Carpal Tunnel Syndrome

Pain and tingling in the hand(s) at night may be a sign of the common condition carpal tunnel syndrome (CTS). This frequently affects individuals, especially women, in their 50s and 60s without an obvious cause, but can strike people at other ages.

CTS is more likely to occur in certain medical (e.g. rheumatoid arthritis) and physiological (e.g. pregnancy) conditions, occupations (e.g. manual labourers) and sports (e.g. rowers, cyclists).

The basis of the pain is compression of the median nerve on the palm side of the wrist. The compression can be due to swellings such as tendinitis, cysts or fluid retention. It can also complicate fractures or trauma at the wrist.

The diagnosis is largely clinical, although appropriate investigations may include x-ray and/or ultrasound to exclude intrinsic compressive lesions. The diagnosis can be confirmed via a nerve conduction study.

If an intrinsic compressive lesion is detected then this can be addressed. Most cases, however, are addressed via activity modification, night splints and corticosteroid injection. If symptoms do not abate, or numbness or weakness develop, this would be an indication for surgical referral for a carpal tunnel release.