"Is it Carpal Tunnel?"

Anyone with a splint or bandage on their hand or wrist has been asked this question by well meaning observers, or just straight "sticky beaks". It is a fair guess, as Carpal Tunnel Syndrome is very common. At Northside Hand & Upper Limb Clinic we get asked about this condition almost daily. But for you to have Carpal Tunnel Syndrome you need to have a few key features. The first thing is to suffer from interrupted sleep due to being disturbed by a "dead", numb or painful hand. Secondly the hand goes numb whilst engaging in prolonged gripping tasks (which compress the carpal tunnel).

It is important to note which fingers go numb, as there are 3 nerves that supply feeling to various parts of the hand, and when one of them is compressed it can feel like the whole hand is numb. If the thumb, index and middle fingers are numb, it is the median nerve (that passes though the carpal tunnel to get to the hand) that has been affected. If the little finger and half of the ring finger are numb then chances are that you are compressing the ulnar nerve. If the numbness seems to be more localised around the back of the thumb and index finger then it's the radial nerve that's in trouble.

Man at ComputerThe first thing to do is try to find out what is causing the nerve problems. Is it simply mechanical compression, or is it due to a reduced blood supply, or poor health of the nerve? Mechanical compression occurs when the nerve is bent or stretched around a bony corner, such as when leaning on your hand and elbow for long periods at the computer. This can give rise to ulnar nerve problems. Grandma was right, keep those elbows off the table!

Many things can cause a reduction to the blood supply to your nerves, such as smoking and diabetes. Stop the smoking and try to get the diabetes under control as best you can. Exercise can increase the profusion of blood to your fingers and toes. So get up and move it, move it!

Your nerves can suffer from poor health for many reasons, such as exposure to certain chemicals at work, or drug or alcohol abuse. Our clinic has a NeurometerTM that can help to distinguish and measure the amount and type of nerve damage that you have. Don't despair, sensory nerve damage is usually reversible, given time and the correct therapy, however if the nerve damage has progressed to include motor nerve damage it is harder and takes longer to reverse.

Carpal Tunnel Syndrome treated in the early stages can resolve. We treat you to identify the causal factors and how to settle the symptoms. This may involve making you a custom made splint (orthosis), teaching you nerve gliding, carpal tunnel stretching and tendon gliding techniques, giving ergonomic advice, carpal joint mobilisations and electrotherapy, such as ultrasound.

Are off-the-shelf splints helpful? Some of the chemist shop braces are not useful as they still allow long flexor tendons to migrate into the carpal tunnel as you make a fist and they also put your wrist in too much extension. Our custom made splints (orthoses) immobilise the metacarpal joints in comfortable extension and the wrist in neutral extension. There's nothing more satisfying than having a patient come back after spending a week in our night time splints and reporting that they slept soundly each night, when previously they were waking up multiple times each night due to their numb hands!