Carpal Tunnel Syndrome

The human wrist is surrounded by fibrous tissue that normally acts as support for the joint. Carpal tunnel is the tight space between this fibrous band and the wrist bone. The median nerve runs from the forearm through a passageway in your wrist to your hand. It is responsible for providing sensation to the palm side of your thumb and fingers with the exception of your little finger. It also sends nerve signals to move the muscles around the base of your thumb (motor function).

Carpal tunnel syndrome is a hand and arm condition that causes numbness, tingling and other symptoms. The carpal tunnel is a narrow passageway bound by bones and ligaments located on the palm side of your wrist. It protects a main nerve in your hand and 9 tendons that bend your fingers.

What causes carpal tunnel syndrome?

Carpal tunnel syndrome is caused by a pinched nerve in your wrist.

Several factors contribute to carpal tunnel syndrome. This includes the anatomy of your wrist, underlying health problems and possibly patterns of hand use.

Generally, anything that crowds, irritates or compresses the median nerve in the carpal tunnel can lead to the syndrome. For instance, a wrist fracture can narrow the carpal tunnel and irritate the nerve, as well as swelling and inflammation resulting from rheumatoid arthritis.

No single cause can be identified in many cases. It could be caused by a combination of risk factors and each condition contribute to the development of the syndrome.

For most people who develop this syndrome, proper treatment can normally relieve the tingling and numbness as well as restore wrist and hand function.

SYMPTOMS OF CARPAL TUNNEL SYNDROME

The symptoms normally develop gradually. Numbness or tingling can be experienced in your thumb, index and middle fingers that comes and goes. This may be associated with discomfort in your wrist and hand.

Common symptoms include:

• Tingling or numbness: Experienced in your fingers or hand, especially your thumb and index, middle or ring fingers but not the little finger. Often occurs while holding a steering wheel, phone, newspaper or when waking up from sleep. This sensation may extend from the wrist to the arm. To relieve their symptoms, many people “shake out” their hands. As it progresses, sensation may become constant.
• Weakness: Weakness may be experienced in the hand and there is a tendency to drop objects. This is due to the numbness in the hand or weakness of the thumb’s pinching muscles.

TREATMENT OPTIONS AVAILABLE FOR CARPAL TUNNEL SYNDROME

This disorder should be treated as soon as possible after noticing the symptoms.

Some people with mild symptoms may ease the discomfort by taking frequent breaks to rest their hands, avoid activities that may worsen symptoms and apply cold packs to decrease occasional swelling.

Additional treatment options include wrist splinting, medications and surgery if these techniques don’t offer relief within a few weeks. Splinting and other conservative treatments are more likely provide relief if you’ve only experienced mild to moderate symptoms for less than 10 months.

Nonsurgical therapy

Nonsurgical methods may help improve carpal tunnel syndrome if it was diagnosed early. Treatment method may include:

• Wrist splinting: A splint that holds the wrist while sleeping can help to relieve nighttime symptoms. Nocturnal splinting may be a good option if you’re pregnant and have the disorder.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Drugs like Ibuprofen (Advil, Motrin IB, others) may help to relieve pain from carpal tunnel syndrome in the short term. However, there isn’t evidence that these drugs can improve carpal tunnel syndrome.
• Corticosteroids: Your carpal tunnel may be injected with corticosteroid such as cortisone to relieve pain. Corticosteroids can decrease inflammation and swelling (which relieves pressure on the median nerve). Oral corticosteroids aren’t as effective as corticosteroid injections when treating carpal tunnel syndrome. If the disorder is a result of inflammatory arthritis such as rheumatoid arthritis, then treating the arthritis itself may help to reduce symptoms of carpal tunnel syndrome. However, this hasn’t been proved.

Surgery

Severe symptoms or symptoms that persist after trying nonsurgical therapy may require surgery.

The goal is to relieve pressure on the median nerve by cutting the ligament pinching the nerve.

The surgery may be performed via 2 different techniques; endoscopic surgery and open surgery.  It’s important to discuss the risks and benefits of each technique with your surgeon. The risks of surgery may include incomplete release of the ligament, wound infections, scar formation and nerve or vascular injuries. The final results of endoscopic and open surgery are similar.

• Endoscopic surgery: A telescope-like device with a tiny camera attached to it is used to see the inside of your carpal tunnel and to cut the ligament through 1 or 2 small incisions made in your hand or wrist. Endoscopic surgery may cause less pain than open surgery in the first few days or weeks after surgery.
• Open surgery: A larger incision is made in the palm of the hand over the carpal tunnel and cuts through the ligament to free the nerve. Alternatively, this surgery can be conducted with a smaller incision which may reduce the risk of complications.During the healing process, the ligament tissues gradually grow back together and allow more room for the nerve than beforeGenerally, your doctor will encourage you to use your hand after surgery working back to normal use of your hand while avoiding forceful hand motions or extreme wrist positions.Soreness or weakness after surgery may take from several weeks to a few months to recover. Severe symptoms after surgery may not go away completely after surgery.

DIAGNOSING CARPAL TUNNEL SYNDROME

• Consult with a doctor: Your symptoms will be reviewed by your doctor. Pattern of your signs and symptoms may offer clues to the cause. For instance, as the median nerve doesn’t provide sensation to your little finger, symptoms in that finger may indicate a problem other than carpal tunnel syndrome.Timing of the symptoms is another clue. The usual times when symptoms are experienced due to carpal tunnel syndrome include while holding a phone or a newspaper, gripping a steering wheel, or waking up during the night.
• Physical examination: Your doctor will test the feeling in your fingers and the strength of the muscles in your hand.Putting pressure on the median nerve at the wrist by bending the wrist, tapping on the nerve or simply pressing on the nerve may bring on the symptoms in many people.
• X-ray: Sometimes an X-ray of the affected wrist may be recommended to exclude other causes of wrist pain such as arthritis or a fracture.
• Electromyogram: Tiny electrical discharges produced in muscles are measured. A thin-needle electrode is inserted into specific muscles. It evaluates the electrical activity of your muscles when they contract and when at rest. It determines if muscle damage has occurred and also may be used to rule out other conditions.
• Nerve conduction study: In a variation of electromyography, 2 electrodes are taped to your skin. A small shock is administered to the median nerve to see if electrical impulses are slowed in the carpal tunnel. It may be used to diagnose your condition and rule out other conditions.