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Carpal Tunnel Syndrome

  • What is carpal tunnel syndrome?

    Carpal tunnel syndrome

    Carpal tunnel syndrome is a condition where the median nerve, which runs the length of the arm and through the carpal tunnel in the wrist, becomes compressed.

    The median nerve controls movement and feeling in all the fingers except the little finger. When it gets compressed, it can lead to discomfort or pain, which worsens if left untreated.

  • Carpal tunnel syndrome can be caused by:

    • A previous wrist fracture, resulting in narrowing of the carpal tunnel
    • Fluid retention, which can cause swelling of tissues and therefore increased pressure in the carpal tunnel.
    • Inflammatory (swelling) conditions, such as rheumatoid arthritis, which can cause the lining of joints and tendons in the carpal tunnel to swell.

    Sometimes, there may be no clear cause for why carpal tunnel syndrome develops. However, there are some known risk factors that increase your risk.

    Risk factors for carpal tunnel syndrome

    • Family history, as you are more likely to experience carpal tunnel syndrome if family members have it also.
    • Medical conditions such as diabetes mellitus (Type 2 diabetes), hypothyroidism, rheumatoid arthritis and gout, which are linked to higher likelihood for developing carpal tunnel syndrome.
    • Obesity, which can contribute to its development.
    • Advancing age, which can lead to changes in the soft tissue or bony structures of the wrist, and thereby contribute to the development of carpal tunnel syndrome.
    • Gender, with women being more likely to develop carpal tunnel syndrome than men.
    • Activities that require prolonged or repetitive flexing of the wrist, including typing, as this may contribute to pressure on the median nerve. This is often the most common cause of carpal tunnel syndrome.

    While it may not be possible to fully prevent carpal tunnel syndrome, you can reduce your risk for developing this painful condition with some lifestyle adjustments.

    Reducing the risk of carpal tunnel syndrome

    • Take short breaks to stretch and bend your wrists, or alternate your tasks to give your wrists some relief. This is especially important if you are using equipment that vibrates or using your hands to exert a lot of pressure.
    • Relax your grip and use less force when performing tasks like writing or typing.
    • Avoid excessive or extreme bending of your wrist. Try to keep to a relaxed, middle position, place your keyboard at elbow height or slightly lower and use a computer mouse that allows comfortable wrist movement.
    • Practice good form and posture to avoid straining neck and shoulder muscles, which can compress the nerves in your neck.
    • Keep your hands and wrists warm, as hand pain and stiffness is more common in people who work in a cold environment.
  • Symptoms of carpal tunnel syndrome include:

    • Tingling or numbness in your hand or fingers

      Most of the time, this can can affect any of the fingers except your little finger. Shaking the hand or wrist may relieve the tingling or numbness but it may recur and become more frequent and severe over time.

    • Tingling, numbness that travels up the arm

      This is more likely to occur when you are using your hand to grip something such as a steering wheel or telephone. In some cases, it may be severe enough to wake you from sleep.

    • Weakness or lack of sensation in your hand

      Weakness or numbness may lead to difficulty holding or grasping things, or you may find yourself dropping things as these muscles are also controlled by the median nerve.

    • Pain or muscle cramps in your hand

      This becomes more common in severe or advanced carpal tunnel syndrome.

    You should seek early treatment for carpal tunnel syndrome as early diagnosis and treatment offer the best chance for effective relief without the need for surgery. If the condition is allowed to progress, it can lead to further weakening of the muscles and impaired function. This can make it difficult to perform daily tasks such as fastening buttons, using chopsticks and picking up small items.

  • Carpal tunnel syndrome can be diagnosed based on your medical history, a physical examination and one or more diagnostic tests.

    • Physical examination

      During a physical examination, your doctor will ask about your symptoms and look for signs of nerve pressure. This includes checking for tenderness, swelling and deformities.

      To help your doctor evaluate sensation in your fingers and muscle strength in your hand, some simple tests include:

      • Tinel’s Sign

        A Tinel’s Sign is where a reflex hammer is tapped on the median nerve in your wrist. A positive test will result in tingling in your fingers or a sensation like a small electric shock.

      • Phalen’s Maneuver

        A Phalen’s Maneuver or wrist flexion test involves you pressing the backs of your hands together, with your fingers pointed down, for one or two minutes. If you feel tingling or numbness, this is an indication of carpal tunnel syndrome.

    • Nerve conduction studies

      Nerve conduction studies measure the speed and function of the median nerve. A small electrode is placed on the skin near the elbow to send a small electrical current down the median nerve. As healthy nerves transmit electrical signals quickly, the amount of time takes for the current to travel to your fingers will indicate the amount of nerve damage you are experiencing.

    • Electromyogram

      In this diagnostic test, a small needle is inserted into the muscles in your hand to send electrical impulses that measure the muscle function around the median nerve while you squeeze and relax your hands several times.

    • Imaging tests

      Imaging tests such as an ultrasound, X-ray or magnetic resonance imaging (MRI) may be performed to rule out any other possible causes of wrist pain such as arthritis.

  • Treatment for carpal tunnel syndrome usually depends on the severity of its symptoms, ranging from lifestyle changes and medication to surgery or a combination of these.

    Lifestyle changes

    To relieve pressure on the wrist, take breaks to stretch your hands and wrists. You can also change activities regularly or alternate which hand you normally use. You should also avoid using unnecessary force while writing, typing or gripping. If your work set-up or requirements are contributing to your symptoms, consider making adjustments to your physical space or the way you perform your tasks.

    Wrist splint or brace

    Putting your wrist in a brace or splint to restrict its movement can allow a period of rest to relieve the symptoms of carpal tunnel syndrome. It may also help to wear one while sleeping.

    Physiotherapy

    Physiotherapy can help you to adjust the way you use your hands and wrist in your daily routine, to reduce pressure and therefore pain. You can also learn different ways to stretch and relieve strain on your wrists, and exercises to strengthen your hand and wrist muscles.

    Medication

    Your doctor may prescribe pain relievers or medication to help reduce swelling, but these should be taken sparingly and only under medical supervision.

    Carpal tunnel release surgery

    For severe and persistent symptoms, carpal tunnel release surgery may be recommended. The procedure involves cutting the carpal ligament to reduce pressure on the median nerve.

    Microsurgical neurolysis

    In cases where carpal tunnel release surgery is unsuccessful, microsurgical neurolysis may be advised. This procedure releases tight scar tissue around the median nerve to relieve pressure. In some cases, soft tissue will then be transferred to the bare median nerve to prevent scarring from happening again, which would cause the symptoms to return.

    See your doctor or a hand surgeon if you have signs and symptoms of carpal tunnel syndrome that interfere with your normal activities and sleep patterns. Early diagnosis and treatment offer the best chances for relief and prevents the symptoms from getting worse.

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  • Complications that may arise from carpal tunnel syndrome include:

    Reduced strength and coordination

    You may find it increasingly difficult to manage tasks such as fastening buttons or picking up small items as the hand muscles shrink.

    Increased pain and cramping

    As the pressure increases on the median nerve, symptoms such as pain and muscle cramps may worsen.

    Less feeling

    Compression of the median nerve leads to slower nerve muscles, leading to reduced feeling or sensation in your fingers.

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