Carpal tunnel syndrome

Introduction

Person holding wrist affected by carpal tunnel syndrome

Carpal tunnel syndrome is a condition of the hand and forearm, which causes numbness, tingling and other symptoms. Sometimes it can expand to the shoulder also. It is caused by a pinched nerve in the wrist, called the median nerve. A number of factors can contribute to carpal tunnel syndrome, including the anatomy of the wrist, certain underlying health problems and possibly the patterns of using the hands.

The carpal tunnel is a narrow (tunnel) passage or tunnel like way, bounded by the bones and ligaments present inside the wrist. The tunnel protects the median nerve of the hands and nine tendons that help in bending your fingers. The compression of the median nerve causes numbness, tingling and weakness in the hands, resulting in carpal tunnel syndrome. But fortunately, carpal tunnel syndrome can be cured. A proper treatment helps relieve the tingling and numbness of the hands and restore the wrist and hand function.

Causes of Carpal Tunnel Syndrom:

Anatomy of wrist showing passageway for the median nerve

The median nerve runs from the forearm through the carpal tunnel to the side of the wrist. It is responsible for the sensation on the palm side of your thumb and the fingers, except the little finger. It also sends the nerve signals to the muscles around the base of the thumb (motor function). As mentioned above, Carpal tunnel syndrome occurs mainly due to compression of the median nerve at the carpal tunnel. For example, a wrist fracture can stretch the carpal tunnel and irritate the median nerve.

The majority of the cases are idiopathic, but the experts say that it can be triggered by a number of risk factors. Some of these are:

Anatomical factor:

A wrist fracture or dislocation that alters the space within the carpal tunnel can create strange pressure on the median nerve. People with smaller carpal tunnels may be more likely to have carpal tunnel syndrome.

Sex:

Carpal tunnel syndrome is more common in women than men. It is because the carpal tunnel area is relatively lower in women than men. The women, who have carpal tunnel syndrome, are also smaller in size than the women without the condition of carpal tunnel.

Conditions that damage the nervous system:

Some chronic diseases such as diabetes, increase the risk of nerve damage, including the damage to the median nerve.

Although, the above mentioned factors may trigger the condition, they directly do not cause carpal tunnel syndrome. They can increase the chances of developing or aggravating the median nerve damage, which in turn develop the symptoms of the condition gradually.

Symptoms of Carpal Tunnel Syndrome:

Palm numbness due to carpal tunnel syndrome

Patient experiences tingling, numbness and pain in the fingers/ hand. Sometimes, the pain spreads to the arms. Usually, the symptoms occur in the thumb, middle finger, and index finger. If you notice the symptoms in your other fingers except the ring finger, then you probably have the condition. It is because, the little finger is connected to a different nerve, not with the median nerve. Typically, the patients notice the symptoms at night. Many of them shake their hands to get relief from the symptoms when they notice the symptoms for the first time. As the disease progresses, the numbness becomes more significant.

You may also experience weakness in the hand, and a tendency to drop objects from the hands. This may be due to numbness in the hands or weakness of the muscles of the thumb grip that are controlled by the median nerve.

Tests and diagnosis:

History of symptoms:

  • Your doctor will first check the symptoms. Depending on the pattern of the signs and symptoms, particularly the function of the median nerve, he/she will diagnose the condition.
  • The physician will also ask if you are experiencing any medical issues like diabetes, arthritis, hypothyroidism, or you are pregnant.
  • The doctor will take the history, like if you recently hurt your wrist, arm, or neck. He/she will record your routine daily activities, which may possibly trigger the condition.
  • During the examination, the doctor will check the sensitivity, appearance, and strength of your neck, arms, shoulders, and hands.
  • Depending on the physical examination, the doctor may suggest some tests, such as nerve tests. In addition, some of the important tests are:

  • X-rays:
  • Some doctors recommend an x-ray of the affected area to rule out other causes of wrist pain, such as arthritis or wrist fracture.

  • EMG (electromyogram):
  • The test measures the electrical activity of the muscles, during the contraction and relaxation. It will help to rule out if there is any muscle damage, and also the underlying conditions.

    Treatment of Carpal Tunnel Syndrome:

    Carpal tunnel syndrome should be treated as soon as possible when you notice symptoms.

    Non-surgical therapy

    If the condition is diagnosed early, nonsurgical methods may help improve carpal tunnel syndrome. The methods may include:

    Wrist splints:

    A wrist splint, even while you sleep can help relieve night-time symptoms of tingling and numbness. A night splint can be a good option if you are pregnant and have carpal tunnel syndrome.

    Non-steroidal anti-inflammatory drugs (NSAIDs):

    NSAIDs such as ibuprofen may help ease the pain within a short time frame.

    Corticosteroids:

    Your doctor may inject into your carpal tunnel a corticosteroid such as cortisone to relieve your pain. Corticosteroid reduces the inflammation and swelling, which in turn, relieves the pressure on the median nerve. Oral corticosteroids are not considered as effective as corticosteroid injections for the treatment of carpal tunnel syndrome.

    Surgical management

    Endoscopic surgery:

    In endoscopic surgery, the surgeon uses a device resembling a telescope with a tiny camera attached to it to see inside your carpal tunnel, through 1-2 small incisions in the hand or wrist ligament. Endoscopic surgery may result in less pain and quicker recovery than the open surgery.

    Open surgery:

    In the open surgery, the surgeon makes a larger cut in the palm of your hand on the carpal tunnel and through the ligament to release the nerve incision. This procedure can also be performed using a smaller incision, which can reduce the risk of complications.

    Physiotherapy management

    Physiotherapy treatment for carpal tunnel syndrome is vital to accelerate the healing process. It also ensures optimal result and reduce the risk of future recurrence. Treatment may include:

  • Soft tissue massage
  • Electrotherapy
  • Orthotics or splints
  • Joint mobilization
  • Dry needling
  • Ice or heat treatment
  • Progressive exercises to improve flexibility and strength
  • Education
  • Training and activity modification tips
  • Technical correction
  • Anti-inflammatory tips
  • Exercises for carpal tunnel syndrome

    The following exercises are commonly prescribed to the patients with this condition. You should discuss the suitability of these exercises with your physiotherapist before starting them. In general, the exercises are done 3 times a day, if they do not increase the symptoms.

    Physiotherapy for carpal tunnel syndrome

    Wrist Flexor Stretch

    Keep your affected arm straight elbow stretched; grab your fingers and stretch back with the other hand until you feel a slight to moderate pain. Hold for 15 seconds and repeat it 4 times whenever there is an increase in the symptoms.