Dr Chris Donohue from Clifton Beach Medical and Surgical shares insights on the cause, symptoms, diagnosis & treatment of Carpal Tunnel Syndrome.
Video Transcription Below.
Dr Chris Donohue BHMSC, MBBS, FRACGP – Insights on Carpal Tunnel Syndrome
Today I was going to talk to you about a common painful condition of the wrist that affects about 2.7% of the population. This condition is called carpal tunnel syndrome.
So carpal tunnel syndrome is a common condition that’s caused by compression of the median nerve as it runs through the carpal tunnel. So, patients with carpal tunnel syndrome will characteristically complain of pain and paresthesia or even muscle wasting over the area that the median nerve supplies.
So this particular area will be the thumb, index and middle fingers. Patients will often complain of these symptoms at nighttime. So the carpal tunnel is a tunnel which is formed at the level of the wrist made up of bones and ligaments, and within that carpal tunnel runs the median nerve and tendons. So anything that takes up extra space within this tunnel can cause compression of the median nerve and subsequently cause the symptoms of carpal tunnel syndrome.
Who gets carpal tunnel syndrome? Carpal tunnel syndrome is more common in certain occupational groups so those exposed to vibration forces through their hand and wrist, those who do repetitive gripping or twisting activities or a combination of these factors.
Certain office workers also can commonly get carpal tunnel syndrome if the ergonomic setup of their keyboard is not correct and they’re getting too much extension of the wrist.
Carpal tunnel syndrome is also associated with certain systemic medical conditions. Examples of these are diabetes, hypothyroidism or low thyroid, rheumatoid arthritis, and even pregnancy to name a few. So it’s important to review with your GP if you do have symptoms of carpal tunnel syndrome because there could be other medical conditions that need to be reviewed as well.
Effectively carpal tunnel syndrome diagnosis is a clinical diagnosis so it’s based on patients presenting with classical symptoms which is often night-time pain and pins and needles over the median distribution, as well as clinical signs that we’d look for in examination in the office.
For difficult cases, there are options for doing nerve conduction studies to confirm the diagnosis. Blood tests are also helpful, not so much into helping to diagnose carpal tunnel but to exclude other associated conditions that can coincide with carpal tunnel syndrome as we discussed earlier such as diabetes.
It’s important before moving onto to management of carpal tunnel syndrome that a correct diagnosis is made because there are other musculoskeletal conditions that can present in a similar way to carpal tunnel syndrome. An example of this would be a cervical radiculopathy where a nerve is compressed in the neck and it can cause similar symptoms of pain and paresthesia, or pins and needles in their hand.
In terms of treatment for carpal tunnel syndrome, the first stage of treatment is obviously to rest and avoid predisposing activities such as excessive gripping, wrist movement, vibration.
The next stage of treatment will be a night splint, so night splints keep the wrist in a neutral position which optimises the space in the carpal tunnel so it can help settle carpal tunnel syndrome symptoms down.
There are also options for doing a carpal tunnel steroid injection which can effectively and safely be done in the office. If these conservative measures fail, there are options for carpal tunnel release surgery to help alleviate the symptoms. Specifically, in regards to the carpal tunnel steroid injections, these can be performed here at the medical centre.
If a patient does have symptoms of carpal tunnel syndrome, we would initially see them as a first consultation to take a history and examine the patient, to confirm the diagnosis but also to make sure we’re not missing some of those associated medical conditions such as diabetes or hypothyroidism. If it was deemed appropriate for a steroid injection, then we would see the patient again at a second consult and that can be completed here.