Time to tackle the tunnel

27 June 2014

Have you ever woken up in the morning with ‘pins and needles’ in one or both of your hands? What about when the numb, tingly sensation persists longer than those few moments when you’re wiping sleep from your eyes? Mr Adrian Chojnowski answers a few questions about this relatively common condition of the hand and fingers.

What is Carpal Tunnel Syndrome (CTS)?

Carpal Tunnel Syndrome (CTS) is a common condition that occurs when there is too much pressure on a nerve in the wrist. This may result in pain, numbness or tingling of the thumb, fingers and sometimes a larger part of the hand.  About three in every 100 people will develop CTS at some point in their lifetime.  While it can develop at any age, most sufferers are in their 40’s and 50’s.

What is the carpal tunnel?

The carpal tunnel is a channel in the palm side of the wrist - close to where one would look for a pulse.  The bones of the wrist are arranged in a semi-circle, and a tough ligament called the transverse carpal ligament forms a ‘roof’ over the bones.  The carpal tunnel is the passageway that is formed by this ‘roof’.  Running through the tunnel are the tendons that we use to bend or flex our fingers, and the median nerve (one of three nerves that connect to the hand). 

What causes Carpal Tunnel Syndrome?

There isn't much room in the tunnel therefore any swelling around it can compress the median nerve, causing symptoms of Carpal Tunnel Syndrome

What are the symptoms?

Symptoms include aching, tingling, ‘pins and needles’, a swollen feeling, burning, numbness or pain in the hand and fingers. Occasionally patients say the pain travels up the arm. Carpal Tunnel Syndrome tends to be worse at night causing sufferers to wake from sleep, it may also be troublesome first thing in the morning.  You may find that you get temporary relief by hanging your arm out of the bed at night or by shaking your hand vigorously.

It can affect one or both hands to varying degrees.  Symptoms may be mild and occasional so many people simply put up with the discomfort at the onset.  Reduced sensation can make fine motor tasks such as picking up small objects or doing up a zip quite difficult.  The night symptoms can be the most annoying and may lead to erratic sleep patterns as a result of waking due to discomfort. In severe, long-lasting cases the thumb muscles may start to waste away or the median nerve may be permanently damaged.

Repeated activities requiring wrist movements or, tasks requiring prolonged wrist positions such as long distance driving, could lead to inflamed tendons or swelling in the carpal tunnel, causing or exacerbating the condition.

What treatments are available for Carpal Tunnel Syndrome?

Non-surgical treatments may include a wrist splint to be worn at night.  Keeping the wrist bent for long periods increases the pressure on the nerve, a splint will help to keep your wrist straight to reduce the pressure.  Mild symptoms may be helped by resting your hands and wrists regularly.  If your condition is linked to the way you use your hands, it is important to try and avoid the uncomfortable actions.  Changing the way repetitive movements are performed, reducing how often you do them, and increasing the amount of rest between periods of activity could also help.

Over-the-counter non-steroidal anti-inflammatory drugs (NSAID’s) such as ibuprofen or aspirin may help by reducing swelling and relieving pain.  Many alternative treatments have been tried and there is some evidence that stretching exercises may help in early cases – for example, yoga.

Corticosteroid injection into the carpal tunnel may relieve symptoms in the short term but how long this lasts is not known.  CTS can be exacerbated during pregnancy, a few medical conditions can also be linked such as low thyroid hormone levels.

If your symptoms are painful and have not been helped with other treatments then surgery has a good chance of curing the problem. It is commonly performed under local anaesthesia and requires half a day in hospital. Most surgeons use an ‘open’ technique i.e. a cut to decompress the nerve by dividing the carpal tunnel ligament. The hand will only be useful for very light tasks for the first two weeks, building up to heavier jobs by around six weeks. This means you may need some help with everyday activities for the first few weeks. It may take some months for full strength to return.

Are there any risks to surgical treatment?

Risks include a tender uncomfortable scar which may be helped with local gentle massage/cream, generally settling fully after a few months. Hand stiffness and swelling is a constant problem after any surgery or injury to the hand and rarely can be quite disabling. The risk can be minimised by gently exercising the hand, taking pain relief as necessary and not attempting any moderate to heavy or, repetitive activities for the first four weeks.

The night symptoms tend to be cured straight away. It may take longer for the tingling to disappear. If the nerve has been damaged by the CTS then it may never fully return to normal - for example, wasting of the muscles around the thumb never tends to recover. Rarely CTS can recur many years later.

Generally this operation provides high satisfaction rates but it is always important to consider the risks and benefits of surgery before embarking on this course.

Your GP will most likely be your first point of medical contact and will make or confirm the diagnosis, consider the non-surgical treatments and recommend a surgical opinion as appropriate.

For further information about Carpal Tunnel Syndrome arrange an appointment with your family doctor or call 01603 255 614 to make a private appointment with Mr Adrian Chojnowski. Further details regarding consultant orthopaedic surgeon Mr Adrian Chojnowski can be found on his consultant profile by clicking on the link; Mr Adrian Chojnowski.

All surgery carries an element of risk and the content of this page is provided for general information only.  It should not be treated as a substitute for the professional medical advice of your doctor or other healthcare professional.

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