Carpal tunnel syndrome

What is it?

Carpal tunnel is compression of the medial nerve as it passes through the carpal tunnel in the wrist.

Symptoms

Pins and needles in the palmar side of the thumb, index and middle fingers of the hand (not involving the thenar eminence). There may also been pain at the flexor crease of the wrist. Frequently sleep is disturbed due to the pins and needles sensations.

Incidence

CTS is a relatively common condition estimated to affect approximately 0.5% of workers. In high risk industries (Eg sewing machining operation, abattoir workers and leather tanning workers it can be as high as 15%).

Possible Contributing Causes

Dr Ross Mills suggests the following as possible causes:

• Diseases and altered health states such as rheumatoid arthritis, collagen – vascular disorders, diabetes, thyroid disease, renal disease, amyloidosis, pregnancy, obesity, alcoholism, endocrinopathies, gout, dupuytren’s disease, space occupying lesions and small wrist dimensions.

• Repeated extreme wrist flexion or extension

• Repeated forces on the base of the palm and wrist

• Use of vibratory hand tools

Differential Diagnosis:

• Cervical spine dysfunction

• Thoracic outlet syndrome

• Previous fracture/trauma to the wrist

• Connective tissue disorders

• Overuse syndrome

• Tenosynovitis of wrists and elbows

Red flag conditions:

• Muscle atrophy

• Significant impairment of activities of daily living

• Altered finger/hand profusion

• Objective neurological deficits

• Systemic signs/symptoms

• Sudden onset of symptoms

Yellow flag conditions:

• Attitudes and beliefs about pain

• Emotions

• Behaviours

• Family

• Compensation issues

• Work

• Diagnostic and treatment issues

• Workplace conflicts

Recommended treatment investigations include nerve conduction studies, FBC, rheumatology screen, Thyroid Function testing, uric acid and glucose.

Possible alternate duties (Dr Ross Mills):

• No repetitive/tight gripping with the (affected hand)

• Maximum lift 5 kgs

• Avoid over hand gripping with the affected hand

• Avoid bending the affected wrist

• Avoid using impact or vibration tools with the affected hand

• Avoid pressure to the base of the palm and wrist of the affected hand

When to Consider Referral for a Specialist Opinion

• The presence of any red flag conditions

• The worker has had more than two weeks certified unfit for duties, or more than one month on selected duties

• The worker has had more than three weeks off work, or on selected duties and has significant yellow flag conditions

• Not back at pre-injury duties within six weeks of the injury

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