Carpal Tunnel Syndrome

Carpal tunnel syndrome refers to entrapment of a particular nerve within the wrist, leading to a distinctive pattern of numbness, pain, or pins and needles in the hand. This condition most commonly affects females of child bearing age

Symptoms include pain, pins and needles, and numbness in the palm of the hand, as well as the thumb, index and middle fingers. Less commonly this can radiate to the elbow, or even shoulder. Often this is worse at night, or on activity. Patients may also notice weakness or clumsiness when gripping things.

One of the most common causes of carpal tunnel syndrome is trauma. This can include repetitive strain injury, such as that seen in typists, or sudden injury, such as a fall onto the hand.

Other causes include pregnancy/menstrual associated fluid retention, lunate subluxation, obesity, and, more rarely, problems such as diabetes, bone tumours, and inflammatory arthropathies.

Often, carpal tunnel syndrome is preceded by minor entrapment elsewhere along the course of the median nerve. This is called a double crush injury, with other possible sites including the neck, shoulder and elbow.

Treatment for carpal tunnel syndrome varies dependant on the cause. Simple mechanical entrapment of the median nerve, such as that caused by carpal misalignment or a double crush injury, generally responds well to conservative treatment. This can be carried out by a chiropractor, mobilisation of the wrist and manipulation of the neck are the main methods used.

Surgery for carpal tunnel syndrome is very effective and relatively safe. Performed under local anaesthetic, the ligamentous floor (or flexor retinaculum) of the carpal tunnel is partially cut. This widens the carpal tunnel, decreasing pressure on the median nerve.

In the cases requiring surgical management, it is important the underlying cause of the carpal tunnel syndrome is addressed.