Carpal Tunnel Syndrome

Carpal Tunnel Syndrome represents a condition that causes tingling, numbness and pain in the hand because of the pressure and compression of the median nerve, located in the wrist and responsible for controlling the feeling and movement in four fingers. The median nerve runs through the carpal tunnel from the forearm to the hand. Permanent nerve damage might occur if the pressure does not disappear and sometimes, patients must undergo surgery in order to escape from experiencing worsening in the severity of symptoms. If the patient receives early diagnosis and treatment, he may get away with simple prevention measures including prohibition to engage in certain activities that might prove to be harmful for his condition and a wrist splint.


Causes of Carpal Tunnel Syndrome

There is not just one cause rather a combination of factors that could lead to carpal tunnel syndrome. According to various studies, women and elders are more prone to suffering at some point from this condition. The pressure on the median nerve generally represents a consequence of swelling or anything else that might narrow or suppress the carpal tunnel, such as pregnancy when women experience hormonal changes, various illnesses or metabolic disorders including diabetes and rheumatoid arthritis or continuously repeating the same movements with the hand and the wrist.

The risk of developing carpal tunnel syndrome increases significantly if the person performs certain jobs, from manufacturing and product packing to cleaning and sewing because these types of activities demand repetitive hand use with maximum flexion and extension for a long period, which aggravates the tendons in the wrist and causes the swelling. Apparently, heredity represents an important risk factor. The size of the carpal tunnel varies from person to person, depending on the traits that run in each family.


Symptoms of Carpal Tunnel Syndrome

At first, the symptoms of carpal tunnel syndrome are temporary and painless. Patients state that they feel weakness, numbness or tingling in the hand area including the fingers, except for the little finger, which receives feeling from another nerve. The symptoms may also include occasional sensations similar to an electric shock, pain that might spread towards the shoulder area, clumsiness, which impedes the patient perform small and fine movements that generally require the use of muscles in the fingers, hands and forearms. A person suffering from carpal tunnel syndrome encounters difficulties in holding things for a long time because of numbness and weakness. Even though at the beginning the symptoms come and go, if the patient does not seek medical attention and allows the condition to worsen, the symptoms will become more frequent and persistent. During daytime, patients experience symptoms when holding various objects or performing certain activities like reading a book or talking to the phone. At night, some people with carpal tunnel syndrome cannot sleep if they have the habit of keeping their wrists bent because the symptoms start to kick in. They usually shake out their hands as an attempt to relieve the pain.


When to Seek Medical Care for Carpal Tunnel Syndrome

Carpal tunnel syndrome does not represent an emergency meaning that people can relive the symptoms without surgical treatment. They can give a shot to home treatment one or two weeks if the symptoms are mild. However, if the symptoms persist despite home care, contacting a doctor becomes imperative. At the beginning, the person can ask the help of the family medicine doctor or an occupational medicine specialist. Otherwise, permanent nerve injury will inevitably occur and it will lead to atrophy, apart from numbness and weakness. Therefore, people who experience sudden loss of feeling in the arm must call a doctor immediately. The first step of the treatment is wearing a wrist brace in a certain position meant to reduce nerve irritation. This significantly helps by relieving the symptoms caused by carpal tunnel syndrome. Generally, the doctor provides a treatment with the purpose of maintaining the hand function.


Carpal Tunnel Syndrome Diagnosis

To prevent serious damage to the median nerve, early carpal tunnel syndrome diagnosis, followed by treatment is essential. The person suffering from carpal tunnel syndrome must go through a series of tests and examinations.

  • Medical history: During the conversation with the patient, the doctor will attempt to obtain an accurate medical history and information regarding the patient’s general health. Then he will proceed to ask about the current symptoms, which are extremely important for establishing a correct diagnosis. The sincerity, attention and control of the patient come into discussion, because the doctor relies on them.
  • Physical examination: However, receiving a confirmation concerning the existence of the condition is not enough and for this reason, the doctor resorts to a physical examination of the hands, arms and neck that will help him eliminate other possible conditions that might cause those symptoms. He carefully examines the wrist and each finger for weakness, swelling, discoloration and signs of atrophy.
  • Tests: After the physical examination, the doctor might use laboratory tests and X-rays in order to detect potential diseases that could cause nerve damage and reveal possible fractures. X-rays provide clear images of the bones structures and ultrasound uses sound waves with high frequency to provide images of bones, tissue and show the size of the median nerve. Magnetic resonance imaging, also known as MRI, allows the doctor to observe closely the body’s soft tissue and establish if abnormal tissue might affect the median nerve. In addition, it helps him discover possible issues with the nerve, following an injury or tumor.
  • An electromyogram is very helpful because it measures the muscles activity, thus revealing the extent of nerve damage.


Treatment for Carpal Tunnel Syndrome

The doctor chooses the treatment for carpal tunnel syndrome while keeping in mind the severity of the symptoms and underlying causes like diabetes. If the patient goes for a diagnosis early, he will most likely get away with a non-surgical method that will slow or even stop the condition progress. For mild symptoms, non-surgical treatment includes:

  • Splinting or bracing: the patient must wear a splint or brace during night to prevent him from bending the wrist while sleeping. Placing the wrist in a neutral position will minimize the pressure on the median nerve, thus relieving the symptoms. The patient can also wear the split or brace during daytime when performing certain activities that might aggravate his condition.
  • Activity changes: If the patient feels discomfort while performing a task, he must take breaks frequently and if the wrist shows signs of redness or swelling, applying cool packs helps. In addition, he must avoid certain activities that might cause symptoms.
  • Medications: Anti-inflammatory drugs like aspirin and ibuprofen can relieve the pain and swelling, but they cannot treat carpal tunnel syndrome itself. These over-the-counter drugs are solely useful for providing discomfort relief for a short term.
  • Injections: Sometimes, doctors choose to inject the patient into the wrist, respectively the carpal tunnel with corticosteroid, which represents an efficient anti-inflammatory agent that can ease the pain caused by symptoms. However, the main downside is that its effect is temporary and people with diabetes can experience problems with the insulin level if they use this treatment for a long time.
  • Alternative therapies: Some people with carpal tunnel syndrome opt for natural treatments like yoga, chiropractic care and acupuncture.  While yoga helps the patient cope with the pain and have a firmer grip, the efficiency of the others remains questionable.

If none of these non-surgical treatments can fight the symptoms successfully, the doctor will not see any other available option besides surgery. Of course, he must take into consideration the severity of the symptoms to avoid irreversible damage. Therefore, patients who experience constant numbness and severe pain must undergo surgical treatment for a more serious case of carpal tunnel syndrome. The standard procedure for this type of condition is known as carpal tunnel release, which involves cutting the ligament around the wrist with the goal to release pressure that negatively affects the median nerve. The doctor must perform local or general anesthesia and has the freedom to choose between two techniques for accomplishing the surgery: open carpal tunnel release and endoscopic carpal tunnel release.

  1. Open release surgery: This traditional procedure involves an incision in the palm of the patient’s hand so the doctor can view inside and divide the ligament or the roof of the carpal tunnel. Consequently, after the procedure, the size of the tunnel will increase while the pressure on the median nerve will decrease. In time, the ligament will restore, but it will remain enough space in the carpal tunnel so the median nerve will not experience the harmful pressure.
  2. Endoscopic surgery: During this procedure, the doctor makes even smaller cuts on the skin just so he can insert a miniature camera or endoscope and view inside. Like the open release surgery, he divides the ligament using a knife that he inserts though the tube holding the miniature camera. By resorting to this intervention, the patient can benefit from a faster recovery and less discomfort but it can experience possible complications.

Regardless of the techniques chosen by the doctor, it should relieve the symptoms almost immediately. Nevertheless, a full recovery from carpal tunnel syndrome can last several months. In addition, people need to change their activities and adjust work duties for weeks after the surgery. Some patients might experience side effects including pain, stiffness, infections and even nerve damage because like any other surgery, complications are possible when it comes to carpal tunnel syndrome. Obviously, the doctor will give his best in order to minimize the risks of complications.  The case of a patient with severe carpal tunnel syndrome may require the involvement of various specialists from practitioners and internists to rheumatologists, orthopedists and neurologists. The prognosis for this condition is excellent because this type of condition generally responds to the measures mentioned above.


Recovery from Carpal Tunnel Syndrome Surgery

After the surgery, the doctor will encourage the patient to move his hand and fingers slowly by elevating it above the heart. This has the purpose to prevent stiffness and minimize swelling. It is normal for the patient to feel pain following the procedure and the soreness in the palm area may last up until a few months. Within the first three months after undergoing surgery, the grip strength gradually returns. The patient needs to wear a wrist brace or splint and avoid activities that might provoke significant discomfort. That being said, he can still use the hand for lighter activities. Just like before the surgery, the doctor has to discuss with the patient again in order to give him clear instructions and inform him regarding any restrictions at the workplace or in general.

If the patient still feels weakness and pain after two or three months following the surgery, his doctor might advise him to consult a hand therapist for full recovery. If an underlying condition, such as tendonitis or arthritis causes those symptoms, then it will slow the recovery process. Shortly, the recovery process can extend up to one year. Carpal tunnel syndrome rarely recurs but if it happens, the patient must undergo another surgery or receive additional treatment.


Can you Prevent Carpal Tunnel Syndrome?

Even though specialists have not discovered efficient strategies to prevent carpal tunnel syndrome successfully, people can use various methods to reduce the stress on the median nerve.

  • They can minimize the use of force during activities that involve hands muscles like working with a cash register. For people whose jobs require prolonged writing, they should relax their grip while holding the pen or any other writing instrument.
  • Correcting bad posture as well as preventing extreme wrist bending can help. People should find a more relaxed form that does not apply stresses on the muscles that much.
  • During time-consuming activities that require a great amount of force or handling a certain type of equipment, it is equally important and beneficial for people to take frequent breaks.
  • Working in a cold environment causes stiffness and pain in the hands, which means that people should provide the necessary protection by wearing gloves.

Last updated on March 2nd, 2018

Chris Riley

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