Carpal tunnel syndrom

What is carpal tunnel syndrome?

Carpal tunnel syndrome is the compression of the median nerve as it passes into the hand. The median nerve is located on the palm side of your hand (also called the carpal tunnel). The median nerve provides sensation (ability to feel) to your thumb, index finger, long finger, and part of the ring finger. It supplies the impulse to the muscle going to the thumb. Carpal tunnel syndrome can occur in one or both of your hands.

Swelling inside your wrist causes the compression in carpal tunnel syndrome. It can lead to numbness, weakness, and tingling on the side of your hand near the thumb.

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Carpal Tunnel Syndrom Causes

Carpal tunnel syndrome is caused due to compression of the median nerve. The median nerveleads to the sensation of fingers and palm side of the thumb except little finger. The median nerve also affects the movement of muscles in the hand.

Symptoms of Carpal Tunnel Syndrome

The symptoms of Carpal tunnel syndrome include numbness or tingling in thumb and fingers as well as weakness and discomfort in wrist.

Numbness or tingling

Numbness and tingling can be experienced in the thumb and fingers. This sensation is often felt while holding a phone, newspaper, steering wheel and waking up from sleep. This sensation may further extend from the wrist to the arm.

Weakness

Weakness in the hand may lead to reduced ability of grasping objects. The numbness in the hand of the thumb's pinching muscles cause weakness in the hand. These muscles are controlled by the median nerve.

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Diagnosis of Carpal Tunnel Syndrome

The doctor may conduct tests to diagnose carpal tunnel syndrome that include physical examination, x-ray, electromyogram and the study of nerve conduction.

Physical examination

The doctor will conduct a physical examination by testing the sensation felt in fingers, pressing and tapping on the nerve and strength of muscles in hand.

X-ray

The doctor may also recommend for an x-ray for the affected area of the wrist to determine the other causes of pain.

Electromyogram

The doctor may conduct electromyogram test to evaluate the electrical activity of the muscles. It helps in determining the damage done to muscles.

Study of nerve conduction

The doctor may conduct a nerve conduction study by passing a small shock to the median nerve. In some cases, the doctor may also recommend to seek help from a neurologist or neurosurgeon.

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Treatment

Although it is a gradual process, for most people carpal tunnel syndrome will worsen over time without some form of treatment. For this reason, it is important to be evaluated and diagnosed by your doctor early on. In the early stages, it may be possible to slow or stop the progression of the disease.

Nonsurgical Treatment

If diagnosed and treated early, the symptoms of carpal tunnel syndrome can often be relieved without surgery. If your diagnosis is uncertain or if your symptoms are mild, your doctor will recommend nonsurgical treatment first.

Nonsurgical treatments may include:

. Bracing or splinting. Wearing a brace or splint at night will keep you from bending your wrist while you sleep. Keeping your wrist in a straight or neutral position reduces pressure on the nerve in the carpal tunnel. It may also help to wear a splint during the day when doing activities that aggravate your symptoms.

. Nonsteroidal anti-inflammatory drugs (NSAIDs). Medications such as ibuprofen and naproxen can help relieve pain and inflammation.

. Activity changes. Symptoms often occur when your hand and wrist are in the same position for too long—particularly when your wrist is flexed or extended.

If your job or recreational activities aggravate your symptoms, changing or modifying these activities can help slow or stop progression of the disease. In some cases, this may involve making changes to your work site or work station.

. Nerve gliding exercises. Some patients may benefit from exercises that help the median nerve move more freely within the confines of the carpal tunnel. Specific exercises may be recommended by your doctor or therapist.

. Steroid injections. 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. A cortisone injection may also be used by your doctor to help diagnose your carpal tunnel syndrome.

Surgical Treatment

If nonsurgical treatment does not relieve your symptoms after a period of time, your doctor may recommend surgery.

The decision whether to have surgery is based on the severity of your symptoms—how much pain and numbness you are having in your hand. In long-standing cases with constant numbness and wasting of your thumb muscles, surgery may be recommended to prevent irreversible damage.

Surgical Procedure

The surgical procedure performed for carpal tunnel syndrome is called a "carpal tunnel release." There are two different surgical techniques for doing this, but the goal of both is to relieve pressure on your median nerve by cutting the ligament that forms the roof of the tunnel. This increases the size of the tunnel and decreases pressure on the median nerve.

In most cases, carpal tunnel surgery is done on an outpatient basis. The surgery can be done under general anesthesia, which puts you to sleep, or under local anesthesia, which numbs just your hand and arm. In some cases, you will also be given a light sedative through an intravenous (IV) line inserted into a vein in your arm.

. Open carpal tunnel release. In open surgery, your doctor makes a small incision in the palm of your hand and views the inside of your hand and wrist through this incision. During the procedure, your doctor will divide the transverse carpal ligament (the roof of the carpal tunnel). This increases the size of the tunnel and decreases pressure on the median nerve.

After surgery, the ligament may gradually grow back together—but there will be more space in the carpal tunnel and pressure on the median nerve will be relieved.

. Endoscopic carpal tunnel release. In endoscopic surgery, your doctor makes one or two smaller skin incisions—called portals—and uses a miniature camera—an endoscope—to see inside your hand and wrist. A special knife is used to divide the transverse carpal ligament, similar to the open carpal tunnel release procedure.

The outcomes of open surgery and endoscopic surgery are similar. There are benefits and potential risks associated with both techniques. Your doctor will talk with you about which surgical technique is best for you.

How do I know if I have carpal tunnel syndrome?

The symptoms are usually found along the nerve path because of compression of the median nerve. Your hand may “fall asleep” frequently and drop objects. Other symptoms include:

• numbness, tingling, and pain in your thumb and the first three fingers of your hand
• pain and burning that travels up your arm
• wrist pain at night that interferes with sleep
• weakness in the muscles of the hand

Can carpal tunnel syndrome go away on its own?

Carpal tunnel is a common repetitive motion injury. It is often seen in people who use computer keyboards or work on assembly lines. When left untreated carpal tunnel can result in permanent injury and loss of function. In some cases, if carpal tunnel syndrome is mild and it is caught early, it may go away on its own with strict rest. If carpal tunnel syndrome is not treated, permanent nerve and muscle damage may occur. Early diagnosis and treatment offers the best results.