Carpal Tunnel Syndrome
Carpal tunnel syndrome is a widespread hand condition resulting from median nerve pressure. This pressure occurs within the carpal tunnel, a narrow pathway enclosed by bones and ligaments on the palm side of the hand. Compression of this nerve can trigger symptoms such as tingling, numbness, and weakness in the thumb and fingers.
Factors such as wrist anatomy, underlying health conditions, and repeated hand movements may lead to the development of carpal tunnel syndrome.
Symptoms
Carpal tunnel syndrome symptoms develop gradually and may comprise:
- Numbness, burning, tingling, and pain—mainly affecting the thumb, middle, index and ring fingers. These sensations often worsen at night, frequently disrupting sleep.
- Shock-like sensations that may radiate to the affected fingers.
- Pain or tingling that can extend up the forearm toward the shoulder.
- Hand weakness and clumsiness, making simple tasks like buttoning clothes more difficult.
- Dropping objects because of numbness, weakness or reduced proprioception (awareness of hand position).
Symptoms usually start gradually and may come and go at first. Nonetheless, as the condition exacerbates, they can become more frequent.
Many people experience symptoms while sleeping at night, as wrist positioning can increase pressure on the median nerve. In the daytime, symptoms arise when holding objects with the wrist bent for extended periods, like driving, using a phone, or reading.
Most individuals experience symptom relief by moving and shaking their hands.
Causes
Carpal tunnel syndrome results from a combination of several factors. Research suggests that women and older individuals are at a higher risk of developing the condition.
Some of the risk factors comprise:
- Heredity: Some people naturally have a smaller carpal tunnel or anatomical differences that reduce space for the median nerve. These traits can be inherited.
- Repeated hand use: Doing similar hand or wrist motions over long periods can irritate tendons, leading to swelling and increased pressure on the nerve.
- Hand and wrist position: Activities involving prolonged extreme wrist and hand flexion or extension can contribute to nerve compression.
- Pregnancy: Certain hormonal fluctuations during pregnancy may lead to swelling that puts stress on the median nerve.
- Underlying conditions: Certain medical conditions, such as rheumatoid arthritis, diabetes, and thyroid disorders, are linked to an increased risk of carpal tunnel syndrome.
Diagnosis
Carpal tunnel syndrome is diagnosed by assessing your symptoms and performing specific tests to confirm the condition.
- Symptom history: The pattern of symptoms is key to diagnosis. Carpal tunnel syndrome frequently causes discomfort when using a phone, gripping a steering wheel or reading. Symptoms frequently worsen at night, sometimes waking individuals from sleep. Numbness may also be noticeable upon waking in the morning. However, the little finger is not affected by the median nerve. If symptoms involve this finger, another condition may be the cause.
- Physical examination: The provider will test the sensation in the fingers and the muscle strength of the hand. Symptoms can be triggered by tapping the nerve, bending the wrist and applying pressure to the nerve.
- X-ray: Used to rule out fractures and arthritis, even though it does not diagnose carpal tunnel syndrome.
- Ultrasound: Produces images of the tendons and nerves in order to help check for nerve compression.
- Electromyography (EMG): Involves inserting a thin needle electrode into muscles to measure electrical activity during contraction and rest. EMG helps detect nerve-related muscle damage and rule out other conditions.
- Nerve conduction study: Two electrodes attached to the skin are used to pass a small electrical impulse through the median nerve. It checks if the impulse slows in the carpal tunnel. Healthcare providers use nerve conduction studies to diagnose carpal tunnel syndrome and exclude other conditions.
Treatment for Carpal Tunnel Syndrome
Early carpal tunnel syndrome treatment can assist in managing symptoms and preventing the condition from worsening. Simple self-care measures may reduce discomfort if addressed in the early stages. These strategies include:
- Taking regular breaks to rest your hands.
- Avoiding activities that worsen symptoms.
- Applying cold packs to minimise swelling.
Nonsurgical options:
If detected early, non-invasive treatments may help manage carpal tunnel syndrome, particularly in mild to moderate cases that have lasted less than 10 months. Options include:
Wrist splinting
Wearing a wrist splint at night can help keep the wrist in a neutral position, reducing tingling and numbness. Night splinting may as well help prevent daytime symptoms and is a safe option for pregnant women, as it doesn’t involve medication.
Medications
Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin IB) might offer temporary pain relief. However, research does not show that NSAIDs significantly improve the condition.
Corticosteroid injections
A healthcare provider can administer corticosteroids (like cortisone) into the carpal tunnel to reduce inflammation and swelling as well as to relieve stress on the median nerve. Ultrasound guidance is sometimes used to ensure precise injection placement. Oral corticosteroids are generally less effective than injections for carpal tunnel syndrome.
Surgical options:
If symptoms are severe or nonsurgical treatments don’t help, surgery can be required. The goal of the procedure is to cut the transverse carpal ligament in order to relieve pressure on the median nerve.
Types of surgeries done to address carpal tunnel syndrome include:
Endoscopic surgery
This is done using a tiny camera (endoscope) to view the carpal tunnel. The ligament is cut through one or two small cuts in the hand or wrist. This method may cause less pain and a quicker recovery than open surgery in the initial days or weeks.
Open surgery
A larger incision is made in the palm above the carpal tunnel. The ligament is cut directly in order to relieve nerve pressure.
Ultrasound-guided surgery
While this is the same as endoscopic surgery, it involves using ultrasound imaging instead of a camera. The ligament is cut using a small knife or a braided wire inserted through a needle in the wrist.
Recovery after Carpal Tunnel Surgery
During recovery, the ligament tissues progressively grow back together but with more space for the median nerve. Whereas the skin normally heals within a few weeks, internal healing can take several months.
Your surgeon will advise when it is safe to start using your hand again. Gradually return to full use of the hand and avoid forceful hand movements and intense wrist positions during recovery to prevent strain.
Bottom Line
Carpal tunnel syndrome can significantly impact your daily life; but early diagnosis and proper treatment can assist in relieving symptoms and restoring hand function. Whether through conservative treatments or surgery, there are effective solutions to help you.
Make an appointment with us today to discuss your treatment options and take a step toward relief!