Carpal Tunnel

Pathophysiology

Carpal tunnel is an irritation of the median nerve as it passes through a tunnel in the wrist. Symptoms tend to occur in the thumb, index and middle fingers but a dull ache may occur more generally into the hand or arm. It is more common in women than men and more common in middle aged and elderly people.

Carpal tunnel can be a symptom during pregnancy. Normally these symptoms will resolve in the post-natal period without further treatment.

Symptoms

• Tingling, pins and needles or numbness in the hand

• Often worse at night and can wake with tingling in the hand

• Weakness in thumb movements including grip strength

• Muscle wastage around the thumb in advanced stage

Management

• Activity modification

• Ice or heat

• Pain relief

• Splinting can help reduce the irritation to the nerve

• Physiotherapy to include range of movement exercises and a graded strengthening programme

• Orthopaedic options include steroid injections and surgery

Investigations

Nerve conduction studies may be carried out