Numbness could be carpal tunnel
Do you ever wake up during the night with tingling or numbness in your hand? Or experience pain that seems to resolve when you shake your arm? If the answer is yes, then the chances are you could be suffering from carpal tunnel syndrome (CTS).
CTS is common, particularly for women – they are affected approximately five times more often than men. Although it can happen out of the blue, you are more likely to get it if you fall into one of the following groups:
■ You are overweight.
■ You are pregnant or have been through the menopause.
■ You are aged 30-60 years.
■ Someone in your family has CTS (there is thought to be a genetic component).
■ You have another medical condition such as hypothyroidism, diabetes, kidney failure or arthritis.
■ You have an occupation or hobby that requires a lot of wrist movement (leading to ‘‘overuse’’).
■ You have previously injured your wrist, particularly if this included a fracture or break.
The symptoms of CTS are due to compression of a big nerve – the median nerve – that supplies sensation and power to part of the hand.
This nerve runs through the wrist in an area known as the carpal tunnel, a channel between the forearm and the hand. The hand bones (called the carpals) form three of the walls and a tough ligament called the transverse carpal ligament form the other.
As there isn’t a lot of space in this tunnel, anything that compresses it (for example, fluid retention, swelling around joints or tendon sheaths) will limit the space the median nerve has, compress and irritate it, leading to the classical symptoms of CTS.
The main symptoms relate to the area of the hand that the median nerve supplies. This includes the thumb, the second, third and half of the fourth finger, and the area of the palm at the base of those fingers and thumb.
The most common symptom to develop first is pins and needles (also described as burning or tingling), particularly at night. This can be so bad that eventually sufferers will develop complete numbness in that part of the hand.
Other symptoms include:
■ Pain – classically this first comes on overnight, but if left untreated lots of people will go on to experience daytime pain as well. It usually originates in the fingers or thumb but often travels up the wrist, into the forearm, upper arm and occasionally as far as the shoulder. Patients typically report that the pain is eased, or even disappears, when they sit up and shake or flick their wrist or hand.
■ Weakness – over time, if the nerve continues to be compressed, weakness will develop. This can affect the fingers, thumb or the whole hand, and is often noticed when people are trying to grip something firmly. If left untreated, this can lead to muscle wasting, particularly at the base of the thumb.
■ Dryness of the skin over the affected area.
Although not dangerous or life-threatening, CTS can be debilitating, especially if it impacts on your ability to perform work tasks or sleep well.
If you are experiencing any of these symptoms, don’t despair – CTS is usually pretty straightforward to diagnose, and effective treatments are available. In most cases, your doctor will be able to tell by examining you whether your symptoms are due to CTS or something else.
If it’s a bit ambiguous, they may suggest you get some blood tests to exclude other causes or look for contributing factors such as undiagnosed diabetes or thyroid disease. If it still isn’t clear what is going on, more specific investigations can help: these include nerve conduction studies, ultrasound scan and MRI imaging.
Once you have a diagnosis of CTS, the suggested management will depend a little on the severity of your symptoms and how long you have had them. The options include:
■ A conservative ‘‘wait and see’’ approach. CTS isn’t life-threatening, so it is usually fine to wait and see if it resolves on its own as long as the pain isn’t too severe. For some people, the symptoms will abate within six months, particularly if you are younger, haven’t had CTS for very long, or your CTS is due to pregnancy.
If you take this approach, try to avoid activities that really exacerbate your symptoms, and (as long as you’re not pregnant) losing some weight can be beneficial as well.
■ Wrist splints. There is some scientific evidence to show that wrist splints, particularly if worn at night, are more helpful than doing nothing, and
anecdotal reports from my patients backs that. The idea of the splint is that it maintains the wrist in such a position as to remove the pressure on the median nerve, reducing your symptoms.
Pharmacists and sports shops often sell these splints, or you could visit a physiotherapist who would be able to recommend something more specific.
Physiotherapists may also be able to help with exercise programmes to increase blood flow to the area, and hence promote healing, and improve flexibility and strength in the hand.
■ Acupuncture. This has been shown to be helpful for reducing symptoms and also improving grip strength.
■ Analgesia. Although unlikely to fix the issue, using anti-inflammatories such as ibuprofen or diclofenac can be a good way to manage the discomfort in the short-term.
■ Corticosteroids. If the above measures have failed, or your symptoms are really severe and/or longstanding, you may want to consider talking to your doctor about getting a steroid injection. Although a little painful at the time, this is an effective way of getting relief – it won’t work for everyone, but is thought to be about as good in the medium-term as surgery
■ Surgical ‘‘release’’. It is called ‘‘release’’ as the procedure basically opens up the carpal tunnel, relieving the pressure on the median nerve. This can be done either via open surgery (the traditional way) or by keyhole, known as laparoscopic. Good results are usually achieved, and most patients can return to limited work within two to three weeks.