Carpal tunnel syndrome is a condition that causes numbness, tingling, and pain in the hand and forearm. The condition occurs when the median nerve of the hand is squeezed or compressed as it travels through the wrist.
In most cases, carpal tunnel syndrome gets worse over time. If untreated for too long, it can lead to permanent dysfunction of the hand, including
- loss of sensation in the fingers
- weakness
For this reason, it is important to diagnose and treat carpal tunnel at an early stage.
Early Symptoms Can Often Be Relieved With Simple Measures Like:
- Wearing a wrist splint while sleeping
- Exercises to keep the nerve mobile
- Avoiding certain activities that aggravate your symptoms
If pressure on the median nerve continues, it can lead to nerve damage and worsening symptoms. To prevent permanent damage, surgery to take pressure off the median nerve may be recommended for some patients
Anatomy
The carpal tunnel is a narrow passageway in the wrist, about an inch wide. The floor and sides of the tunnel are formed by small wrist bones called carpal bones.
The Carpal tunnel anatomy Explained
The carpal tunnel contains the median nerve and flexor tendons that helps to bend the fingers and thumb.
- The roof of the tunnel is a strong band of connective tissue called the transverse carpal ligament. Because these boundaries are very rigid, the carpal tunnel has little capacity to stretch or increase in size.
- The median nerve travels down the upper arm, elbow, and forearm, then passes through the carpal tunnel at the wrist to reach the hand and fingers. These nerves helps in sensations in the thumb, index finger, middle finger, and half of the ring finger (the thumb side). It also controls the muscles around the base of the thumb.
- The nine flexor tendons that helps to bend the fingers and thumb also travel through the carpal tunnel with the nerve.
Description
Carpal tunnel syndrome occurs when the tunnel becomes narrowed or when the tissue surrounding the flexor tendons (known as synovium) swells, putting pressure on the median nerve and reducing its blood supply. This abnormal pressure on the nerve can result in numbness, tingling, pain, and weakness in the hand.
Who is at the risk of Carpal tunnel syndrome ?
Most cases of carpal tunnel syndrome are caused by a combination of factors. Studies show that women and older people are more likely to develop the condition.
Heredity -The carpal tunnel may be naturally smaller in some people, or there may be anatomic differences that change the amount of space for the nerve; and these traits can run in families.
Repetitive hand use – Repeating the same hand and wrist motions or activities over a prolonged period of time may aggravate the tendons in the wrist, causing swelling that puts pressure on the nerve.
Hormonal changes during pregnancy can cause swelling that results in pressure on the nerve. Health conditions like Diabetes, rheumatoid arthritis, and thyroid gland imbalance are conditions that are associated with carpal tunnel syndrome.
Symptoms Seen In Carpal Tunnel Syndrome
Numbness, tingling, burning, and pain primarily in the thumb and index, middle, and ring fingers. This often wakes people up at night. Occasional shock-like sensations that radiate to the thumb and index, middle, and ring fingers. Pain or tingling that may travel up the forearm toward the shoulder
Weakness and clumsiness in the hand , this may make it difficult to perform fine movements such as buttoning your clothes .Dropping things due to weakness, numbness, or a loss of proprioception (awareness of where your hand is in space)
In most cases, the symptoms of carpal tunnel syndrome begin gradually, without a specific injury. Many patients find that their symptoms come and go at first. However, as the condition worsens, symptoms may occur more frequently or may persist for longer periods of time.
Night time symptoms are very common. Because many people sleep with their wrists bent, symptoms may awaken you from sleep. During the day, symptoms often occur when holding something for a prolonged period of time with the wrist bent forward or backward, such as when using a phone, driving, or reading a book.
Many patients find that moving or shaking their hands helps relieve their symptoms.
Diagnosing Carpal Tunnel Syndrome
Press down or tap along the median nerve on the palm side of your wrist and hand to see if it causes any tingling into your fingers (Tinel’s sign).
Bend and hold your wrists in a flexed position to test for numbness or tingling in your hands.
Test sensitivity in your fingertips and hands by lightly touching them with a special instrument while your eyes are closed.
Check for weakness and atrophy in the muscles around the base of your thumb. In severe cases, these muscles may become visibly smaller.
Tinel’s test for nerve damage – To perform Tinel’s test for nerve damage, your doctor will tap on the inside of your wrist over the median nerve.
Detecting Carpal Tunnel Syndrome Through Investigations
- Nerve conduction studies (NCS) measure the signals travelling in the nerves of your hand and arm and can detect when a nerve is not conducting its signal effectively.
- Electromyogram (EMG) measures the electrical activity in muscles. EMG results can show whether you have any nerve or muscle damage.
- Ultrasound help create pictures of bone and tissue. Ultrasound of wrist helps to evaluate the median nerve for signs of compression.
- X-rays provide images of dense structures, such as bone. If you have limited wrist motion or wrist pain, it helps to exclude other causes for your symptoms, such as arthritis, ligament injury, or a fracture.
- Magnetic resonance imaging (MRI) scans provide better images of the body’s soft tissues than X-rays. It helps to determine other causes for your symptoms or to look for abnormal tissues that could be impacting the median nerve; such as a tumour or scarring from an injury.
How To Manage Carpal Tunnel Syndrome
Although it is a gradual process, for most people carpal tunnel syndrome will worsen over time without some form of treatment. For this reason, it is important to be evaluated and diagnosed by your doctor early on. In the early stages, it may be possible to slow or stop the progression of the disease.
Nonsurgical Treatment
If your symptoms are mild, your doctor will recommend nonsurgical treatment first.
- Wrist brace – Wearing a splint or brace reduces pressure on the median nerve by keeping your wrist straight.
- Activity changes – Symptoms often occur when your hand and wrist are in the same position for too long , particularly when your wrist is flexed or extended. Changing or modifying activities can help slow or stop progression of the disease. In some cases, this may involve making changes to your work site or workstation.
- Nerve gliding exercises – It help the median nerve move more freely within the confines of the carpal tunnel.
Surgical Treatment
Surgery may also be recommended if you do not get relief with non-operative treatments and/or demonstrate significant nerve changes on testing.
Carpal tunnel release – the goal of both is to relieve pressure on your median nerve by cutting(divide) the ligament that forms the roof of the tunnel (transverse carpal ligament). Release of this ligament increases the size of the tunnel and decreases pressure on the median nerve, allowing for appropriate blood flow to the nerve and function of the nerve.
Endoscopic carpal tunnel release. In endoscopic surgery, your doctor makes one or two smaller skin incisions (called portals) and uses a miniature camera, or endoscope, to see inside your hand and wrist. A special knife is used to divide the transverse carpal ligament, similar to the open carpal tunnel release procedure.
The outcomes of open surgery and endoscopic surgery are similar. There are benefits and potential risks associated with both techniques. Your doctor will talk with you about which surgical technique is best for you.
Lets Restart Life
Immediately after surgery, you will be encouraged to elevate your hand above your heart and move your fingers to reduce swelling and prevent stiffness. You should expect some pain, swelling, and stiffness after your procedure. Minor soreness in your palm may last several weeks to several months.
Night time symptoms improve dramatically for most patients in the first week or so after surgery. Grip and pinch strength usually return several months after surgery. Numbness and tingling tend to improve over the first several months after surgery.
You may have to wear a splint or wrist brace for several weeks after surgery. You will be allowed to use your hand for light activities, taking care to avoid significant discomfort.
Keep in mind
Although complications are possible with any surgery, the most common complications of carpal tunnel release surgery include:
- Bleeding
- Infection
- Wound healing issues
Nerve aggravation or injury
What To Expect
For most patients, complete recovery may take up to a year. If you have another condition that causes pain or stiffness in your hand or wrist, such as arthritis or tendinitis, it may slow your overall recovery.