Carpel tunnel syndrome - a cause of pain and tingling in the hands

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Updated July 2009

Whoever designed the human body made some errors! One of these was to mix soft nerves with hard tendons. In the wrist, the tendons which move the fingers and the median nerve which supplies the hand pass together through the bones and connective tissue (flexor retinaculum) of the wrist. This means if there is any reason for swelling at the wrist, the softest thing gets squashed - this is the median nerve.

Clinical picture

Pain in the wrist and hand, often spreading up towards the elbow.

Tingling in the palm of the hand, thumb, index, middle and sometimes ring fingers. The little finger is spared.

Often both sides affected.

Symptoms often worse at night and are sometimes relieved by letting the arm hang out of the bed.

May occur during pregnancy.

May occur as a result of fluid retention such as allergy.

Sometimes occurs in very muscular men - I presume because the tendons enlarge to cope with the extra forces.

The diagnosis is confirmed by nerve conduction studies.

Treatment

Check for hypothyroidism - a T4, T3 and TSH are required.

Vitamin B6 can be very effective. The active form of B6 is piridoxal 5 phosphate and I usually suggest 100mgs daily.

I like all my patients to take nutritional supplements - vitamins and minerals work together (synergistically) for the best results.

In the short term a "cock up" splint can relieve symptoms at night. Most physios have access to these.

Don't take diuretics which only work as long as you take them, and cause loss of essential minerals.

For some decompression surgery is the only option.

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