Carpal tunnel syndrome

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What is carpal tunnel syndrome?

Carpal tunnel syndrome develops when there is increased pressure on the median nerve as it passes through the carpal tunnel, a passageway in the palm side of your wrist. It is a common condition that causes numbness, tingling and pain in the hand and forearm. If pressure on the median nerve continues, it can damage the nerve and worsen your symptoms.

 

What causes carpal tunnel syndrome?

​There are multiple causes of carpal tunnel syndrome. Here are some examples: 

  • Repetitive hand use – Repeating the same hand and wrist motions or activities over a prolonged period may cause swelling of the tendon that puts pressure on the nerve.

  • Hand and wrist position – Doing activities that involve extreme flexion or extension of the hand and wrist for a prolonged period can increase pressure on the nerve.

  • Health conditions – Diabetes, rheumatoid arthritis and thyroid gland imbalance are conditions associated with carpal tunnel syndrome.

  • Pregnancy – Hormonal changes during pregnancy can cause swelling that results in pressure on the nerve.

 

Symptoms of carpal tunnel syndrome

The symptoms of carpal tunnel syndrome vary and depend on its severity. The following are some examples of the symptoms. 

  • Numbness, tingling, burning or shock-like sensation in the thumb, index, middle and ring fingers.

  • Weakness and clumsiness in the hand may make it difficult to perform fine movements such as buttoning your clothes.

  • Dropping things due to weakness and numbness of the hand muscles.

In general, the symptoms of carpal tunnel syndrome start gradually.

 

When should I seek medical help?

There are circumstances when wrist pain might be caused or accompanied by severe issues. If such symptoms are present, it is best to seek immediate medical attention to avoid further complications:

  • Pain in your wrist is stopping you from doing normal activities

  • The pain is getting worse

  • The pain has not improved after treating it at home for two weeks

  • Any tingling or loss of sensation in your hand or wrist

  • Painful, warm, swollen and stiff wrists

 

Diagnosis

To diagnose carpal tunnel syndrome, your doctor will take your case history and past medical history into account and perform a physical examination. Your doctor may:

  • Press down or tap along the median nerve on your wrist and hand to see if it causes any tingling in your fingers (Tinel's sign).

  • Bend and hold your wrists to test for numbness or tingling in your hands.

  • Test sensation in your fingertips and hands by touching them with an instrument while your eyes are closed.

  • Check for the strength of the muscles in your palm. 

  • Look for muscle wasting in your palm. In severe cases, the palm muscles may become visibly smaller.

Further tests for your doctor to get an accurate diagnosis include:

  • Electrophysiological tests, including nerve conduction tests and electromyograms, are standard tests to measure your median nerve function and determine whether there is compression on the nerve. 

  • Ultrasound can evaluate the median nerve for signs of compression.

 

Treatment

Treatment would involve a gradual reduction of compression on the median nerve. Some examples of non-surgical treatments: 

  • Bracing or splinting. Wearing a brace or splint at night will keep you from bending your wrist while you sleep and keep the pressure off the nerve

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) are anti-inflammatory medications such as ibuprofen and naproxen that can help relieve pain and inflammation.

  • Changes in activity. If your job or recreational activities aggravate your symptoms, changing or modifying these activities can help slow or stop the progression of the disease. 

  • Steroid injections. Corticosteroid is a potent anti-inflammatory agent that can be injected into the carpal tunnel. These injections often relieve painful symptoms or help to calm a flare-up of symptoms.

If nonsurgical treatment does not relieve your symptoms, your doctor may recommend surgery to prevent irreversible damage. The surgery aims to relieve pressure on your median nerve by cutting a ligament that forms carpal tunnel (transverse carpal ligament). The release of this ligament decreases pressure on the median nerve, allows blood to flow into the nerve and heals the damage caused by compression.

 

Prevention of carpal tunnel syndrome

There are different measures to prevent carpal tunnel syndrome. Here are some examples: 

  • Pay attention to ergonomics. Keep your wrists straight when using tools such as a computer mouse or a keyboard. When you type, keep your wrist in a relaxed, neutral position. An ergonomic keyboard and foam or gel wrist support may help.

  • Avoid flexing and extending your wrists repeatedly.

  • Avoid repetitive, firm grasping with the wrist.

  • Take frequent rest breaks from repetitive activities, especially if you work for long periods on a keyboard

  • Do conditioning and stretching exercises before and after activities.