Carpal Tunnel Syndrome
What is Carpal tunnel Syndrome?
Carpal tunnel syndrome is a common disorder that causes pain, numbness, tingling, and weakness in the hand and wrist. It occurs when there is a high amount of pressure within the wrist on a nerve called the median nerve. This median nerve provides sensation to the thumb, index, and middle fingers, and half of the ring finger. The little finger (the “pinky”) is typically not affected. This median nerve also provides strength to few muscles at the base of the thumb and index finger.
Carpal tunnel: - Carpal tunnel is a narrow passage in the wrist. The bottom and sides of the tunnel are formed by small semi-circular bones called carpal bones. A tissue called ligament forms in the top of the tunnel. The median nerve and tendons pass through this space. These tendons connect muscles in the forearm to bones in the hand. These help the finger and thumb to bend and straighten.
Who is at risk?
Women are three times more possible to have carpal tunnel syndrome than men. Carpal tunnel syndrome is mostly diagnosed between the ages of 30 and 60. Jobs that involve repetitive finger use, mainly those associated with high force, extreme wrist motions may develop this disorder.
Many factors contribute to the development of carpal tunnel syndromes such as high salt intake, sedentary lifestyle and, obesity. People who work in professions like Manufacturing, Assembly line work, Keyboarding occupations, and Construction work are at greater risk.
Causes:
The carpal tunnel is a narrow passage in the wrist; it is surrounded by bones and ligaments. Tendons run through the carpal tunnel and help the fingers and the median nerve move, which is responsible for both sensation and movement in the hand, thumb, index finger, middle finger, and ring finger.
Any condition that causes swelling of the membranes of the carpal tunnel can lead to the carpel tunnel syndrome. When the tissues of the carpal tunnel become swollen, it will cause the median nerve to be compressed, which is known as nerve entrapment.
Conditions related to carpal tunnel syndrome are:
- Diabetes
- Thyroid dysfunction
- Fluid retention from pregnancy or menopause
- High blood pressure
- Autoimmune disorders such as rheumatoid arthritis
- Fractures or trauma to the wrist
- Wrist fracture or dislocation
- Wrist Deformity
- Tumor in the carpel tunnel
- Older age
- Placing of your wrists while using your keyboard or mouse
- Continuous exposure to vibrations from using hand-tools or power-tools
- playing the piano or typing
Symptoms:
Symptoms begin slowly, early symptoms occur along the nerve path because of compression of the median nerve. Your hand may asleep often and drop objects.
Early symptoms are numbness, tingling, and pain in your thumb and the first three fingers of your hand, wrist pain at night that interferes with sleep.
Symptoms in the daytime include: tingling in the fingers, pain and burning that travels up your arm, weakness in the muscles of the hand, unable to use the hand for small tasks like- picking small objects, unable to drive, unable to hold book to read, difficult in writing, unable to type on computer keyboard.
Diagnosis:
Your doctor will check your medical history and examine you. Later tests are performed, that include:-
- Tinel’s sign:- In this test, the doctor will tap over the median nerve at the wrist to check if it produces a tingling sensation in the fingers.
- Wrist flexion test:- in this test, the patient rests his elbow on a table and allows the wrist to fall forward freely. People with carpal tunnel syndrome will experience numbness and tingling in the fingers within 60 seconds. The severity of the carpal tunnel syndrome is diagnosed based on how quickly symptoms appear.
- X-rays: X-rays of the wrist is done if there is limited wrist motion, or to exclude if any other causes such as arthritis or fracture.
- Electromyography (EMG): This test is conducted to know the health of the muscles and the nerve cells that control them. A thin needle electrode is inserted into specific muscles to evaluate the electrical activity when muscles contract and rest; this is to find out if there is any muscle damage.
- Nerve conduction study. In this test, two electrodes are taped to the skin and a small shock is passed through the median nerve to check if electrical impulses are slowed in the carpal tunnel. This method is done to check your condition and to rule out other conditions.
Treatments for CTS given are:
If the Carpal tunnel syndrome is diagnosed at an early stage then non-surgical treatments are given first such as
- Avoid continuous movement of your hand
- Wrist splints that hold your hand in a neutral position
- Medication for mild pain and to reduce inflammation
- Treatment of any underlying conditions you may have, such as diabetes or arthritis
- Steroid injections into your carpal tunnel area to reduce inflammation
- Physiotherapy
- If swelling occurs, use a cold pack to reduce
Surgery treatment: - if non-surgical treatment doesn’t help, surgery may be recommended for serious cases. This is done in one day by giving local anesthesia. The surgery is known as carpal tunnel release. This surgery has two techniques and your doctor will suggest the ideal one for your condition.
Open release surgery: - An incision is made in your wrist and palm and the surgeon locates the flexor retinaculum (a strong band of tissue within the carpal tunnel that wraps the median nerve and the tendons that move the fingers). The flexor retinaculum is cut and released, with that, the pressure on the median nerve is released then the skin is stitched back together.
Endoscopic surgery:- in this technique the doctor uses a narrow telescope called an arthroscope. This is used to see the structures of the carpal tunnel from inside. In this procedure two small incisions are made – one in the wrist and one in the palm and then the arthroscope is passed through one incision and the surgical instruments through the other. The surgeon will be able to see the structures of the carpal tunnel on the monitor while using the surgical instruments to release the flexor retinaculum. The incisions are closed either with stitches or small paper tapes (steristrips).
Recovery: - Endoscopic carpal tunnel release usually has a quicker recovery time; it has less postoperative pain and causes less scarring than open release surgery. However, this endoscopic type of surgery is not suitable for all people.
Postoperative recovery:- usually the recovery from the surgery happens very quick and have very fewer complications. 95% of people who undergo carpal tunnel release surgery get relief from the symptoms.
It is very important to follow the post-operative recovery guidelines. You will be recommended to use a splint. This helps you to restrict hand movement and promote healing. Gentle hand exercises may also be recommended.
If your condition is long term (chronic) then the symptoms may take a longer time to disappear.
Prevention:
Carpal tunnel syndrome is caused by multiple factors, you can try to prevent carpal tunnel syndrome by making lifestyle changes that help decrease some of your risk factors
- Try to maintain your levels of diabetes, high blood pressure, and arthritis that may lessen your risk of developing carpal tunnel syndrome.
- Paying cautious attention to hand posture and avoiding activities that overstretch your wrist are also significant approaches for reducing symptoms.
- Physical therapy exercises may be co-operative as well.
- Position your wrist straight while sleeping.
- Avoid curling your wrists repeatedly.
- Take frequent breaks while working.
- Perform exercises and warm-ups before and after activities.