Carpal Tunnel Syndrome: Causes, Symptoms, Diagnosis & Treatment
Medically Reviewed By : Dr K. Hari Chandana
MBBS, MS ORTHOPAEDICS
( Fellowship in Trauma, Fellowship in Pain Management )
Do You Feel Like Your Hand is Heavy and Numb?
Very few know the term carpal tunnel syndrome. Tunnel sounds like a familiar term; does it mean the same in the body?
Yes, there is a tunnel-like structure in the hand in which the nerve passes, known as the median nerve. If this nerve is compressed, it causes carpal tunnel syndrome. In the initial stages, the symptoms are not intense, but as time progresses, they worsen. So to know about its diagnosis, treatment becomes necessary on time.
What is carpal tunnel syndrome?
It’s a neurological problem, as the nerve is involved. The basic function of the nerve is to provide sensation and help in carrying out the movement of that part.
Basically, in the hand area, there is a tunnel-like structure in which the median nerve passes along and supplies mainly the thumb, index finger, middle finger, and a part of the ring finger but not the little finger. So sensation and movement in this area are controlled by the median nerve.
When this median nerve is affected or compressed in the canal for any reason, it results in carpal tunnel syndrome.
What are the causes of carpal tunnel syndrome?
- Obesity: If a person is overweight, it can compress the nerve due to extra fat deposition and bulkiness, causing pressure on the nerve and causing carpal tunnel syndrome.
- Wrist injury or fracture: A fracture or any injury to the wrist causes swelling around the area and causes compression of the nerve in the narrow passage.
- Rheumatoid arthritisis an inflammatory arthritis causing deformation of joints and swelling, compressing the median nerve around the wrist joint, causing Carpal tunnel syndrome
- Pregnancy or menopause: Around this time, hormonal changes occur, which are responsible for causing water retention, swelling, and compression of the nerve.
- Occupation: Occupational causes are common, the workers continuously work with stress on the wrist, like sewing, packing, or cleaning, which can cause compression of nerves.
- Diabetes or hypertension: These metabolic disorders cause neuropathy involving peripheral nerves, damage them, and ultimately result in compression of the median nerve.
- Thyroid gland disorder: Hypo or hyperthyroidism is also associated with nerve damage causing compression of the median nerve.
- Ganglion, cyst, or tumor: A ganglion is a water-filled cyst in the wrist area. If the ganglion is big, or any other cyst, the tumor can cause compression of the median nerve in the tunnel.
- Sex: Women are more likely to suffer from carpal tunnel syndrome. As a part of the anatomy, the tunnel in women is narrow as compared to men, so narrow passageway makes women more prone.
Any condition causing nerve damage, inflammatory arthritis, or the wrong wrist using positions, deformities, or dislocations can pose this problem, irrespective of sex or ethnicity. So the causes can vary.
What are the symptoms of carpal tunnel syndrome?
- Tingling and numbness: Many people complain of a numb feeling and a tingling sensation in their hands while sleeping at night in the initial stages. But as the disease progresses, these sensations are felt in the morning or while carrying out any activities like cleaning, driving, writing, etc.
- Swelling: swelling in hands is common.
- Heaviness and loss of sensation: in some cases, there is no sensation in the hands regarding temperature, like hot or cold.
- Weakness: Weakness is another symptom. when a person attempts to hold any object, he drops it because of weak hands. He has no power to reach out and pick up the objects
How to diagnose carpal tunnel syndrome:
Doctors generally prefer a physical examination first to confirm the diagnosis before conducting the tests
- The patient's hand examination for pain during movement
- Any tingling or numbness sensation after flexion of the wrist on the palm side
- Finger examination to see whether the sensation is intact or not by pricking the needle or touching hot or cold
- Any atrophy or wasting of the muscle of the hand is checked.
- Foot or toe examination to rule out other neuropathies.
Along with the physical examination, history-taking is conducted to inquire about the history of a wrist injury, occupation, family history, diabetes, hypertension, or any inflammatory arthritis.
It is carried out to see the extent to which the median nerve is affected. What are the causes of compression, whether the nerve supplying the hand area is giving proper sensation to that part or not?
It detects nerve damage. The nerve enters the muscle and supplies sensation and movement to the muscle through electrical stimulation. As the nerve is damaged, it lacks electric stimulation signals.
It detects the site of compression and its causes
it helps to detect the compression if it is due to a cyst, a tumor, or any abnormal tissues causing pressure on nerves. It also detects scar tissue if there is a history of any previous injury.
It can diagnose dislocations in the wrists or fractures causing compression of the nerves.
What is the treatment?
If carpal tunnel syndrome is diagnosed in the primary stage. Some precautionary measures are helpful to reduce the intensity of symptoms and the disease itself.
1. Primary measures to be taken:
- The use of a brace or splint suggested by doctors. To maintain the wrist in a normal position and to avoid bending or flexion, a brace is helpful, as bending the wrist aggravates the tingling and numbness.
- Physiotherapy : Can help to a greater extent. It can reduce tingling, numbness, and pain as well. Exercise-related to the median nerve under the proper guidance of a physiotherapist is essential.
- Medications : Can reduce the intensity of symptoms ibuprofen medications can help manage the pain and keep the routine normal.
- Steroid injections: In the initial stages, steroid injections given directly at the site of the nerve are helpful. It can relieve the symptoms for a long period of time. But if the disease has progressed, steroid injections are given more frequently, as relief cannot last long.
- Surgical procedure : carpal tunnel syndrome is caused by the narrow passage through which the nerve passes and supplies the hand.
So, the surgical procedure is aimed at making the passage wider so that the nerve does not compress. There is a ligament known as the transverse carpal ligament that is released in surgery so that the pressure on the nerve decreases and blood flow becomes normal to the nerve. This procedure is done in the outpatient department. General or local anesthesia is given.
2. Open ligament surgery:
In this surgical procedure, general anesthesia is given
The cut or incision is given on the palmar surface of the hand, and the transverse carpal ligament is half cut and divided towards the roof so that it creates more space in the tunnel and pressure is released.
3 .Endoscopic ligament surgery:
This surgery is just like open ligament surgery.
In this procedure, a small cut is made on the palm like a whole so that an endoscope can be inserted through it and the wrist can be visualized. The rest procedure is similar to open ligament surgery.
After surgery, the patient is told to move the hand to reduce swelling and pain. It takes a few days to heal the incision and almost 1-2 months to relieve the symptoms.
If carpal tunnel syndrome is associated with other morbid conditions like diabetes, inflammatory arthritis, or thyroid disorders. The main root-cause treatment is essential. Treating diabetes or arthritis becomes the first line of treatment.