Carpal Tunnel Syndrome

Carpal tunnel syndrome (often shortened to CTS) is a condition caused by compression of a nerve in the carpal tunnel of the wrist. Compression of the nerve can lead to a combination of pain, pins & needles, tingling, numbness and weakness to the hand and fingers. Carpal tunnel is a common nerve condition of the upper limb. 

You are more at risk of developing carpal tunnel syndrome if: 

• You already have any form of arthritis in the wrist, especially if there’s swelling of the wrist joint or the tendons that run through the carpal tunnel 
• Suffer hormonal changes, for instance during pregnancy, which can sometimes affect connective tissues and put pressure on the nerve (please see treatment for pregnancy below) 
• The thyroid gland not producing enough hormones, sometimes  called hypothyroidism or an underactive thyroid gland 
• Have additional medical conditions such as Diabetes, Menopause, Systemic lupus erythematosus, Scleroderma, Dermatomyositis Renal failure, Long-term, haemodialysis Acromegaly,  Multiple myeloma, Sarcoidosis, Leukemia, Alcoholism, Haemophilia 
• Suffered previous wrist fracture 
• Genetics (parent, brother, sister previously diagnosed with CTS) 
• Age (40 plus) 
• Gender (female) 
• Obesity 
• Work in environments that places heavy demand on your wrist 
• Work using vibrating tools 

If you suspect you have Carpal Tunnel Syndrome or have any of the below symptoms, it is advised that you see a Health Care Professional. The information on this page can be used whilst you await your appointment.

• An ache or pain in your fingers, hand/s or arm/s 
• Numbness in the hand/s 
• Tingling or pins and needles in the hand/s 
• Muscle weakness when making a fist 
• Difficulty gripping or holding onto items  
• Muscle wastage in the palm of the hand  
• Symptoms increase or are worse of a night 
• Relief of symptoms when shaking your hands

Diagnosis is usually made from a consultation with your Health Care Professional, involving a detailed history of the onset of symptoms, current pattern of symptoms and your current functional ability.

Further tests such as nerve conduction studies may be performed if the Health Care Professional needs further information to finalise the diagnosis or if surgery is being considered.

It is possible the hand symptoms can be caused by neck related issues. Please see Neck with upper limb page for further details.

The primary aim of treatment is to help manage your symptoms. This allows you to move more and help you return to normal activities sooner. Initial treatment therefore is aimed at symptom control.

Take Pain relief

Pain medication, like paracetamol or ibuprofen, may help carpal tunnel pain short-term. 

Wear a wrist splint

A futura wrist splint is something you wear on your hand to keep your wrist straight. It helps to relieve pressure on the nerve. You wear it at night while you sleep. It may take some time before symptoms start to improve. You can buy futura wrist splints online or from pharmacies. 

Activity modification

Stop or cut down on anything that causes symptoms to increase. This may be caused by frequently bending your wrist or griping hard, such as when using vibrating tools for work, typing or playing an instrument. 

Hand exercises may help ease the symptoms of CTS.

Download some simple hand exercises to help settle the symptoms of CTS.

Thumb Opposition (thumb to every fingertip)

Place elbow or back of your hand on a table. Put your thumb against each fingertip in turn. Practice picking up small objects.

AROM wrist flexion/extension

Start in a seated position with your forearm resting on a table and your thumb facing upright to the ceiling. Bend your wrist forwards, and then extend your wrist backwards, keeping your fingers relaxed throughout the whole movement.

AROM forearm pronation/supination

Sit up straight with your forearm resting on a table. Try to turn your palm to face upwards. Then try to turn your palm to face down. Continue this movement. It is important the movement only comes from your forearm, so ensure you do not allow your upper arm or body to twist.

You should see a Health Care Professional if you: 

• Have pain that doesn’t show any signs of improvement, within a couple of weeks of self help
• Have pain that has rapidly deteriorated or suddenly worsened despite self help
• Have a history of inflammatory arthritis, immuno-suppression, cancer, Tuberculosis (TB), drug abuse, AIDS or other infection
• Feel unwell, have a fever, or unexplained weight loss
• Are experiencing significant and regular changes to your usual sleeping pattern
• Have any tingling or loss of sensation in your hand or wrist 
• Notice changes to your grip strength and are frequently dropping things
• Have severe pain after trauma, such as a fall, collision, or impact to the wrist or hand
• Notice your fingers becomes acutely red hot and swollen without any prior explanation of activity/overuse  

CTS can be a common occurrence during pregnancy. It is a result of having more fluid in the body during pregnancy and this then results in a build up of pressure on the nerves in the hand and wrist.  

Symptoms can vary and can effect one or both hands. CTS can not hurt the baby and symptoms usually resolve after giving birth.  

Treatment: Follow conservative management options outlined above. It is important to inform your GP and or midwife if you develop CTS symptoms during your pregnancy at your next check up. Please note injection therapy should not be considered during pregnancy.

Decision support tools, also called patient decision aids, support shared decision making by making treatment, care and support options explicit. They provide evidence-based information about the associated benefits/harms and help patients to consider what matters most to them in relation to the possible outcomes, including doing nothing.

These decision support tools are designed to support shared decision making between people and a clinician. People may find they are useful before, during or between consultations depending on their care pathway.