Hand pain

Hand pain is very common with many causes ranging from osteoarthritis to trapped nerves.

The common cause of hand pain is Carpal Tunnel Syndrome (CTS). Approximately 1 in 1,000 people develop CTS each year with excellent information relating to diagnosis and surgery by following the below links;

Carpal Tunnel Syndrome: Your Diagnosis and Treatment Options

Carpal Tunnel Decompression: What to Expect Following Surgery

The carpal tunnel is a canal formed between the small bones of the wrist called carpal bones and a ligament that lies across the front of the wrist.  A large nerve, called the median, along with the tendons that attach the forearm muscles to the fingers, pass through this canal.  In CTS the nerve becomes compressed and in most cases it is not clear why, although increased pressure is believed to compress and restrict blood flow to the median nerve.

Symptoms include pins and needles, pain and/or numbness in the index and middle fingers and weakness of some muscles in the fingers and/or thumb which may cause poor grip.

What causes CTS?

Often the cause is not clear as to what increases the pressure in the carpal tunnel resulting in restricted blood supply to the median nerve.  However it is more common in manual workers with jobs using lots of wrist movement such as scrubbing or wringing.  Therefore overuse may be contributing factor to CTS

Bone or arthritic conditions - such as osteoarthritis and rheumatoid arthritis or wrist fractures may lead to CTS

Genetics – hereditary factors have been identified and 1 in 4 people with CTS also have a close familiar member (father, mother, brother or sister) with CTS

Other conditions – CTS is associated with pregnancy, obesity, diabetes, hypothyroidism and the menopause.

What are the symptoms?

Pins and needles – tingling or burning in parts of the hands supplied by the median nerve.

Pain – in the same fingers as the pins and needles and may travel to the forearm

Numbness – in the same fingers, or in part of the palm may develop if the condition becomes worse

Dryness of the skin – in the same fingers

Weakness – in the muscles of the fingers and/or thumb in severe cases, you may experience poor grip and may eventually lead to wasting of the muscles at the base of the thumb.

Morning symptoms – people often wake in the night or find the symptoms are worse in the morning

How do you diagnose CTS?

No special tests are usually required to diagnose CTS as the symptoms are classic in their presentation.  If a diagnosis is clear then a nerve conduction study may be required which is a test measure of how well the nerve is transmitting its impulses.

How is CTS treated?

If a specific trigger is identified such as a work, hobby or sport related cause then modification of activities should be considered to help settle the symptoms.  Over use of the wrists should be avoided such as excessive squeezing, gripping, wringing etc.  If you are over weight then consider losing weight to improve your symptoms and PhysioHey may be able to advise you on services and support available locally to help you do this.  Please our other services section.
Simple painkillers available from your pharmacist such as paracetamol or co-codamol are beneficial to reduce pain.   There is no evidence that anti-inflammatories are of any benefit to reducing CTS symptoms

Not treating – this may be an option as 1 in 4 cases resolve without treatment after a year or so and 2 out of 3 cases of pregnancy related CTS resolve after the baby is born.  Often only mild symptoms are suitable to leave to spontaneously resolve. 

Splinting – wrist splints aim to keep the wrist in a neutral position and is a first step intervention.  Once worn for 2 – 3 months, especially overnight, results in patients symptoms significantly improving or full resolution of symptoms if used in the first 2 – 3 weeks

Surgery – only severe symptoms or moderate symptoms that have not improved with treatment are usually considered for surgery.  It is a small operation that cuts the ligament over the front of the wrist to ease the pressure in the carpal tunnel, this is done most times under local anaesthetic and usually cures the problem.  Post surgery you will not be able to use your hand at work for 2 – 3 weeks.

Clinical decision making tool

To you make a clear informed decision about how to move forward in the management of your CTS please click here for more information and to weigh up which what is right for you.