Carpal tunnel syndrome is a common condition that causes pain, numbness, weakness and tingling in the hand and arm.
The condition develops when one of the major nerves that runs from the wrist to the hand, the median nerve, is compressed.
The carpal tunnel is a narrow passageway in the wrist. The floor and sides of the tunnel are formed by small wrist bones called carpal bones. The carpal tunnel protects both the median nerve and flexor tendons that are responsible for bending the fingers and thumb.
The flexor tendons are protected by the synovium, which helps to lubricate the tendons making finger movements easier. When the synovium swells, it places pressure on the median nerve which causes pain and discomfort.
Early diagnosis and treatment are important. Initially, symptoms can often be relieved with wearing a wrist brace or avoiding certain activities. In most patients, however, carpal tunnel syndrome can get worse if left untreated.
Symptoms
Early symptoms include numbness at night, tingling, and/or pain in the fingers (especially the thumb, index, and middle fingers). These symptoms usually begin slowly and can happen at any time. Other symptoms include:
- Hand and wrist pain.
- A burning sensation in the middle and index fingers.
- Thumb and finger numbness.
- An electric-like shock through the wrist and hand.
Could you be at risk?
People at risk of developing this condition are those with jobs or activities that involve repetitive finger movements or wrist and hand movements involving high force, extreme movements and vibration.
Other carpal tunnel syndrome risk factors include:
- Heredity.
- Wrist fracture and dislocation.
- Hand or wrist deformity.
- Rheumatoid arthritis and gout.
- Thyroid gland hormone imbalance (hypothyroidism).
- Diabetes.
- Alcoholism.
- A mass or tumour in the carpal tunnel.
- Older age.
- Pregnancy.
Treatment
According to Harvard Medical School, ignoring symptoms of this common wrist problem can lead to permanent nerve damage. Therefore, it’s important to get medical help when you first notice persistent symptoms.
The purpose of treatment is to reduce or eliminate repetitive injury to the median nerve.
Usually, non-surgical treatments like medication, bracing or physical therapy are recommended. However, if those don’t provide enough relief, your doctor may do special investigations to determine if surgery is needed.
Physical therapy, along with avoiding aggravating activities, may be beneficial. These non-surgical measures may continue for one to two months. Specific hand and wrist exercises may be helpful too.
Before you can be given treatment, your doctor will evaluate the condition, look into your medical history; perform a physical examination and diagnostic test. The physical exam will include assessments of sensation, strength and reflexes.
Diagnostic studies may include:
- X-ray: To look at the bones of the wrist to determine if any abnormalities may contribute to the condition.
- EMG/NCS (Electromyogram and Nerve Conduction Study): These tests show how the nerves and muscles are working together. They measure the electrical impulse along nerve roots, peripheral nerves and muscle tissues.
- An open incision procedure involves the surgeon opening the wrist and cutting the ligament at the bottom of the wrist to relieve pressure.
- An endoscopic procedure involves smaller incisions, and using a mini camera to view the carpal tunnel. The possibility of nerve injury is slightly higher with endoscopic surgery, but your recovery and return to work may be quicker.
References:
- https://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/diagnosis-treatment/drc-20355608
- https://orthoinfo.aaos.org/en/diseases–conditions/carpal-tunnel-syndrome/
- https://my.clevelandclinic.org/health/diseases/4005-carpal-tunnel-syndrome
- https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Carpal-Tunnel-Syndrome
- https://www.health.harvard.edu/diseases-and-conditions/dont-delay-treatment-for-carpal-tunnel-syndrome