Carpal tunnel syndrome

Carpal tunnel syndrome is a relatively common condition that causes pain, numbness and a tingling sensation in the hand and fingers.

These sensations usually develop gradually and start off being worse during the night.They tend to affect the thumb, index finger, middle finger and half of the ring finger.

Carpal tunnel syndrome is caused by compression of the nerve that controls sensation and movement in the hands.

It will sometimes get better on its own. Otherwise,wrist splints and corticosteroid injections are often recommended. There is a lack of evidence to support the use of non-steroidal anti-inflammatory drugs (NSAIDs) , such as ibuprofen.

Surgery ( carpal tunnel release surgery ) is usually only recommended for severe cases of carpal tunnel syndrome, when symptoms last for more than six months or other treatments have not been effective.

Itoften affects three main areas of the hand:

• base of the thumb
• joints closest to the fingertips
• middle joints of the fingers

The fingers may become stiff, painful and swollen, and bumps may developon the finger joints.Over time, the pain may decrease and eventually disappear altogether, although the bumps and swellingcan still remain.

The fingers may bend sideways slightly at the affected joints. Painful cysts may develop on the backs of the fingers.

In some cases, a bump may also develop at the base of the thumb, where it joins the wrist. This can be painful, making itdifficult to perform manual tasks such as writing, opening jars or turning keys.

Osteoarthritis also commonly affects the knees and hips, so is probablythe cause if you have pain in other joints as well.

Rheumatoid arthritis is an autoimmune disease. This means that your immune system (which usually fights infection) attacks the cells that line your joints by mistake, making them swollen, stiff and painful.

The handpain associated with rheumatoid arthritisis usually a throbbing andaching pain. It is often worse in the mornings and after a period of inactivity.

It is made up of a thick, jelly-like fluid, called synovial fluid, which surrounds joints and tendons to lubricate and cushion them during movement.

Ganglions are most commonon the wrists (particularly the back of the wrist), hands and fingers.

They are generally harmless, but can sometimes be painful, especially if they are next to a nerve.

The cause isn't understood. Some sources claim it is a type of tenosynovitis (see below)or tendonitis, but this is not true. De Quervain's disease is not associated with inflammation.

Some mild cases get better on their own after a few weeks of rest and avoiding the activity that triggered it. A wrist splint or a corticosteroid injection may help.

Severe cases may need to be treated with surgery, which involves widening the tunnel through which the tendon passes.

When the affected finger or thumb is bent towards the palm, the tendon gets stuck and the finger clicks or locks. The exact cause is not known.

Thesymptoms can include pain, stiffness, clicking and a small lump in the palm at the base of the affected finger or thumb.

If you think you may have trigger finger, make an appointment to see your GP, so they can examine your hand and offer advice about treatment.

In some people, trigger finger may get better without treatment.

It's a relatively rare cause of hand pain that can affect the wrist or the fingers.

The cause is not always known. Itmay be brought on by a series of small injuries to the tendon, a previous injury or strain, infection, or rheumatoid arthritis.

It's important to rest the hand or keep the tendons still, to allow recovery. You might be able to relieve the pain and inflammation by applying heat or cold to the area, and by taking non-steroidal anti-inflammatory medications (NSAIDs) such as ibuprofen.

Injections of corticosteroids (steroid medication)can sometimes help.

Tenosynovitis caused by infection will need treating with antibiotics.

After the hand has recovered, strengthening exercises using the muscles around the affected tendon will help prevent the injury returning. Your GP or physiotherapist will be able to advise about this.