There are a large number of reasons for hand pain. Trauma is perhaps the most common be it acute injury or repetitive strain. Fairly high up the list of causes is carpal tunnel syndrome. A syndrome is a collection of three or more signs or symptoms that point to a particular condition.
The major features of carpal tunnel syndrome are pain in the hand or wrist, pins and needles or numbness in the distribution of the median nerve: the thumb, first and second fingers and part of the third finger. Pain and numbness are usually felt at night and subside when the patient shakes his or her hands. These features are often enough to provide a diagnosis but sometimes nerve conduction studies are carried out.
The problem occurs because of the anatomy of the wrist. As it traverses the wrist to enter the hand, the median nerve passes through a narrow gap – the carpal tunnel. There’s not much room to play with in this area so anything that causes swelling in this part of the wrist is likely to produce constriction of the median nerve and hence the pain and numbness.
Causes of Carpal Tunnel Syndrome
These can be local or arise from any wider body problem that causes the retention of fluid.
- Tenosynovitis. Inflammation of the tendons of the palm side of the wrist can constrict the carpal tunnel. This is often due to overuse injury.
- Rheumatoid arthritis. Can cause swelling and inflammation in parts of the wrist and hand which may compress the median nerve.
- Premenstrual effects. Some women build up fluid in the lead up to menstruation; in some individuals this can result in carpal tunnel syndrome that appears and disappears as the menstrual cycle progresses.
- Pregnancy. Again the build up of fluid in the body is responsible here. Along with swollen ankles, some women will develop carpal tunnel syndrome in late pregnancy. It disappears after the birth of the baby.
- Thyroid disease. Deficiency of thyroid hormone can cause carpel tunnel syndrome. The patient will normally have other signs and symptoms such as: weight gain, puffy face, intolerance to cold and gruff voice.
Treatment
Clearly it’s important to identify any systemic cause such as a hormone problem and try to deal with that. If the cause is local then there are various options. As with quite a few treatments in medicine, not many good quality trials on the different treatments for carpel tunnel have been carried out. The few that have been done have been reviewed by the Cochrane Collaboration. The reviewers found that oral steroids, splinting and ultrasound provided short term relief. Yoga and carpal bone manipulation are less common treatments that were also found to be effective.
The common treatment methods are listed below.
- Splinting. The most conservative treatment. Splints are worn at night to keep the wrist in a fixed position. May be enough to sort the problem out if carried out in the early stages.
- Acupuncture. This can be helpful, again if carried out early.
- Medication. Pain killers, oral steroids and non-steroidal anti-inflammatory drugs are those commonly used.
- Ultrasound. Can be effective in the early stages.
- Injection. An injection of corticosteroid is made into the carpal tunnel. This is often very effective.
- Surgery. If non-surgical methods fail decompression of the median nerve is carried out.
It’s important not to let carpal tunnel syndrome persist for too long as wasting of the hand muscles supplied by the median nerve can occur.
This article is for information only. Consult a medical professional if you have any concerns.
References
National Institute of Neurological Disorders and Stroke
ABC of Rheumatology, ed. Snaith. BMJ Publishing, 2004
John Richard Roberts - I am a practicing osteopath and acupuncturist living and working in the UK. I hold a Master's degree in Clinical Neuroscience. I have ...
