Carpal Tunnel Syndrome

The carpal tunnel is a small space in the underside of the wrist. When the contents of the tunnel becomes squashed and a nerve is irritated, you have carpal tunnel syndrome (CTS).

The carpal tunnel is made from the bones of the wrist at the bottom, and a layer of soft tissue on the top (the retinaculum). Within the tunnel there are tendons for muscles that control movements of the fingers and wrist, as well as blood vessels and nerves. All of these structures are tightly packed into the tunnel, so relatively little swelling is required to upset things.

The Median Nerve

One nerve that runs through the tunnel is the median nerve. It provides sensation to most of the palm, and into the thumb and first three fingers. When irritated, it can cause numbness, pins and needles, or pain into this area. The wrist itself can also be painful.

You might describe this irritation as the symptoms of a "trapped nerve" with similarities to some forms of sciatica. But "trapped" may be an inaccurate description, when in reality there is just a bit of pressure on it. As with any nerve irritation, the longer it goes on for, the more severe symptoms are likely to be, and the slower we expect it to respond to treatment.

Causes of Carpal Tunnel Syndrome

Pregnancy is a risk factor of carpal tunnel syndrome. As a pregnancy progresses, it's not uncommon to notice increased water retention and swelling. This is often quite generalised, and can affect the hands and wrists like any other area. Sometimes the first sign of this is rings being harder to get on and off. You can imagine how swelling that is significant enough to change your ring size could affect the tightly packed carpal tunnel.

There are other times in life when the same fluid retention process can cause carpel tunnel syndrome (CTS). People on certain medications are more prone to water retention, as are people with some kidney or heart problems. Lymphoedema can also cause swelling in the wrist, for example after lymphadenectomy following breast cancer.

Work can be a factor if it involves pressure on the wrist or overuse of the local muscles. Computer work at a desk can cause avoidable pressure on the wrists if positioning is wrong. You don't want to be resting your wrists on the desk as you type or use a mouse. If this is the case, you can move your keyboard closer to the edge of the desk, or you might be able to alter your arm rests.

Management

In the case of water retention, your osteopath may be able to help with general drainage techniques. Gently encouraging the fluid to move back into circulation can reduce local pressure and give some short term relief. This may be prolonged by continuing the techniques as exercises at home. It may also be appropriate to refer you back to the GP if the swelling is systemic.

Alongside treatment in clinic, your osteopath may recommend a splint to wear on the wrist overnight. Symptoms can be particularly bad at night, and sometimes this is related to sleeping position. Many people curl up overnight, and the wrist is no exception- but of course this only offers further compression to the carpal tunnel. A simple splint can prevent this additional pressure.

There are a number of similar conditions that may seem like CTS, but are in fact nothing to do with the wrist. The median nerve can be irritated further up the arm by something as simple as a tight muscle. Your osteopath will look at your case and see how your symptoms respond to treatment to be sure that the treatment is appropriate.

If you have symptoms of carpal tunnel syndrome, book in online here.