Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

Carpal tunnel syndrome is a medical condition characterized by symptoms such as pain, tingling, numbness, and weakness in the wrist and hand. The gap in the wrist bones is known as carpal tunnel and functions similarly to a tunnel road carved through a hillside. Rather than creating space for cars to drive through, it serves as a channel in the bones, allowing ligaments, tendons, and nerves to travel through to reach the hand.

Carpal tunnel syndrome is caused by an irritation or increased pressure on the median nerve running through the carpal tunnel. The median nerve facilitates forearm movement and provides sensation to the majority of the fingers and hands. In case of damage or compression against the carpal tunnel wall, it transmits extra or erroneous feelings to the wrist and hand.

It’s, therefore, important to see a medical doctor if you experience tingling, numbness, or pain in your wrists and hands. Although carpal tunnel syndrome treatment is usually effective, it can cause permanent damage to the median nerve if not addressed on time.

Wrist anatomy

Having a basic knowledge of the anatomy or structure of the wrist is fundamental in understanding carpal tunnel syndrome well. The wrist is an intricate joint comprising tiny carpal bones linked by ligaments. Tendons and muscles that facilitate motion and give stability also surround these bones.

Carpal tunnel syndrome causes swelling and inflammation in the carpal tunnel, generally affecting the wrist. The inflammation exerts pressure on the median nerve. This results in distinctive symptoms of the syndrome.

Proper alignment of the wrist is essential to maintain ideal hand function and prevent disorders, including carpal tunnel syndrome. A misaligned wrist or subjecting the wrist to too much stress can increase the possibilities of the syndrome. 

Symptoms of Carpal Tunnel Syndrome

The common symptoms associated with carpal tunnel syndrome are:

• Pain in the hand, wrist, or fingers
• Numbness in the wrist, fingers, or hand (particularly on the fingertips)
• Tingling
• Difficulty using hands to control or grasp objects (for instance, holding your phone, clasping the steering wheel, typing on a keyboard, or holding a pen)

Normally, carpal tunnel syndrome is a slow-developing condition with initial symptoms being minor and potentially worsening with time. Individuals mostly begin noticing first symptoms during the night, including tingling or pain that might wake them. As the condition progresses, the symptoms could also affect the timing of the day, particularly if one’s activities involve repetitive motions such as writing, typing, or using tools.

What does carpal tunnel syndrome feel like?

Carpal tunnel syndrome causes discomfort in the hands, wrists, and fingers. Sensations can range from pinpricks to a feeling similar to your hands or fingers’falling asleep’. Additionally, you can experience numbness, which causes your hand to shake.

The pain associated with carpal tunnel syndrome normally feels like it emanates from within the wrist or hand, but it is not the discomfort similar to a cut. It may also manifest as a sharp burning stab or a persistent ache.

In some instances, persons with carpal tunnel syndrome can notice an unusual weakness in their grip and hands. It may seem impossible to firmly grasp a pen or cup despite focusing on it fully. In addition, the hand and fingers might feel clumsier than usual.

Causes of Carpal Tunnel Syndrome

Carpal tunnel syndrome stems from the pressure exerted on the median nerve. The median nerve running from the forearm through the wrist passageway to the hand is the carpal tunnel. In addition, the median nerve is responsible for giving feeling to the palm side of the thumb as well as all fingers, excluding the little finger. In addition, this nerve sends signals to direct the movement of muscles surrounding the thumb base (motor function).

An irritation or squeezing of the median nerve within the carpal tunnel space can trigger carpal tunnel syndrome. Conditions like a wrist fracture can irritate the nerve and constrict the carpal tunnel. Also, inflammation and swelling caused by rheumatoid arthritis or another disorder can contribute to this condition.

In most cases, carpal tunnel syndrome has no actual cause, and its exact origin may be unknown. However, it is likely that a combination of several risk factors collectively contributes to this disease.

Risk Factors

Carpal tunnel syndrome has been connected with a number of factors. While they might not directly cause the condition, they can escalate the risk of median nerve damage or irritation.

These risk factors include:

• Anatomical factors: A dislocation or fracture of the wrist can change the space in the carpal tunnel. Also, arthritis disorder causing alteration to the small bones within the wrist can impact the carpal tunnel. All these changes may compress the median nerve, increasing the chances of carpal tunnel syndrome. Moreover, individuals with smaller carpal tunnels might be more susceptible to the condition.
• Gender: In general, carpal tunnel syndrome is more prevalent in females. This might be because the carpal tunnel space is somewhat smaller in women compared to men. Alternatively, it might be due to hormone effects on the tendon lining within the carpal tunnel.
• Inflammatory diseases: Gout, rheumatoid arthritis, and other disorders characterized by swelling or inflammation can impact the lining near the wrist tendons. This can lead to compression of the median nerve.
• Nerve damaging disorders: Certain chronic conditions, including diabetes, can increase the possibility of nerve damage and impairment of the median nerve.
• Medicines: Some research studies suggest a potential connection between anastrozole (Arimidex), the medication used for breast cancer treatment, and carpal tunnel syndrome.
• Obesity: Being overweight is a contributing risk factor for developing carpal tunnel syndrome.
• Body fluid changes: Retention of fluid can raise the pressure in the carpal tunnel, resulting in an irritation of the median nerve. This occurrence is common in women, especially during pregnancy and menopause. However, pregnancy-related carpal tunnel syndrome usually resolves on its own after delivery.
• Other medical problems: Certain health conditions, including kidney failure, lymphedema, and thyroid disorders, might increase the probability of developing carpal tunnel syndrome.
• Workplace factors: Operating vibrating equipment or working on an assembly line requiring repetitive wrist flexing motions might pressure the median nerve or aggravate pre-existing nerve damage. Also, working in cold environments could worsen the compression of the nerve.

Nonetheless, the scientific proof regarding these factors contradicts and hasn’t been conclusively confirmed as a direct cause of the syndrome.

Some studies have assessed the possibility of a connection between carpal tunnel syndrome and using a computer. Other evidence indicates that using a mouse but not a keyboard might be linked to the syndrome. However, there’s a lack of consistent and reliable evidence supporting extensive computer usage as a contributing risk factor for carpal tunnel syndrome. Even so, computer use could still result in different kinds of hand and wrist pain.

Carpal Tunnel Syndrome Diagnosis

During carpal tunnel syndrome diagnosis, the medical provider may begin by asking about your symptoms. They may also conduct one or more examinations and tests to determine if you actually have the condition. These procedures can include the following:

• History of the symptoms: To make a diagnosis, your healthcare provider will need to understand the pattern of your symptoms. Typically, the symptoms of carpal tunnel syndrome manifest when holding a newspaper or phone or while grasping a steering wheel. Also, they tend to strike during the night and can even awaken you. In other cases, you might experience numbness in the morning upon getting up.

The median nerve doesn’t usually give the little finger a sensation. So, any symptoms around this finger might suggest a different problem.

• Physical examination: During a physical exam, the doctor will test the sensation in your fingers and check the muscle strength in your hand. In most people, bending the wrist and pressing or tapping the nerve could prompt the symptoms.
• X-ray: An X-ray of your affected wrist may be necessary to rule out other causes of pain, including arthritis and fracture. X-rays aren’t, however, effective in diagnosing carpal tunnel syndrome.
• Ultrasound: An ultrasound scan of the wrist gives an image of the nerves and tendons, which can help determine whether or not there is compression.
• Electromyography (EMG): EMG is used to measure the tiny electrical expulsions the muscles produce. A tiny need electrode is put inside particular muscles to check the electrical activity during contraction and when resting. This test can help detect damage to the muscles the median nerve controls. Also, doctors can use EMG to rule out other problems.
• Nerve conduction study: This test involves taping two electrodes to the skin and administering a mild shock through the median nerve to check if electrical impulses slow down in the median nerve. This procedure can also help rule out other conditions besides diagnosing carpal tunnel syndrome.

Carpal Tunnel Syndrome Treatment Options

It is important to address carpal tunnel syndrome as soon as the symptoms appear. During the early stages, these simple practices could help ease your symptoms:

• Frequently taking breaks to rest your hands
• Avoiding activities that can exacerbate the symptoms
• Using cold packs to minimize swelling

Wrist splinting, surgery, and medication are additional treatment alternatives for carpal tunnel syndrome. Wrist splinting and other conservative options may be effective for mild and moderate symptoms that fluctuate for less than ten months.

Additionally, see a healthcare provider if you experience numbness in your hands.

Non-surgical treatment:

These non-surgical treatment options can help manage carpal tunnel syndrome if detected earlier:

• Wrist splinting: Using a splint when sleeping to hold your wrist can help ease numbness and tingling symptoms at night. Although a splint is only worn at night, it could also help manage daytime symptoms. Also, since night time wrist splinting doesn’t include any medications, it is a suitable option for pregnant women.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs like ibuprofen (Montril IB, Advil) can provide short-term pain relief caused by carpal tunnel syndrome. Even so, there is no evidence that these drugs improve and manage carpal tunnel syndrome.
• Corticosteroids: Cortisone is a corticosteroid drug that your medical provider can inject into the carpal tunnel to ease pain. An ultrasound may sometimes be used to help guide the injections.

Corticosteroids typically ease compression on the median nerve by minimizing swelling and inflammation symptoms. Oral corticosteroids are considered less effective compared to corticosteroid injections.

When rheumatoid or inflammatory arthritis is the main cause of carpal tunnel syndrome, addressing this condition can help minimize the symptoms. Nonetheless, there is no research supporting the effectiveness of this approach.

Surgery:

When the symptoms of carpal tunnel syndrome are severe or other treatments are ineffective, a surgical procedure may be recommended. The primary objective of carpal tunnel surgery is to alleviate pressure on the median nerve by cutting the ligament that is compressing it.

Carpal tunnel surgery involves these three different methods:

• Endoscopic surgery: This procedure involves using a telescope-like instrument equipped with a small camera known as an endoscope. It enables visualization inside the carpal tunnels, making it easy for the surgeon to cut the ligaments through one or two tiny incisions on the hand or wrist.

Endoscopic operation may cause less pain compared to open surgery during the first days of recovery.

• Open surgery: This involves creating an incision or cut in the palm above the carpal tunnel and cutting through the ligament to free up the nerve.
• Ultrasound-guided surgery: Similar to endoscopic surgery, this approach involves using ultrasound to visualize the nerve, ligament, tendons, and arteries. Next, the surgeon cuts the ligament with a small blade or a braided wire inserted into the wrist through a needle.

Before undergoing a surgical operation, it’s important to discuss with your surgeon the advantages and risks of each procedure. These potential risks may be associated with the surgery:

• Incomplete ligament release
• Infection on the wound
• Formation of a scar
• Nerves or blood vessel injury

Following the carpal tunnel surgery, the healing process involves gradual growth of the ligament tissues while providing more space to the nerve. Typically, this internal healing takes some months, though the skin will heal within a few weeks.

Your healthcare provider will most likely advise using your hand once the ligament has completely healed. It is also crucial to gradually resume full hand use and avoid forceful movements or extreme positions of the wrist.

Hand weakness and soreness might resolve within several weeks to months after the surgical treatment. However, if the initial symptoms were too severe, complete resolution may be impossible after surgery.

Carpal Tunnel Syndrome Prevention

Sometimes, preventing carpal tunnel syndrome may be difficult, particularly if it is caused by a medical condition or an activity that isn’t avoidable. Even so, you can lower the risks of the disorder by protecting your wrist using the following measures:

• Stretching your hands and wrists before and after engaging in vigorous physical activities.
• Frequently taking resting breaks when using hands.
• Utilizing the appropriate technique and maintaining a proper posture when typing on a keyboard or using tools.

Recovery and Rehabilitation Following Carpal Tunnel Surgery

Following the carpal tunnel surgery, appropriate care and rehabilitation contribute to a successful outcome. First, the wrist and hand can be restrained using a splint or cast to aid the healing process. It is also important to adhere to the surgeon’s post-operative care guidelines, which include ensuring that the surgical incision always remains clean and dry. 

Therapies and rehabilitation exercises are essential in reinstating your hand and wrist’s flexibility, strength, and function. A physical therapist can create a rehabilitation plan tailored to your gradual healing process. The program may include activities to strengthen and stretch your wrist and hand and other manual therapy approaches.

The recovery timeline following carpal tunnel surgery may vary based on the patient and the kind of surgical procedure done. Generally, you can expect to return to complete function in a few weeks or months. Also, it is necessary to schedule routine follow-up visits with the surgeon to monitor the healing process and address other possible concerns.

Living With

Can carpal tunnel syndrome resolve on its own?

Carpal tunnel syndrome can heal independently, particularly by resting or avoiding repetitive movements for a while. Nevertheless, there is a possibility that the condition will not resolve unless it is diagnosed and treated.

Given the risk of potentially irreversible damage to the median nerve, you should seek medical care immediately if you notice any pain, numbness, or tingling in your hand, wrist, or fingers.

Conclusion

Carpal tunnel syndrome is a common disorder affecting wrists and hands and usually causes pain, weakness, and numbness. Understanding the associated symptoms, causes, and available treatment options of the condition is thus essential for successful management and preventing more complications. Also, identifying the early warning signs ensures timely medical treatment, eventually improving the general outcome.