Carpal tunnel syndrome is a compressive nerve condition in which the median nerve (the nerve supplying the hands and fingers) is squeezed when it passes through the carpal tunnel in the wrist. As the carpal tunnel in the wrist is formed by tendons on either side, when these tendons get inflamed or swell they further narrow the carpal tunnel and result in the compression of the median nerve. This results in the carpal tunnel syndrome. The median nerve is both a motor and sensory nerve, controlling the motor movements of some of the thumb muscles and it carries sensory information back to the brain about the sensations felt in your thumb and fingers.
Who gets carpal tunnel syndrome ?
It can occur in any patient but is more common in females over the age of 50 years.
What are the causes for carpal tunnel syndrome ?
In the majority of patients, the cause is still unknown. However there are a number of medical conditions that predispose patients to Carpal Tunnel syndrome. These include pregnancy, thyroid disease, rheumatoid arthritis and wrist injuries.
Carpal tunnel syndrome occurs when the median nerve is compressed at the level of the wrist. The nerve and tendons that bend the fingers pass from the forearm into the hand through a narrow tunnel called the carpal tunnel. When there is a build up of pressure in this tunnel the nerve becomes squashed and causes symptoms of carpal tunnel syndrome.
What are the symptoms of carpal tunnel syndrome ?
When the median nerve is squeezed, it can possibly result in pain, aching, tingling or numbness in the affected hand. The fingers affected mostly include the thumb, index, and middle fingers. The little finger is spared of the numbness and tingling as that is supplied by ulnar nerve. These symptoms tend to get worse at night and may perturb your sleep, but you may also feel it most while waking up in the morning. The symptoms in the daytime include tingling and a definite decrease in the feeling in the fingertips. As the carpal tunnel syndrome progresses, the symptoms become constant. Weakness in the hand also develops and inabilities to perform tasks that need delicate motions begin to occur such as holding a steering wheel or a book, in writing, or in using a computer keyboard.
How is clinical examination of carpal tunnel syndrome done ?
- Modified Phalen’s test – Direct pressure over the carpal tunnel especially whilst bending the wrist forward, may reproduce the pins and needles in the thumb, index and middle fingers.
- Tinel’s test – Tapping the nerve in the carpal tunnel may cause tingling in these fingers.
Nerve conduction studies are used to record the speed of the nerve across the wrist joint. This can be compared to the other hand, or in cases where both hands are affected, compared to normal population data. The test takes about 20 minutes and is slightly uncomfortable.
How can carpal tunnel syndrome be treated ?
In the early stage of the disease, hanging the hand out of bed or shaking it around will often alleviate the pain and tingling. It is important to take frequent breaks to rest wrists and hands. Avoiding activities that deteriorate symptoms and putting cold packs to diminish swelling also may help. As the condition progresses, the treatment options consist of wrist splinting, medications and surgery. It is important to know that conservative treatments such as splinting are of help only if the symptoms are mild to moderate for lesser than 10 months.
Non-surgical therapy
The key to using nonsurgical methods is that the condition should have been diagnosed in the
beginning. These include the following.
- Wrist splinting: A wrist splint is one that holds your wrist still and in place while you sleep. This will definitely ease night symptoms of tingling and numbness.
- Painkillers: Non-steroidal anti-inflammatory drugs (NSAIDs) can control pain temporarily. However, it is not certain if these drugs improve the carpal tunnel syndrome, as such.
- Corticosteroids: Your doctor may have to use injectable corticosteroids such as cortisone to reduce the pain and inflammation. How these corticosteroids work is that they ebb inflammation and swelling, which relieves pressure on the median nerve. Corticosteroid injections are preferred over oral corticosteroids for treating carpal tunnel syndrome.
Surgical therapy
Surgery is the choice if your symptoms are aggravating or not responding to other treatments. The objective of the carpal tunnel surgery is to dispel pressure by cutting the ligament pressing from the top on the median nerve.
This surgery can be done with two different techniques.
- Laparoscopic or endoscopic carpal tunnel surgery : Your surgeon uses a minimally invasive approach with a thin telescope-like device and a tiny mounted camera (also called as endoscope) to see within your carpal tunnel. Your surgeon will then cut and release the ligament through one or two minute incisions made on your wrist or hands. It is important to know that endoscopic surgery causes less pain than open surgery in the initial days or weeks after surgery.
- Open carpal tunnel surgery : As the name suggests your surgeon makes a deep incision in the palm of your hand covering the carpal tunnel and cuts the ligament to release the nerve pressure. Your surgeon will recommend the right procedure for you.
The hand should be elevated as much as possible for the first 5 days to prevent the hand and fingers swelling. Gently bend and straighten the fingers from day 1. My preference is to remove the dressing at 2 days. The wound is cleaned and redressed with a simple dressing. Avoid forced gripping or lifting heavy objects for 2-3 weeks. The sutures dissolve at about 10 days. You should notice an improvement in symptoms within a week but the final result may be realised at about 3 months.
What are the risks of carpal tunnel surgery ?
- If the ligament has not been completely released.
- Infection of the wound
- Subsequent scar formation
- Median nerve or blood vessel injuries
How to find orthopedic surgeons for carpal tunnel surgery ?
Now you can find orthopedic surgeons for carpal tunnel surgery from different hospitals and destinations on a single platform, Hinfoways. You can avail opinions and information from multiple orthopedic surgeons, get cost estimates for carpal tunnel surgery from different hospitals, compare things and then choose an orthopedic surgeon for carpal tunnel surgery.
Find and choose an orthopedic surgeon for carpal tunnel surgery on Hinfoways. Make an informed choice.
Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
