Carpal Tunnel Syndrome: Symptoms, Causes & Treatment
Carpal tunnel syndrome (CTS) is a medical condition involving squeezing or compression of the median nerve in the carpal tunnel on the palm side of the hand. The median nerve is one of the primary nerves of the hand. Excessive strain or pressure on it causes symptoms such as numbness, tingling, pain, and weakness in the hand. It can occur in both hands, and genetics is considered the leading risk factor for this disease.
Carpal tunnel syndrome deteriorates with time in many patients. If left unchecked, the regular movements of the hand and fingers can disappear, involving loss of sensation and weakness. Women are more prone to getting this syndrome than men. If liver cirrhosis progresses to an advanced state, the damage to the liver is irreversible. Although cirrhosis is often permanent, it's indeed treatable.
Carpal Tunnel Syndrome Symptoms
The symptoms of carpal tunnel syndrome are as follows-
- Electric shock sensations on the thumb, index, middle, and ring fingers now and then.
- Burning, tingling, numbness, and pain sensations are observed in digits 1-4, including the thumb, index, middle, and ring fingers. These symptoms usually cause sleep problems.
- Tingling and pain sensations that may move up the forearm on the way to the shoulder
- Feelings of clumsiness and weakness in the hands make it difficult to perform fine finger movements like writing, using a computer keyboard, or holding a book. Weakness is prominent in the thumb.
- Having less grip when holding things makes them drop quickly from the hands.
Most often, the symptoms of carpal tunnel can begin slowly, without any injury. Initially, many individuals experience symptoms that come and go. After a prolonged period, the condition intensifies, and symptoms are seen more regularly or may be able to stay for an extended period.
The symptoms of tunnel syndrome at night are common. They may cause sleep problems, as many people sleep with their wrists bent. The symptoms are commonly seen during the daytime when holding anything for a long time (resulting in less grip to keep things), for example, while driving, writing, using a phone, or reading a book.
Carpal Tunnel Syndrome Causes
The exact cause of this compression is often multifactorial, involving a combination of anatomical, lifestyle, and medical factors:
Anatomical Factors
Narrowing of the Carpal Tunnel
Individuals with smaller carpal tunnels may be more prone to nerve compression, as there is less space available for the median nerve.
Wrist Fractures or Dislocations
Wrist injuries, such as fractures or dislocations, can cause swelling or inflammation, narrowing the carpal tunnel and compressing the median nerve.
Lifestyle Factors
Repetitive Hand or Wrist Movements
Activities or occupations that involve repetitive hand or wrist movements, such as typing, assembly line work, or playing musical instruments, can contribute to the development of CTS.
Awkward Hand Positions
Prolonged or frequent use of hand positions that bend the wrist, such as using a computer mouse or keyboard with improper ergonomics, can increase pressure on the median nerve.
Medical Conditions
Obesity
Excess body weight can increase pressure on the median nerve, contributing to the development of CTS.
Diabetes
Diabetics are at an increased risk of nerve damage and may be more susceptible to developing CTS.
Rheumatoid Arthritis
Inflammatory conditions like rheumatoid arthritis may cause inflammation and swelling in the wrist, leading to compression of the median nerve.
Thyroid Disorders
Conditions such as hypothyroidism or hyperthyroidism may be associated with CTS due to their effects on nerve function and metabolism.
Hormonal Changes
Pregnancy
Hormonal changes during pregnancy, along with fluid retention, can increase pressure on the median nerve, leading to symptoms of CTS. Symptoms may resolve after childbirth, but some women may continue to experience CTS postpartum.
Risks factors
Here are some of the most common risk factors of Carpal Tunnel Syndrome:
- Continuous and small movements with the hands. For example - I was typing or using a keyboard.
- A wrist fracture, rheumatoid arthritis, or dislocation compresses the median nerve, causing swelling, bleeding, and deformity.
- Certain physical activities and sports cause frequent hand movements.
- Changes in hormones and metabolic disorders such as menopause, pregnancy, or thyroid problems.
- Abnormal blood sugar levels are often seen in type 2 diabetes.
- Wrist injuries include swelling, bruising, and sprains.
- Genetic factors
Carpal Tunnel Syndrome Diagnosis
Tinel's sign
This test is done to check for nerve problems. To check for Tinel's sign, the doctor lightly taps over the median nerve at the wrist to see if it gives rise to a tingling or "pins and needles" type of sensation in the fingers.
Wrist flexion test (or Phalen test)
In this test, the doctor asks the patient to keep both elbows on the table and both forearms vertical. The patient has to stretch both wrists at 90 degrees for sixty seconds. The test is positive when there is pain in one finger connected with the median nerve.
X-rays
If wrist motion is limited or if arthritis or injury is present, the doctor will recommend an X-ray test of the wrist area.
Electrophysiological tests
This test is performed to check how well the median nerve is functioning and to find out whether there is too much pressure on the nerve. This test includes Nerve conduction studies (NCS) & Electromyogram (EMG)
This test includes:
Ultrasound or USG scan
USG scans use high-frequency sound waves to generate pictures of carpal bones and the surrounding tissues. This test helps evaluate the condition of the wrist and the intensity of the median nerve compression.
Magnetic resonance imaging (MRI) scans:
MRI scan is used to monitor the condition of the wrist (the carpal bones) and also the intensity of the syndrome. This scan is preferred only in a few cases.
Carpal Tunnel Syndrome Treatment
The following are some examples of nonsurgical treatments:
Carpal tunnel splints
The wrist splints for carpal tunnel assist in keeping the wrist in a straight position because they decrease pressure on the median nerve and do not aggravate the symptoms.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
These medicines help to relieve pain and inflammation.
Nerve gliding exercises
The physiotherapist will make the patient do these exercises to facilitate wrist movements and speed up recovery.
Corticosteroids
The doctor may use an anti-inflammatory agent that can be injected into the carpal tunnel to reduce the pain and inflammation.
Surgical Treatment For Carpal Tunnel Syndrome
If nonsurgical methods fail to relieve the syndrome's symptoms or give only temporary relief, then surgery will be needed to treat carpal tunnel syndrome. The surgical procedure used to treat the syndrome is known as carpal tunnel release. There are two different techniques for performing this operation, but both aim to decrease pressure on the median nerve by separating the ligament at the top of the tunnel (transverse carpal ligament).
By cutting the ligament, the tunnel size widens and reduces strain on the median nerve. This facilitates proper blood circulation to the nerve and improves nerve function.
The two surgical procedures are:
- Open carpal tunnel release
- Endoscopic carpal tunnel release
