QUESTION: A 52 year old woman is complaining of numbness in her thumb, index and middle fingers. It is waking her at night and she tries shaking her hands to relieve the symptoms. She also gets tingling in these fingers when she is driving. What should she do?
What is it?
Carpal Tunnel Syndrome is the compression of the median nerve as it passes through the carpal tunnel. The median nerve supplies sensation to the thumb, index, middle and half of the ring finger. Compression of the nerve can cause symptoms such as numbness, pins and needles, tingling, swelling, pain and weakness. It can be worse at night due to the wrist resting in a flexed posture or during the day when driving or when performing activities requiring strong repetitive gripping.
Your therapist can assess you for Carpal Tunnel Syndrome. Sometimes nerve conduction testing is useful, your therapist can advise you whether this is required.
Most people with Carpal Tunnel Syndrome will respond well to a custom made splint, and instruction in various self-help strategies along with an appropriate exercise program. A hand therapist will provide you with:
- Advice about appropriate activity modifications and workstation ergonomics
- Median nerve gliding exercises to reduce nerve irritability
- A wrist splint to immobilise the wrist in a neutral position. This may need to be worn full time or just at night time when sleeping
- Graded strengthening exercises when appropriate
Surgical review may be required depending on your response to conservative treatments. Your therapist will be happy to discuss with you and your GP whether referral to a hand surgeon is appropriate.