Overview
Carpal tunnel syndrome is a hand and wrist condition where the median nerve is compressed. This results in symptoms of pain, weakness, and numbness which may radiate up to the affected arm.
The carpal bones and the transverse carpal ligament create a narrow tunnel known as the carpal tunnel. This tunnel is a small area where the median nerve and the tendons from flexor muscles of the forearm are housed.
Due to its fixed area, when irritated tendons or other forms of swelling occur, the space within it becomes narrowed. This in turn compresses the median nerve, which controls sensations to the palmar aspect of the thumb and fingers, except for the little finger.
Causes
- Repetitive movements of the wrist
- Irritated flexor tendons
- Other existing conditions
- Rheumatoid arthritis
- Diabetes
- Hypothyroidism
- Pregnancy
There are several factors that can increase the chances of aggravating the median nerve and developing carpal tunnel syndrome.
These factors include:
- Sex – Generally, carpal tunnel syndrome is more common among women
- Anatomic factors – A wrist dislocation or fracture that affects the space within the carpal tunnel can result in extraneous pressure on the median nerve
- Inflammatory conditions – Conditions like rheumatoid arthritis and other diseases characterized by inflammation might also affect the tendons on the wrist, putting pressure on the median nerve in the process
- Nerve-damaging illnesses – Chronic diseases like diabetes can increase one’s risk of nerve damage including likely damage to the median nerve
- Workplace factors – Work that entails repetitive or prolonged flexing of the wrist may create unwanted pressure on the median nerve and can lead to nerve damage
- Other medical conditions – Certain conditions like kidney failure, thyroid disorders, menopause, and obesity can increase one’s chances of developing carpal tunnel syndrome
Symptoms
In most cases, symptoms of carpal tunnel syndrome usually start with tingling or numbness in the index, thumb, and middle fingers. This tingling sensation can come and go.
Other prevalent signs of the condition can include the following:
- Pain of wrist and/or hand
- Numbness of wrist and/or hand
- Weakness of wrist and/or hand
- All three symptoms above may also radiate to the arm
If signs and symptoms become persistent and interfere with routine activities and even affecting sleeping patterns, it is advisable to seek medical treatment. If left untreated, the condition can result in permanent muscle and nerve damage.
Diagnosis
Apart from reviewing patient’s symptoms and conducting a physical examination, the doctor may order the following tests for diagnosis:
- Electromyogram – This device works by measuring the tiny electrical discharges that are produced in the muscles. In essence, this test will evaluate the electrical activity of the muscle both when contracting and at rest. Electromyogram can help determine if there is existing muscle damage. It can also be used to effectively rule out other conditions
- X-ray – Doctors would sometimes require an X-ray of the affected wrist. This is done to rule out other possible causes of wrist pain like fracture or arthritis
- Nerve conduction study – This test is done to rule out other possible conditions that might manifest the same symptoms
Prevention
While there are no infallible strategies that have been proven effective in preventing the onset of carpal tunnel syndrome, several ways are recommended to efficiently minimize hand and wrist stress:
- Breaks – Apart from gentle stretches and periodical bending, it is advisable to give your hands and wrists frequent breaks. When engaged in activities that involve exerting a tremendous amount of force, taking periodic breaks should be deemed vital.
- Form – At all times, make sure you do not bend your wrist all the way up or down. Aim for a relaxed middle position instead. When utilizing a keyboard, ensure you keep it at elbow height or lower.
- Grip – Manual tasks that involve using force can also increase one’s chance of developing carpal tunnel syndrome. Case in point: if your work entails prolonged handwriting, use a big pen that comes with a soft grip adapter. This will help guarantee you won’t need to grip the pen tightly as you perform the task.
- Posture – While unknown to many, incorrect posture can compress the nerves found in the neck. This can also affect the fingers, hands, and wrists.
Treatment
Treatment for carpal tunnel syndrome is aimed to allow you to regain the normal function in your fingers and hand. For mild cases, the surgeon might recommend resting the wrist with a splint. Physiotherapy sessions may help with range-of-motion exercises to improve your posture, flexibility, and also to strengthen the muscles affected.
Given that the carpal tunnel syndrome is diagnosed early, some nonsurgical methods can be adapted to help improve the condition.
Some of these methods may include:
- NSAIDs – NSAIDs like ibuprofen may help effectively alleviate pain and inflammation.
- Corticosteroids – Corticosteroids minimize swelling and inflammation thereby relieving pressure on the median nerve. However, oral corticosteroids are considered less effective compared to corticosteroid injections when treating carpal tunnel syndrome.
- Wrist splinting – Nocturnal splinting is highly beneficial in relieving common nighttime symptoms like numbness and tingling. It is also advisable for pregnant women suffering from the condition.
Surgery is considered for chronic cases after other treatment options have failed to yield satisfying results or if there is a risk of nerve damage. The surgery can be carried out using any of the two techniques:
- Open surgery – In open surgery, a large incision is made in the palm of the hand over the carpal tunnel. The incision will also cut through the ligament in order to free the nerve.
- Endoscopic surgery – This type of surgery employs a telescope-like device that comes equipped with a tiny camera to make the incision and cut through the ligament.
As a general rule of thumb, it is recommended that the benefits and risks of each should be thoroughly discussed with the surgeon. Surgery risks may include vascular or nerve injuries, scar formation, and wound infections among others.
After the surgery, patients are usually encouraged to gradually use their hands. However, extreme wrist positions and forceful hand motions should be avoided at all cost.