“I often wake up in the morning with my thumb, index and middle fingers being numb or tingling. MY GP says I have carpal tunnel syndrome. What is this?"
The wrist is a very crowed place. It consists of a canal which has bones on three sides and the last side is a tight fibrous band. Through the canal have to go the blood vessels and the nine tendons that allow the muscles in the forearms to curl your fingers up. The canal also protects the main nerve that supplies the sensation and movement to the part of the hand that you describe. This is called the median nerve. If something happens to reduce the volume of the canal the first thing that gets squashed is the nerve leading to the symptoms that you describe.
Carpal tunnel syndrome usually comes on fairly slowly over time. The symptoms usually start at night because the wrist is flexed and this makes the canal tighter, squeezing the nerve. It can take a few minutes in the morning to get better. Over time, things can get a little worse, and there may be some difficulty holding things, or making a fist. The diagnosis is made by the story you tell your doctor. If there is any doubt, they may send you to the hospital to see a wrist or nerve specialist who may do further tests on the nerve.
Most cases of carpal tunnel have no known cause, but there are a few things that can precipitate it, or make it worse. Inflammation of the tendons – tendonitis – can make them bigger, so squashing the nerves. Fluid retention, such as with pregnancy or an underactive thyroid gland may also lead to problems – but once the baby has been delivered, the problem should resolve within a few days.
Very occasionally, excessive typing with bad posture, the continued use of power tools, or heavy manual work can cause carpal tunnel syndrome.
In the early stages, treatment is by fixing the cause – such as the use of proper wrist supports when typing. Using anti-inflammatory drugs or physiotherapy can be helpful. Very occasionally a steroid injection can be used to reduce the inflammation. As a last resort surgery may be offered. This is where the tight fibrous band making up the fourth side of the canal is loosened. However, not everyone who has the surgery gets total relief from the symptoms. It may relieve the pain, but if the condition has been present for a long time, things may not completely recover.
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