What is carpal tunnel syndrome?

CTS is a common condition where pressure on the median nerve causes uncomfortable pins and needles, a tingling sensation and, in more advanced cases, numbness and weakness.

The median nerve runs from the neck down to the wrist and through a tunnel called the carpal tunnel into the hand.

The carpal tunnel is formed by the wrist bones in a U-shape and a wide ligament across the top to form the roof of the tunnel.

What causes CTS?

CTS can occur due to irritation of the median nerve caused by increased pressure in the carpal tunnel.

Most cases occur without any obvious cause. However, there are some factors that can be linked to CTS, such as:

• diabetes

• pregnancy

• hypothyroidism

• previous wrist fractures

• some forms of arthritis.

Some patients report an increase in CTS symptoms after heavy activity.

Many patients with CTS report an increase in symptoms at night during the early stages. As the condition progresses, symptoms may also occur during the daytime and become more frequent.

How can CTS be treated?

• splinting – you may be provided with a night-time splint to hold the wrist in a neutral position, reducing compression or irritation of the median nerve. The splint is normally worn at night for six to 12 weeks
• therapy – alongside splinting, therapy may include exercises such as nerve glides, ergonomic advice and education
• injection – a local cortisone steroid injection (CSI) administered into the carpal tunnel can provide relief from symptoms
• surgery – if conservative management and CSI have not worked, or the CTS is severe, surgery may be an option. This normally involves a small cut across the carpal ligament at the base of the palm to create more room for the nerve. This is carried out through the orthopaedic service.

Simple exercises