There are eight small bones called carpal bones in the wrist, with a ligament that lies across the front of the wrist. In-between these carpal bones and the ligament there is a space called the carpal tunnel. The tendons that attach the forearm muscles to the fingers pass through this tunnel. One of the three main nerves going to the hand (the median nerve) also passes through this tunnel before dividing into smaller branches.
The median nerve is in charge of the sensation of the thumb, index and middle fingers, and half of the ring finger. Moreover, it controls the movement of the small muscles at the base of the thumb.
What is Carpal Tunnel Syndrome?
It represents a cascade of symptoms believed to be due to the compression of the median nerve while passing through the carpal tunnel. Women are more likely than men to develop carpal tunnel syndrome and although the condition affects people of all ages, it’s more common in middle aged and elderly people.
It is also more common among obese people and it often runs in families. It is more common in women who are pregnant.
What could be the symptoms?
- Sense of Pins and needles. The patient will complain of tingling or burning sensation in part or all of the involved area of the hand. Usually, this is the first symptom to develop. The index and middle fingers are commonly the first to be affected.
- Pain in the same fingers may then develop. The pain may travel up the forearm and even to the shoulder.
- Numbness of the same finger(s), or in part of the palm, may develop if the condition becomes worse.
- Dryness of the skin may develop in the same fingers.
Weakness of some muscles in the fingers and/or thumb occurs in severe cases. This may cause poor grip and eventually lead to muscle wasting at the base of the thumb.
Indeed, symptoms and its severity vary from one person to the other. The problem may involve one or both hands simultaneously. Initially, the symptoms tend to come and go, often induced by the use of the hand. With progression the problem, the symptoms tend to become persistent. Characteristically, the symptoms are worse during the night and the person may wake up with tingling or even pain.
Another commonly-encountered comment is that symptoms may be eased for a while by raising the hand. Also, flicking/shaking the wrist may give some temporary relief.
What could be the causes for carpal tunnel syndrome?
The symptoms associating carpal tunnel syndrome are due to excess pressure in the wrist and on the median nerve. Inflammation can cause swelling. The leading cause of this inflammation is an underlying medical condition that causes swelling at the wrist, and sometimes it can hinder blood flow. Some of the most common ailments that are linked with carpal tunnel syndrome are:
- thyroid dysfunction
- fluid retention (e.g. pregnancy or menopause)
- high blood pressure
- autoimmune disorders such as rheumatoid arthritis
- Wrist fractures
- Occupational: repetitive motions of the wrist may contribute to swelling and compression of the median nerve. Such may include:
- poor positioning of the wrists while using keyboard or mouse for long periods
- prolonged exposure to vibrations from using hand tools or power tools
- repeated overextending wrist movements, such as typing and piano playing
What tests could be done?
Usually the symptoms are so typical that no tests are required to confirm the diagnosis. However, in certain situations where the case is not so clear, a neurological test to measure the speed of the nerve impulse through the carpal tunnel may be requested by the attending doctor; Nerve Conduction Test.
Ultrasound uses high-frequency sound waves to help create pictures of bone and tissue. Attending doctor may recommend an ultrasound of the wrist to evaluate the median nerve for signs of compression.
Magnetic resonance imaging (MRI) scans provide enhanced images of the body’s soft tissues. Attending doctor may request an MRI to help determine other causes for the symptoms or to look for abnormal tissues that could be impacting the median nerve. An MRI can also help the doctor determine if there are any problems with the nerve itself (such as scarring from an injury or tumor).
What could be treatment plan?
Although it is a gradual process, for most people carpal tunnel syndrome will worsen over time without some form of treatment. Hence, it is essential to be evaluated and diagnosed by the doctor early on. In the early stages, it may be possible to slow or even stop the progression of the problem.
Refrain from the over-use of the wrist by excessive and repeated squeezing and/or gripping movements. Overweight is one of the prime suspects so striving to lose some weight may help. Oral anti-inflammatory / painkiller medications may be prescribed to ease the pain. If the cause is identifiable (e.g. arthritis) then treating it may help in reducing the pain.
A removable wrist splint / brace is often advised as a first line of treatment. The aim of the splint is to keep the wrist at a neutral angle without applying any force over the carpal tunnel so as to rest the nerve. This may cure the problem if used for a few weeks in combination with oral anti-inflammatory medications course.
An injection of steroid into, or near to, the carpal tunnel is an option which several doctors advocate. Corticosteroid, or cortisone, is a powerful anti-inflammatory agent that can be injected into the carpal tunnel. Although these injections often relieve painful symptoms or help to calm a flare up of symptoms, their effect is sometimes only temporary.
If nonsurgical treatment does not relieve symptoms after a period of time, the attending doctor may recommend a surgical intervention.
The decision whether to have surgery is based on the severity of symptoms; how much pain and numbness the patient feels in his hand. In long-standing cases with constant numbness and wasting of thumb muscles, surgery may be recommended to prevent irreversible damage of the nerve.
A small surgical procedure can cut the ligament over the front of the wrist and ease the pressure in the carpal tunnel to give the compressed nerve more space. This usually cures the problem. In most cases, carpal tunnel surgery is done on an outpatient basis. The surgery can be done under general anesthesia, which puts the patient to sleep, or under local anesthesia, which numbs just the hand and arm. The Orthopedic surgeon in charge will discuss which technique is appropriate for his patient.
As for recovery, immediately following surgery the patient will be encouraged to elevate his hand above the heart level and move his fingers to reduce swelling and prevent stiffness. Off course the patient should expect some pain and swelling after the procedure but this can be easily countered by pain killers prescribed by the doctor. Minor soreness in your palm may last for several weeks to several months.
Usually grip and pinch strength return by about 2 to 3 months after surgery, during the first couple of weeks of which the patient is encouraged to wear a splint or wrist brace. The treating doctor will explain to his patient when he will be able to return to work and whether he will have any temporary restrictions on his work activities.
One last Advice
To help keeping carpal tunnel syndrome from coming back, the patient must take care of his basic health; staying at a healthy weight, refraining from smoking, regularly exercising to stay strong and flexible.
Dr. Mohamed Saddam, MD
Orthopedic Surgery Specialist
Coordinator of Orthopedic Department
German Medical CenterLeave a reply →