Carpal tunnel syndrome
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Carpal tunnel syndrome results from pressure on the median nerve located in the wrist. This nerve is connected to the hand and forearm through a narrow canal surrounded by bones and ligaments on the palm side of the hand. People with carpal tunnel syndrome experience pain, numbness, and weakness in the wrist and hand.
The anatomy of the wrist, certain health issues, and repetitive hand movements can all contribute to carpal tunnel syndrome. This condition occurs when the median nerve is compressed due to the narrowness of the canal and the surrounding tissues. As a result, the nerve is unable to function properly, leading to discomfort and impaired hand and wrist function.
Proper treatment is crucial in relieving the symptoms of carpal tunnel syndrome. Treatment options may include rest, splinting, medication, physical therapy, and in severe cases, surgery. With appropriate treatment, patients can alleviate tingling and numbness and restore proper hand and wrist function.
Symptoms
The following list of signs and symptoms of carpal tunnel syndrome includes:
- Tingling or numbness. Tingling and numbness in the fingers or hand, accompanied by an electric shock-like sensation, are common symptoms of a condition that typically affects the thumb and index, middle, or ring fingers but not the little finger. Activities such as holding a steering wheel, phone, or newspaper may trigger the symptoms, which can also occur during sleep. Many people try to alleviate the discomfort by shaking out their hands. However, if left untreated, the numbness may persist and become constant.
- Weakness. Weakness in the hand leading to dropping objects can occur as a result of numbness in the hand or weakness of the pinching muscles of the thumb, which are controlled by the median nerve.
If the symptoms and signs of carpal tunnel syndrome disrupt your regular activities or sleep habits, it is advisable to consult a medical professional. Without therapy, permanent nerve and muscle damage can occur.
Causes
Carpal tunnel syndrome occurs due to the compression of the median nerve, which runs from the forearm through the wrist’s carpal tunnel to provide sensation and motor function to the thumb and fingers’ base muscles, excluding the little finger. The pressure on this nerve can result from various factors, such as wrist fractures, inflammation caused by rheumatoid arthritis, or any other condition that narrows the carpal tunnel space. Usually, carpal tunnel syndrome is not caused by a single factor but a combination of risk factors, leading to its development. These risk factors can include genetic predisposition, repetitive hand and wrist movements, hormonal changes, obesity, and certain medical conditions. Identifying the underlying cause and managing the associated risk factors can help prevent and treat carpal tunnel syndrome effectively.
Risk factors
Carpal tunnel syndrome has been linked to a number of variables. Although they may not be the direct cause of carpal tunnel syndrome, they may make the median nerve more susceptible to irritation or damage. These include:
- Anatomic factors. Carpal tunnel syndrome may result from a wrist fracture or dislocation, or arthritis that deforms the small wrist bones, leading to a decrease in the carpal tunnel space and increased pressure on the median nerve. Furthermore, individuals with smaller carpal tunnels have a higher risk of developing this syndrome since the limited space makes the median nerve more susceptible to compression or irritation.
- Gender. In general, women are more likely to develop carpal tunnel syndrome. This may be due to the fact that women’s carpal tunnel syndrome is less severe than men’s. In comparison to women without the illness, women with carpal tunnel syndrome may have smaller carpal tunnels.
- Nerve-damaging conditions. The risk of nerve damage, particularly damage to the median nerve, is increased by a number of chronic conditions, including diabetes.
- Inflammatory conditions. The lining around the tendons in the wrist can be impacted by rheumatoid arthritis and other inflammatory diseases, placing pressure on the median nerve.
- Medications. The use of anastrozole (Arimidex), a medication commonly prescribed for breast cancer treatment, has been associated with carpal tunnel syndrome in several studies.
- Obesity. Obesity increases the likelihood of developing carpal tunnel syndrome.
- Body fluid changes. The median nerve may become irritated if fluid retention raises the pressure inside the carpal tunnel. This frequently occurs during menopause and pregnancy. Pregnancy-related carpal tunnel syndrome typically gets better on its own after giving birth.
- Other medical conditions. Carpal tunnel syndrome may be more likely in those who have menopause, thyroid issues, kidney failure, lymphedema, and other medical concerns.
- Workplace factors. Repetitive use of vibrating tools or working on an assembly line that requires constant wrist flexing may potentially cause harm to the median nerve, and the risk may be exacerbated in cold environments. However, there is conflicting scientific evidence, and these factors have not been conclusively established as direct causes of carpal tunnel syndrome.(2)
Diagnosis
In order to identify if you have carpal tunnel syndrome, your doctor may ask you questions and perform one or more of the tests listed below:
- History of symptoms. The symptom pattern will be examined by your healthcare provider. For instance, since the little finger does not receive sensation from the median nerve, problems in that finger may point to anything other than carpal tunnel syndrome.
Symptoms of carpal tunnel syndrome frequently appear when holding a phone, a newspaper, or firmly clutching a steering wheel. Additionally, they frequently happen at night, and you can be awakened by them or wake up feeling numb.
- Physical examination. Your doctor will examine you physically. He or she will assess the strength of the hand’s muscles and the sensation in the fingers. Many people can experience symptoms as a result of bending the wrist, tapping on the nerve, or just pressing on the nerve.
- X-ray. To rule out alternative causes of wrist pain, such as arthritis or a fracture, some medical professionals advise taking an X-ray of the affected wrist. However, X-rays are useless for identifying carpal tunnel syndrome.
- Ultrasound. A healthcare provider may suggest an ultrasound of the patient’s wrist to obtain clear images of the bones and nerves. This approach can aid in identifying any compression of the nerve.
- Electromyography. This examination measures the minute electrical discharges that muscles make. In order to measure the electrical activity that occurs when muscles contract and relax, your doctor will implant a thin-needle electrode into a few selected muscles during this test. This test may rule out other disorders while detecting damage to the muscles the median nerve controls.
- Nerve conduction study. Two electrodes are taped to the skin in an electromyography version. To determine whether electrical impulses in the carpal tunnel are delayed, a brief shock is delivered to the median nerve. This examination could be used to identify the ailment and rule out any others.
Treatment
As soon as symptoms of carpal tunnel syndrome appear, start treatment. Simple things you can do for yourself could solve the issue in its early stages. For instance:
- Avoid doing things that aggravate your symptoms.
- Increase the frequency of your hand rests.
- Use cold therapy to lessen swelling.
Surgery, medicine, and wrist splinting are further therapeutic possibilities. If you’ve only experienced mild to moderate symptoms that come and go for less than 10 months, splinting and other conservative treatments are more likely to be effective. You should see a doctor if you get numbness in your hands.
Nonsurgical therapy
In the event that carpal tunnel syndrome is detected early, nonsurgical treatments, such as:
- Wrist splinting. Numbness and tingling during the night can be eased by wearing a wrist splint while you sleep. Even if the splint is only worn at night, it can still help prevent symptoms from occurring during the day. Given that it does not require the use of any pharmaceuticals to be effective, nighttime splinting may be a suitable choice if you’re expecting.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). Carpal tunnel syndrome discomfort may be temporarily reduced by NSAIDs like ibuprofen (Advil, Motrin IB, etc.). However, there is no proof that these medications help in carpal tunnel syndrome.
- Corticosteroids. To ease pain, your doctor may administer an injection of a corticosteroid such cortisone into the carpal tunnel. These injections are occasionally guided by ultrasound, according to the provider.
Inflammation and edema are reduced by corticosteroids, relieving strain on the median nerve. For treating carpal tunnel syndrome, oral corticosteroids are not thought to be as beneficial as corticosteroid injections.
Treating the inflammatory arthritis, such as rheumatoid arthritis, which may be the cause of carpal tunnel syndrome, may lessen its symptoms. But this hasn’t been proven.
Surgery
If symptoms are severe or do not improve with previous therapies, surgery can be necessary. Carpal tunnel surgery aims to relieve pressure on the median nerve by severing the ligament that is obstructing it.
There are two methods for doing the surgery:
- Endoscopic surgery. The endoscope (a device resembling a telescope with a tiny camera attached to it) is used by your surgeon to view the interior of the carpal tunnel. Through one or two small incisions in the hand or wrist, your surgeon slices the ligament. Instead of using a telescope to guide the tool that cuts the ligament, some surgeons may use ultrasound instead.
In the initial days or weeks following surgery, endoscopic surgery might be less painful than open surgery.
- Open surgery. To release the nerve, your surgeon makes a cut through the ligament over the carpal tunnel in the hand’s palm.
Surgery for ligament release is a medical procedure with potential risks and benefits. Before undergoing the operation, it is essential to discuss these factors with your surgeon. Possible risks of this surgery include incomplete release of the ligament, wound infections, scar formation, and nerve or blood vessel injuries.
After the surgery, your healthcare provider will likely encourage you to use your hand, starting with light movements and avoiding forceful or extreme wrist positions. It is important to gradually work back to normal use of the hand while being aware that soreness or weakness may take several weeks to a few months to fully resolve. While surgery can provide relief for carpal tunnel syndrome, it is important to note that symptoms may not completely go away after surgery, especially if they were severe before the procedure.
