Carpal tunnel syndrome is caused by the compression of one of the nerves in your hand (the median nerve) that helps you move your thumb. It also gives a particular area of skin the sensation to touch, pain and temperature - this is the skin over the thumb and parts of the first two fingers.
The median nerve runs through something called the carpal tunnel as it navigates through your wrist into your hand. The carpal tunnel, which is a gap formed from the bones in your wrist and a big ligament, can swell up and squash the nerve. This usually causes pins and needles, numbness and pain in your thumb, index finger and middle finger, and sufferers typically say symptoms are worse at night.
Sometimes, if you’ve suffered from this for a long time, the muscle at the bottom of the thumb loses power as the muscle wastes away.
There is no one specific cause of carpal tunnel syndrome but it is more common in women, the elderly and during pregnancy or menopause. Swelling of the carpal tunnel can occur from injury to your hand or wrist, joint conditions, such as rheumatoid arthritis, and from diabetes or obesity. You may be at higher risk if your job or hobby involves a lot of manual work, such as having to bend the wrist or grip things for a long time, or using work tools that vibrate such as a pneumatic drill.
It is thought to be more common in pregnancy and menopause as there is often increased water retention so the tissues in the wrists and hands may be more swollen, causing the carpal tunnel to narrow and put pressure on the nerve.
Carpal tunnel syndrome often improves by itself over a couple of months. If you can stop the cause of it, the nerve will recover. So if pregnancy has caused it, it resolves after you’ve given birth, and if manual work is the cause, stopping this will help it repair.
You can treat carpal tunnel syndrome symptoms at home. These include avoiding repetitive bending of the wrist, gripping or lifting heavy objects and anything else which seems to make the pain worse. You can buy a wrist splint from your pharmacy and wear it at night to prevent bending the wrist as you sleep, giving the nerve some respite from being compressed.
For pain relief relating to carpal tunnel syndrome, a sensible stepwise approach would be to try one to two paracetamol tablets up to four times daily (leaving a 4 to 6 hour interval between doses). Paracetamol is generally well-tolerated and safe for most (unless for example, you have a severe liver problem).
The addition of an anti-inflammatory medication, such as ibuprofen, will bring down swelling and provide additional pain relief. Take 200mg to 400mg three times a day regularly for a few days, which will allow the anti-inflammatory effect to get to work.
Ibuprofen is known to cause irritation to the stomach lining, so it's best to take ibuprofen with food. You should speak to your doctor or pharmacist before taking ibuprofen if you are taking any other medicines, particularly for high blood pressure or stroke prevention, if you have kidney disease or you are pregnant.
Additional pain relievers are available over-the-counter which are codeine-containing combinations with either paracetamol (co-codamol), or ibuprofen – these may help if you're suffering with more severe pain.
A wrist support brace can help to prevent over-rotation of the wrist, providing general support, and are recommended especially at night. During the day, these may help to prevent further injury caused by repetitive strain injury or lifting heavy objects.
If in doubt about any medicines or appliances or the suitability for you specifically, speak to your local pharmacist or doctor.
You should see your doctor if you have persistent numbness or weakness in your hand, if this is affecting your ability to work, or if symptoms have been going on for several weeks or months without improvement. They can prescribe stronger painkillers for short-term use.
They may refer you to a physiotherapist for exercises, and in more severe cases, they may refer you for a steroid injection to relieve joint pain, or to an orthopaedic surgeon, or sometimes offers a surgical technique to release the trapped nerve.
You are likely to be fit for work if you have carpal tunnel syndrome. However, depending on the severity and the kind of work you do you may need to request altered duties. Your doctor will help assess this with you and can even provide a letter of support if necessary.
Read about Repetitive strain injury (RSI)
Read about Wrist pain
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