Carpal tunnel syndrome

Carpal tunnel syndrome is a hand and arm condition characterised by pain, numbness and a tingling feeling.

The carpal tunnel is a narrow passageway located on the palm side of your wrist. It protects the median nerve and the nine tendons that connect the fingers to the muscles in the forearm.

Carpal tunnel syndrome occurs when the median nerve is compressed either due to swelling of the nerve or tendons, or any other factors that put pressure on the nerve.

There are a number of possible causes that contribute to carpal tunnel syndrome, including a congenital predisposition (the carpal tunnel is narrower in some people) and the way the wrist is used, especially when it comes to repetitive movements.

Certain underlying conditions may also contribute, for example, obesity, pregnancy, hypothyroidism, arthritis and diabetes. It is more common in women.

What are its symptoms?

Carpal tunnel syndrome symptoms include the following:

  • Burning, tingling or an itchy numb feeling in the palm of the hand, the thumb and two and a half fingers (not the little finger)
  • Weakness in the hand
  • The symptoms mentioned may extend into the centre of the arm, sometimes as far as the shoulder
  • Symptoms often first appear at night, and may wake the person up.

How is it diagnosed?

If you are experiencing any of the above symptoms, it is advisable to see your doctor; if carpal tunnel syndrome is left untreated, it may cause permanent nerve and muscle damage.

Your doctor will take your medical history, ask you about your daily routine and whether you’ve sustained any injuries to your wrist, arm or neck. A physical exam will include checking the neck, shoulders, arms, wrists and hands for feeling and strength, and appearance.

In addition, the following may be performed:

  • X-ray: This will exclude other causes of the pain, for example, arthritis or a fracture.
  • Electromyogram: This is used to test the electrical activity of your muscles at rest and when they contract, and can determine if muscle damage has occurred and can rule out other conditions.
  • Nerve conduction study: Electrodes are taped to the skin and a small shock passed through the median nerve to se if electrical impulses are slower in the carpal tunnel. This is a good diagnostic tool that can also rule out other conditions.

What are your treatment options?

Carpal tunnel syndrome treatment may involve a number of therapies, including:

  • Lifestyle: adjusting the way a particular activity is performed, including the frequency, and increasing the rest time in between. Exercises to stretch and strengthen may also help. 
  • Immobilising with a splint: this supports the wrist in a comfortable and neutral position, especially at night.
  • Medication: anti-inflammatory drugs or steroid injections to reduce swelling are generally successful for mild to moderate carpal tunnel syndrome.
  • Surgery: if the condition does not respond to treatment, your doctor may recommend surgery, which involves opening the carpal tunnel and cutting the ligament to relieve the pressure. This procedure can be performed endoscopically as well, so discuss both options with your surgeon.

Can it be prevented?

The following may help to prevent carpal tunnel syndrome:

  • Avoid extending and flexing your wrists repeatedly
  • Use splints to keep your wrists straight when you go to bed
  • Arrange your workspace ergonomically, paying attention to how your computer keyboard and mouse are positioned. Try to keep your wrists as straight as possible when working on your keyboard. 

For more info

For more information or to ask a specific question about ergonomics, visit the Ergonomics Society of South Africa.

The accuracy of this information was checked and approved by physician Dr Thomas Blake in December 2015