Overview
When I was in high school, I took a typing class where the main objective was to keep on typing since ‘practice makes perfect’. Back in the day, considering possible harm to your hand was as foreign as the former planet Pluto is today. Needless to say, the term ‘carpal tunnel syndrome’ was not in anyone’s vocabulary at the time.
But, in truth, carpal tunnel syndrome is one of the most common conditions of the hand. It’s a major nerve, called the median nerve, which travels through the wrist. The carpal tunnel is the path through which the median nerve passes. The nerve provides sensation to the inner side of the thumb, and to the index, middle, and part of the ring finger. The little finger is usually not affected by this condition. When the median nerve is compressed, it leads to numbness in fingers, and weakness in some parts of the hand. It also causes pain in the hands and the wrist.
Carpal tunnel syndrome is a progressive condition that worsens over time. Also if the nerve continues to get compressed, it can lead to permanent damage. So it is important to treat it as soon as possible.
Causes of Carpal Tunnel Syndrome
There are many factors that contribute to developing this condition. Some of which includes the following:
Repetitive Motion
Repetitive motion of the wrist makes a person more prone to developing carpal tunnel syndrome. Professional typists, assembly line workers, and weight lifters are at a higher risk of this condition.
Medical Conditions
Medical conditions such as hypothyroidism, obesity, rheumatoid arthritis, and diabetes can increase the risk of developing carpal tunnel syndrome. The development of a cyst in the carpal tunnel can also lead to compression of the median nerve.
Pregnancy
Fluid retention in the body during pregnancy is also one of the causes of carpal tunnel syndrome.
Heredity
Genetics can play a role as well. Some people may have a smaller carpal tunnel. This leaves little space for the median nerve and results in compression.
Symptoms of Carpal Tunnel Syndrome
Since the condition affects the nerve, it can lead to one or more of the following symptoms:
- Tingling, numbness, and burning sensation in the palm, thumb, and fingers.
- Fingers may feel heavy and swollen despite no apparent swelling.
- Decrease in grip strength along with pain in the wrists.
- The symptoms are more severe when the person wakes up. As the condition progresses, people continue to experience tingling, numbness, and pain throughout the day.
The condition can affect one or both hands.
Risk of Developing Carpal Tunnel Syndrome
The condition is three times more common in women compared to men. This is because the tunnel is naturally narrower in women’s bodies. People with medical conditions like diabetes are more likely to develop it. This is because metabolic disorders like diabetes directly affect a person’s nerves.
Assembly line workers involved in manufacturing, sewing, and meat packaging, along with professional typists, are at a higher risk of developing this condition. It is rare among adults younger than 20 years of age. However, the chances of getting carpal tunnel syndrome increase with age.
Diagnosis of Carpal Tunnel Syndrome
Since it is a progressive condition, early diagnosis plays an important role in effectively treating carpal tunnel syndrome. A physical exam of the hand, shoulder, elbows, and arm can help determine a person’s ability to perform day-to-day tasks such as gripping. Routine lab tests include an x-ray, which helps rule out the possibility of a fracture or arthritis.
More specialized techniques for diagnosing carpal tunnel syndrome include electromyography and MRI scans. Electromyography is a recording technique that detects the nerve’s ability to send signals to the muscles. This helps indicate the severity of the damage to the median nerve. An MRI scan is very detailed imaging of the carpal tunnel, however, it is not considered very useful in the diagnosis of this condition.
Treatment Options
Treatment should start immediately after the diagnosis. A professional doctor can recommend the right treatment depending upon the age and overall health of the patient. Usually, doctors opt for non-surgical treatments but in case of more severe symptoms, surgery is often the last resort.
Non-Surgical Treatments
Splinting
One of the first treatments recommended to treat carpal tunnel is splinting. Doctors recommend wearing a splint at night. This helps reduce the pressure on the nerve. It is also one of the best ways to manage symptoms of tingling and numbness, especially at night.
Medication
Doctors often recommend the use of painkillers along with anti-inflammatory properties. This helps reduce the swelling of the nerve, which in turn helps manage the symptoms of carpal tunnel.
Corticosteroids Injections
If pain and other symptoms of carpal tunnel syndrome do not subside with the use of oral medicines, doctors recommend injecting corticosteroids in the wrist. This helps reduce the inflammation of the nerve due to compression. It is one of the most effective non-surgical treatments of carpal tunnel syndrome.
Lifestyle Changes
If the condition is caused by repetitive motion, doctors often recommend taking frequent breaks during the day. They may also suggest certain stretching and muscle strengthening exercises that help relieve the pressure from the nerve.
Surgical Treatment
Carpal tunnel surgery is one of the most common hand surgical procedures in the US. It involves cutting a ligament around the wrist. This procedure helps reduce the pressure on the median nerve. The surgery is often performed as a daycare treatment under local anesthesia. Doctors may choose one of the following methods of severing the ligament.
Open Release Surgery
The procedure involves an open incision which can be up to two inches in the wrist. It is followed by cutting the ligament which helps open up space in the tunnel.
Endoscopic Surgery
This surgery is performed using a laparoscopic camera. The camera helps identify the location of the nerve and the ligament. A small knife is inserted through a tube which then cuts the ligament. This procedure has a higher risk of complications and the need for another surgery. Thus it is not a preferred method by doctors.