What is Carpal tunnel syndrome?
Carpal tunnel syndrome is a common condition that causes the pain, numbness, and tingling in the hand and arm. The condition occurs when one of the major nerves in the hand – the median nerve – is compressed as it travels through the wrist.
In most patients, the carpal tunnel syndrome gets worse over time, so early diagnosis and treatment are important. Early on, symptoms can often be relieved with simple measures such as wearing a wrist splint or avoiding certain activities.
Cause of Carpal tunnel syndrome
Most cases of the carpal tunnel syndrome are caused by a combination of factors. Studies show that women and the elderly are more likely to have this condition.
Other risk factors for the carpal tunnel syndrome include:
- Genetics. This is likely an important factor. The carpal tunnel may be smaller in some people or there may be anatomical differences that change the amount of nerve space – these features can run in families.
- Frequent manual use. Repeating the same hand and wrist movements or activities over an extended period of time may aggravate the wrist tendons, causing swelling that press on the nerve.
- Hand and wrist position. Doing activities that involve intense flexion or extension of the hand and wrist for an extended period of time can put more pressure on the nerve.
- The hormonal changes during pregnancy can cause swelling.
- Health conditions. Diabetes, rheumatoid arthritis, and thyroid imbalance are conditions associated with carpal tunnel syndrome.
Symptoms of Carpal Tunnel syndrome
Symptoms of carpal tunnel syndrome may include:
- Numbness, tingling, burning, and pain – primarily in the thumb, index, middle, and ring fingers
- Occasional bump-like sensations that radiate to the thumb, index, middle, and ring fingers
- The pain or tingling that may travel up the forearm toward the shoulder
- Weakness and clumsiness in the hand – this can make it difficult to perform precise movements such as buttoning your clothes
- dropping objects – due to weakness, numbness or loss of proprioception (perception of where your hand is in space)
In most cases, symptoms of carpal tunnel syndrome begin gradually – without specific injury. Many patients find that their symptoms come and go at the first. However, as the condition worsens, symptoms may occur more frequently or may last for longer periods of time.
Nocturnal symptoms are very common. Since many people sleep with the wrist bent, symptoms may wake you from sleep. During the day, symptoms often appear when holding something for an extended period of time with the wrist bent forward or backward, such as when using a phone, driving, or reading a book.
Treatment of Carpal Tunnel Syndrome
Although it is a gradual process, for most people, carpal tunnel syndrome will get worse over time without any form of treatment. For this reason, it is important to be evaluated and also diagnosed by your doctor early on. In the early stages, it may be possible to slow or stop progression of the disease.
1. Non-surgical treatment
If carpal tunnel syndrome is diagnosed and treated early, symptoms of carpal tunnel syndrome can often be relieved without surgery. If your diagnosis: is uncertain or if your symptoms are mild. The doctor will recommend the nonsurgical treatment first.
Non-surgical treatments may include:
Bracing or splinting
Wearing a brace or the splint at night will prevent you from bending your wrist while you sleep. Keeping your wrist straight or neutral reduces pressure on the nerve in the carpal tunnel. It may also be helpful to wear a splint during the day when doing activities that exacerbate symptoms.
Non-steroidal anti-inflammatory drugs (NSAIDs). Medicines such as ibuprofen and naproxen can help reduce pain and inflammation.
Symptoms often occur when your hand and wrist are in the same position for too long — particularly when your wrist is bent or extended.
If your job or recreational activities worsen your symptoms, changing or modifying these activities can help slow or stop the progression of the disease. In some cases, this may involve making the changes to your worksite or the workstation.
Injecting a steroid into the carpal tunnel may relieve symptoms for a while.
Nerve gliding exercises
Some patients may benefit from exercises that help the median nerve to move more freely within the confines of the carpal tunnel.
A corticosteroid, or cortisone, is a powerful anti-inflammatory agent that can be injected into the carpal tunnel. Although these injections often relieve painful symptoms or help calm a flare-up, sometimes their effect is temporary. Your doctor may also use cortisone shot to help diagnose carpal tunnel syndrome.
If nonsurgical treatment does not relieve symptoms after a while, your doctor may recommend surgery.
The decision to have surgery depends on the severity of your symptoms – how much pain and numbness you have in your hand. In long-term cases with persistent numbness and wasting of the thumb muscles, surgery may be recommended to prevent irreversible damage.
2. Surgical procedure
The surgical procedure performed for the carpal tunnel syndrome is called “carpal tunnel release.” There are the two different surgical ways to do this, but the goal is to relieve pressure on the median nerve by cutting ligament that forms the roof of the tunnel. This increases the size of the tunnel and reduces pressure on the median nerve.
In most cases, the carpal tunnel surgery is performed on an outpatient basis. The surgery can be performed under general anesthesia, which puts you to sleep, or under local anesthesia, which numbs only your hand and arm. In some cases, you’ll also be given a mild sedative through an intravenous (IV) line inserted into a vein in your arm.
Open carpal tunnel. In open surgery, your doctor makes a small incision in the palm of your hand and looks inside your hand and wrist through this incision. During the procedure, your doctor will split the transverse carpal ligament (the roof of the carpal tunnel). This increases the size of the tunnel and reduces pressure on the median nerve.
Thumbay University Hospital offers expert care through a multidisciplinary team of compassionate reproductive and caring professionals, perinatal specialists, diagnostic experts, nursing staff and highly trained technicians. Our team will assist you throughout your personal experience from diagnosis to your individual treatment plan.