Carpal tunnel syndrome (sometimes called ‘carpet tunnel’ by accident!) is a common condition we treat at Riverina Hand Therapy. We see it in our adult patients of both genders, more commonly in the middle and later decades of life, though it can affect people of all ages.  People with carpal tunnel often experience tingling, pins and needles, numbness or pain in their hands. It is limited to the thumb, index, middle, and radial half of the ring finger and the palm, for this is the area which is powered by the median nerve, which passes through the carpal tunnel. People often complain that they wake up during the night or in the morning with numb, tingling hands.

People often feel like their fingers are clumsy and may drop objects; you may also notice that sensations such as pressure, texture and vibration feel different in your affected hand. Swelling may also be visible or your hands may feel swollen. Rub your hands on your shirt, or through your hair; does it feel the same on both hands?

These symptoms are caused by compression of your median nerve as it passes through the carpal tunnel. The carpal tunnel is a C-shaped structure formed by the carpal bones within your wrist. Through this tunnel passes several tendons and your median nerve. 

 Carpal-Tunnel

(Image courtesy of johnrossmckay.com)

The tunnel is closed by a ceiling formed by a tough sheet of ligament known as the flexor retinaculum; it acts to keep everything in place, much like the loops on a fishing rod that keep the line in place. The tunnel is a fairly tight fit, and excessive pressure on the nerve can be caused by postures such as prolonged wrist flexion, or by swelling that can occur with trauma, or even the swelling associated with pregnancy. Left untreated, this can cause permanent damage to the nerve.

I sometimes compare an irritated nerve to an overtired toddler – it has a low threshold and needs a good rest so that it can tolerate more activity. Removing compression on the nerve and giving it a chance to recover enables it to tolerate more pressure and activity before symptoms develop. We ‘rest’ the median nerve by preventing wrist flexion whilst sleeping. In a deep sleep, we tend to curl up – flexing the elbow and wrist throughout the night, and the wrist flexion continues to compress the nerve. We treat this issue through the use of a comfortable wrist brace or custom made thermoplastic splint. We also use compression and other techniques to reduce swelling in the area if it is problematic. This process can often take 4-6 weeks to fully resolve the nerve irritation, but often delivers big improvements within a few days. 

A common misconception I hear is that if you have carpal tunnel syndrome, you need to have surgery. This is not the case. For some people, their nerve is so severely compressed that conservative management is unlikely to resolve the issue. However, for a vast number of people, their symptoms can be managed simply and effectively (and comparatively cheaply!). If you do have surgery to decompress the nerve, keep in mind that scarring and hypersensitivity can cause discomfort and functional difficulties after surgery. If you have any issues after surgery, contact your hand therapist and we can assist in resolving these problems quickly. 

Louise Brown, Senior Occupational Therapist