The most likely problem is carpal tunnel syndrome (CTS). This is a condition in which one of the main nerves supplying the hand is compressed as it passes through a bony-ligamentous tunnel in the wrist, resulting in the nerve not functioning normally, causing numbness, and in the more severe cases, weakness. The nerve concerned is the median nerve, which supplies sensation to the thumb, index and middle fingers and half of the ring finger, and the muscles that move the thumb.
CTS is more common in females over 40 years of age. It may also be associated with frequent use of the hand and use of vibration tools.
In the mild stage, there may be intermittent numbness with tingling (pins and needles sensation) to the involved digits. This comes with certain activities that stress the hands and wrist, as in your case of having to take care of your grandson. The numbness and tingling may also occur at night, usually in the early hours of the morning, when a patient wakes up, having to shake the hands and wrist before feeling better.
In the moderate stage, there will be constant numbness, even when at rest. There may also be occasional dropping of things which the patient is holding, such as a cup, handphone, or newspapers.
In the severe stage, there will be an associated weakness of the thumb and shrinkage (wasting) of the thumb muscles in the palm.
Treatment involves avoidance of activities that precipitate the symptoms and wearing of a wrist splint at night to prevent bending of the wrist during sleeping as this increases the pressure on the nerves. Certain medication may also help. Steroid injections are usually temporary and are not recommended as a standard method of treatment.
Nerve conduction studies can help to confirm the diagnosis but are not always necessary.
If non-surgical treatment fails, surgery to release the ligament that compresses the nerve can be done. This may be done in the conventional open technique or using minimally invasive techniques such as the scope-assisted release, as a day surgery procedure.
Recovery from surgery usually takes up to 6 weeks after surgery, whilst the wound takes 1-2 weeks to heal.
Written by Dr Winston Chew Yoon Chong, Hand Surgeon.
