Definition:
Carpal tunnel syndrome is a progressively painful hand and arm condition caused by a pinched nerve in your wrist.
Bound by bones and hand ligaments, the carpal tunnel is a narrow passageway located on the palmar side of the wrist. This tunnel protects a main nerve to your hand and tendons to your fingers. Compression of the nerve produces the numbness, pain and, eventually, hand weakness that characterize carpal tunnel syndrome.
Early and proper treatment can relieve the pain and numbness and restore normal use of their wrists and hands.
What is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome is the most common nerve constriction causing numbness in the hands. It is caused by excessive pressure on the median nerve as it goes across the wrist into the hand. This nerve is the main nerve providing sensation in the hand and control of the thumb muscles. Along with the flexor tendons to the fingers, this nerve goes through a tunnel at the wrist, consisting of the wrist bones and a thick band of fibrous tissue across the top.
Any increase in the pressure within this space will decrease blood flow to the median nerve, affecting its function and causing numbness, tingling, and burning pain in the hand. Out of every 1000 people, 3-5 will develop carpal tunnel syndrome in their lifetime.
What are the Symptoms?
The typical history of carpal tunnel syndrome starts with night symptoms of tingling, pain and numbness in the hand, often on both sides. It may wake the patient up at night and the patients finds relief in shaking his or her hands for the numbness to go away.
Symptoms most often occur in the thumb, index finger, middle finger, and half of the ring finger. It can progress to having the same symptoms during the day and eventually, to having constant numbness and paranesthesia. Weakness of thumb muscles develops in the later stages of the problem
How Do I Know I Have it?
If you have numbness, tingling or burning pain in the thumb, index, middle or ring fingers you may have carpal tunnel syndrome. These symptoms usually are worse in the morning after waking up and may sometimes wake you up from sleep.
Gripping an object tightly, using a mobile phone or holding up a newspaper can also trigger these symptoms. Tingling, pain, and stiffness are worse when the hands are cold and better when warm. Shaking the hands vigorously usually relieves the symptoms. Over time, the ability to feel becomes worse. It may feel as if there is a layer between the skin and the object making it harder to feel it properly. The thumb muscles may become weak and waste away, resulting in difficulty performing simple tasks like doing up buttons or picking up coins.
It is important to see a hand surgeon to get the right diagnosis and treatment if you have numbness or tingling in the hands. Your hand surgeon may order a nerve conduction study, ultrasound scan or MRI of the hand to help confirm the diagnosis.
Other nerve compressions can cause numbness or pain in the hands, such as cubital tunnel syndrome (ulnar nerve compression at the elbow) and pronator tunnel syndrome (median nerve compression in the forearm). These less common conditions may be misdiagnosed as carpal tunnel syndrome resulting in the wrong treatment.
When to See a Doctor?
If you have persistent signs and symptoms suggestive of carpal tunnel syndrome, especially if they interfere with your normal activities and sleep patterns, see your doctor. If you leave the condition untreated, nerve and muscle damage can occur.
Some people with mild symptoms of carpal tunnel syndrome can ease their discomfort by avoiding extreme bending or extending the wrist during sleep. Normal activities that involve a lot of repetitive wrist motion should also be avoided. If these techniques don’t offer relief within a few weeks, additional treatment options include wrist splinting, medications and surgery. Splinting and other conservative treatments are more likely to help you if you’ve had only mild to moderate symptoms for less than 10 months.
What Causes Carpal Tunnel Syndrome?
The pressure in this tunnel increases as we grow older due to thickening of the tendons from repeated daily use. Other conditions such as wrist fractures, gout, or tumours may also increase the pressure in this tunnel. The increased pressure decreases blood flow to the nerve, impairing its function.
Carpal tunnel syndrome is also commonly associated with frequent repetitive work using the hands for long hours. Production line workers and homemakers, and those who work long hours at the computer keyboard with poor posture are at greater risk.
Pregnant women are also susceptible due to water retention. It is also more common among people with diabetes, renal failure, hypothyroidism, and rheumatoid arthritis.
How is Carpal Tunnel Syndrome Treated?
Conservative Treatment
Early or mild carpal tunnel syndrome can be treated by keeping the wrist in a brace especially when sleeping and avoiding postures and activities that increase the pressure around the nerve. Non-steroidal anti-inflammatory medication, high dose Vitamin B6 and steroid injections around the nerve may also provide temporary relief. Special “nerve gliding” exercises done several times a day can help loosen the median nerve in the carpal tunnel.
Conservative treatment is often effective in early and mild carpal tunnel syndrome but may not work if the symptoms have already been present for several months. Symptoms may recur after successful conservative treatment. If symptoms do not improve after 2-3 months of conservative treatment, or if symptoms keep coming back later, surgery will be needed.