Carpal tunnel syndrome is a condition wherein there is a tingling sensation, weakness, or numbness in the hand caused due to the median nerve being compressed. The median nerve passes through the carpal tunnel, a passageway in the wrist. It is responsible for the control of movements or sensations of the thumb as well as all the fingers except the pinky finger.
Causes
Carpal tunnel syndrome occurs due to extreme pressure on the median nerve and the wrist. Various conditions are linked with carpal tunnel syndrome, as these underlying conditions cause inflammation, which leads to swelling and pain in the wrist. Sometimes, the blood flow may also get restricted. The conditions that might be associated with carpal tunnel syndrome include wrist trauma or fractures, high blood pressure, thyroid dysfunction, autoimmune disorders, fluid retention, and diabetes.
Moving your wrist repeatedly such that your wrist gets overextended, can worsen carpal tunnel syndrome. This includes the position of the wrist while using a mouse or a keyboard, playing the piano, typing, using power or hand tools, and other such activities.
Symptoms
Symptoms of carpal tunnel syndrome include –
- Pain in the first three fingers and thumb, along with tingling sensation or numbness
- Tingling or pain radiating to the shoulder from the forearm
- Not being able to hold things due to loss of awareness of your hand’s position, weakness, or numbness
- Sensations such as shock felt in the first three fingers and thumb
- Clumsiness in the hands
Risk Factors
Various risk factors can be linked to carpal tunnel syndrome, including –
- Chronic illness – Certain chronic illnesses such as diabetes can cause damage to the median nerve, ultimately leading to carpal tunnel syndrome.
- Medication – According to some studies, certain medications such as anastrozole which is used for the treatment of breast cancer can be linked to carpal tunnel syndrome.
- Anatomy – Anatomical problems such as deformities in the small bones of the wrist due to arthritis or fracture or dislocation of the wrist can cause changes within the carpal tunnel, leading to carpal tunnel syndrome due to the median nerve being compressed.
- Autoimmune conditions – Certain autoimmune conditions such as rheumatoid arthritis can cause inflammation in the wrist, which causes the pressure on the median nerve to increase.
- Obesity – Obesity can be linked to carpal tunnel syndrome.
- Gender – Women are more likely to have carpal tunnel syndrome since the carpal tunnel in women is smaller as compared to men.
- Fluid retention – Pressure on the median nerve can increase due to fluid retention, which is common during menopause and pregnancy.
- Working conditions – If an individual has to flex their wrists repeatedly or work using power or hand tools, pressure on their median nerve can be created or worsened, especially in colder areas. However, there isn’t enough evidence to confirm this.
Diagnosis
First, your doctor will ask you about your symptoms and perform a physical exam. They will test the strength of your hand muscles as well as sensation in your fingers by bending your wrist, pressing, or tapping on the median nerve.
Imaging tests such as an X-ray may be performed so that other factors such as fractures or arthritis that might be causing wrist pain, can be eliminated. Other tests include electromyography wherein an electrode is inserted into different muscles to evaluate electrical discharges that occur when the muscles rest and contract. With this test, damage to muscles that are controlled by the median nerve can also be identified.
Treatment
It is essential to treat carpal tunnel syndrome as soon as symptoms start to appear, as it can worsen with time. If possible, carpal tunnel syndrome symptoms should be treated with nonsurgical options such as –
- Avoiding overextending your wrist repeatedly
- Treatment of underlying conditions if any
- Pain medication or steroid injections to reduce pain and inflammation
- Splinting the wrist at night to relieve symptoms
If there is severe damage to the median nerve, surgery may be recommended. Surgery for carpal tunnel syndrome can be performed using two techniques –
- Endoscopic – In this procedure, an endoscope is used so that the surgeon can see inside the carpal tunnel. Then, the surgeon will make one or two tiny incisions in the wrist and cut the ligament. In some cases, ultrasound may be used instead of an endoscope. This is a less-invasive option that might result in less pain, as compared to open surgery.
- Open surgery – In this procedure, the surgeon will make a cut in the palm, cutting through the ligament so that the median nerve can be freed.
Complications
As with any surgery, there are some complications associated with surgery for carpal tunnel syndrome, such as:
- Scarring
- Ligament not being released completely
- Injury to blood vessels or nerves
- Infection to the wound
Recovery
After surgery for carpal tunnel syndrome, the ligament in the wrist will start growing back together and the median nerve will have more room. It may take months for internal healing, but the skin will heal after a few weeks. Patients should use their hands once the ligament has healed, making sure that they don’t make any forceful movements or overextend their wrist. They might experience some weakness or soreness for several weeks to months after the surgery.
Prevention
Carpal tunnel syndrome can be prevented by making certain lifestyle changes such that the risk factors for developing carpal tunnel syndrome can be reduced. These changes include –
- Treatment of underlying medical conditions such as high blood pressure, diabetes, or arthritis
- Avoiding activities wherein overextension of wrist is required
- Paying attention to hand posture at different times
- Losing weight if a person is overweight or obese
- Taking a break at regular intervals if doing activities that require repetitive hand movements
- Stretching fingers and palms and rotating wrists
Outlook
If you are experiencing any symptoms of carpal tunnel syndrome, try to make some lifestyle changes to observe if the symptoms disappear or not. Early treatment of carpal tunnel syndrome can make a huge difference. If left untreated, carpal tunnel syndrome can cause permanent damage to the nerve, loss of hand function, or disability.
