutaneous neuroma - a benign post-surgery growth on your medium nerve that can cause a burning pain sensation, numbness, and tingling.

How much does carpal tunnel syndrome surgery cost? 

The costs of your carpal tunnel syndrome surgery will depend on the exact surgery you have and your chosen Ramsay hospital. 

If you decide to pay privately for your treatment, Ramsay offers an all-inclusive Total Care package, where a single one-off payment at a pre-agreed price, delivers direct access to all the treatment you need for complete reassurance. You can also spread the cost of your treatment with a 0% payment plan.

A carpal tunnel surgery may be covered by your medical insurance policy. We advise you to check directly with your insurance provider to discuss the costs involved and get written confirmation before commencing treatment.

Living with carpal tunnel

If you have carpal tunnel syndrome, it’s important to see your doctor. You may have to change some of your daily activities and look at things like posture when typing, as well as making sure your hands and wrists get enough rest. They will likely advise on any nonsurgical treatments too, that may help to relieve your symptoms. 

If your symptoms don’t improve, your doctor may suggest surgery.

Can carpal tunnel heal by itself? 

Yes, it is possible if you rest your wrists or avoid repetitive motions. However, the best thing to do is see your doctor if you think you have carpal tunnel syndrome. They will be able to diagnose it and offer treatment suggestions and lifestyle changes specific to you. 

Carpal tunnel surgery with Ramsay Health Care

Ramsay Health Care offers you rapid access to appointments to diagnose and treat carpal tunnel syndrome at a time and convenient hospital location that suits you.

Carpal tunnel surgery is performed by our experienced orthopaedic surgeons who are specialists in hands and wrists.

Your chosen hand and wrist surgeons will discuss non-surgical treatment as well as surgical treatment of CTS. If remedies such as painkillers, splints, and steroid injections don’t provide enough relief for your symptoms, then surgery is recommended.

Surgery for CTS is usually carried out in our outpatient clinics. It is a quick procedure, usually performed by keyhole surgery so that patients have minimal scars, less pain, and a faster recovery than open surgery.

We aim to offer you the best local care at one of our local hospitals for your carpal tunnel surgery treatment.

Carpal tunnel FAQs 

What activities make carpal tunnel worse? 

Activities that involve repetitive hand and wrist movement can make carpal tunnel worse. One of the biggest culprits is typing on a laptop or a computer, especially if you have poor posture. Other activities include painting, texting and using hand tools. 

What is the fastest way to get rid of carpal tunnel? 

Rest is one of the best ways to reduce your carpal tunnel syndrome. However, it may come back when you pick up the activity again. If you have symptoms, speak to your doctor. They will likely recommend non-surgical treatments including wrist splinting and nonsteroidal anti-inflammatory drugs. 

What is mistaken for carpal tunnel?

Many conditions can be mistaken for carpal tunnel, including tendonitis and arthritis. If you think you may have carpal tunnel, it’s best to see your doctor for a diagnosis. 

How do I check myself for carpal tunnel? 

The easiest way to check yourself for carpal tunnel is using the Phalen test. Hold the backs of your hands together firmly with your fingers pointing down. Keep your arms parallel to the floor. If you experience numbness or pain (or both) after about a minute, you likely have carpal tunnel. 

Is squeezing a ball good for carpal tunnel? 

You may see this “stress ball” exercise recommended for carpal tunnel, where you squeeze a ball and work the flexor muscles in your forearm. This actually isn’t a good idea for carpal tunnel and can make your symptoms worse. 

Is carpal tunnel serious? 

Yes, carpal tunnel is serious. Carpal tunnel symptoms get worse over time and can eventually lead to a loss of function in your hand. If you think you have carpal tunnel symptoms, speak to your doctor. With early treatment, many people make a full recovery. 

Why is carpal tunnel worse at night? 

The symptoms of carpal tunnel are often worse at night due to a number of factors, such as sleeping position, decreased blood flow and reduced blood pressure. 

What is the best position to sleep in with carpal tunnel? 

If you have carpal tunnel syndrome, you want to avoid sleeping in positions where you clench your fists – many people do this in the foetal position. One of the best positions to sleep in is on your back with your wrists by your side. If you do sleep on your side, hug a pillow or use a body pillow to prevent yourself from going into the foetal position. Consider wearing a wrist brace at night too.