CARPAL tunnel syndrome is one of the most common hand disorders.

The usual symptoms are numbness and tingling of the fingers. The numbness may be aggravated by activities such as driving or holding a phone. Sometimes the numbness awakens the patient at night and may be relieved by shaking the hand.

In the early stages, the numbness might come and go but if the condition is not treated, the numbness of the hand may become continuous and may be associated with pain. Weakness and atrophy of the small muscles at the base of the thumb sometimes develop in the advanced stages, causing severe impairment of hand function.

The condition is caused by pinching or compression of the median nerve in the carpal tunnel at the wrist. The median nerve is vitally important and provides sensation to most of the hand. It also supplies the muscles at the base of the thumb (thenar muscles).

Carpal tunnel syndrome may be caused by overuse of the hands from repetitive activities like typing. It is more common in individuals with diabetes or rheumatoid arthritis and sometimes there is a family history of the disorder.

Numbness of the hand should never be ignored. Medical attention should be promptly sought. Usually, the diagnosis can be made by a doctor after a careful history and examination. A nerve conduction study (NCS) should be done to confirm the diagnosis and determine severity.

Proper treatment depends on the severity as determined by the NCS. Mild cases can improve with non-surgical treatment, which consists of wearing a wrist splint at night to rest the area, vitamin B6 which helps nerve function, and anti-inflammatory tablets which help reduce the pressure on the median nerve.

Attention should also be given to modification of job duties to avoid overuse of the hands. Alternation of job duties is usually helpful in reducing the harmful effects of repetitive work. Severe cases usually require surgery to relieve the pressure on the median nerve. Ninety-five per cent of cases have a good outcome after surgery.

Moderate cases may improve with conservative treatment, but some may require surgery if symptoms do not subside after two to three months.

Surgery is usually performed under local anaesthesia in an outpatient setting. In advanced cases where thumb function is compromised, reconstructive hand surgery may be required to restore proper grasp.

In summary, numbness of the hands should never be ignored. If you have numbness and tingling in your hands, make an appointment with your doctor so that a thorough evaluation can be done and proper treatment initiated promptly.

Dr Cecil Aird MBBS, FRCS(C), FACS is a hand and microsurgeon at the Carnegie Hand Institute and Surgery Center in Ironshore, St James. His office may be contacted at 631-7871.