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Pressure on the median nerve causes carpal tunnel syndrome. The carpal tunnel is a tiny channel on the palm side of the hand bordered by bones and ligaments. Numbness, tingling, and weakness in the hand and arm can occur when the median nerve is crushed.
Carpal tunnel syndrome can be caused by the anatomy of the wrist, health problems, and possibly repeated hand motions.
Treatment frequently cures the tingling and numbness while also restoring wrist and hand function.
WHAT ARE THE SYMPTOMS OF CARPAL TUNNEL SYNDROME?
Symptoms of carpal tunnel syndrome typically appear gradually and include:
- Numbness or tingling: Tingling and numbness in the fingers or hand are possible symptoms. The thumb, index, middle, and ring fingers are usually afflicted, but not the little finger. You may experience an electric shock sensation in these fingertips.
The sensation may spread up the arm from the wrist. These symptoms frequently occur while you are holding a steering wheel, phone, or newspaper, or they may awaken you from a deep sleep.
Many people "shake out" their hands in an attempt to alleviate their symptoms. Over time, the numb sensation may become permanent.
- Weakness: You may suffer hand weakness and drop objects. This could be due to numbness in the hand or weakness in the pinching muscles of the thumb, which are likewise controlled by the median nerve.
WHAT ARE THE CAUSES OF CARPAL TUNNEL SYNDROME?
Pressure on the median nerve causes carpal tunnel syndrome.
The median nerve travels from the forearm to the hand via a channel in the wrist (carpal tunnel). Except for the little finger, it delivers feeling to the palm side of the thumb and fingers. It also sends nerve signals to the muscles at the base of the thumb (motor function).
Carpal tunnel syndrome can be caused by anything that squeezes or irritates the median nerve in the carpal tunnel area. A wrist fracture, as well as the swelling and inflammation induced by rheumatoid arthritis, can constrict the carpal tunnel and irritate the nerve.
Carpal tunnel syndrome is frequently caused by multiple factors. It's possible that a combination of risk factors adds to the condition's emergence.
WHAT ARE THE RISK FACTORS FOR CARPAL TUNNEL SYNDROME?
Carpal tunnel syndrome has been linked to a number of variables. Although they may not directly cause carpal tunnel syndrome, they may raise the risk of median nerve irritation or injury. These are some examples:
- Anatomical considerations: A wrist fracture or dislocation, as well as arthritis that deforms the tiny bones of the wrist, can change the space within the carpal tunnel, putting pressure on the median nerve.
Carpal tunnel syndrome may be more common in people with smaller carpal tunnels.
- Sex: Women are more likely than males to suffer from carpal tunnel syndrome. This could be because women's carpal tunnel areas are smaller than men's.
Those with carpal tunnel syndrome may have smaller carpal tunnels than women without the illness.
- Nerve-damaging diseases: Diabetes, for example, increases the risk of nerve injury, including damage to the median nerve.
- Inflammatory diseases: Rheumatoid arthritis and other inflammatory disorders can impair the lining of the tendons in the wrist, putting pressure on the median nerve.
- Medications: Some research has found a link between carpal tunnel syndrome and the usage of anastrozole (Arimidex), a breast cancer treatment.
- Obesity: Obesity increases the risk of carpal tunnel syndrome.
- Changes in bodily fluids: Fluid retention may raise pressure within the carpal tunnel, causing irritation to the median nerve. This happens frequently during pregnancy and menopause. Carpal tunnel syndrome caused by pregnancy usually resolves on its own after the pregnancy.
- Other medical issues: Carpal tunnel syndrome is more likely in people who have menopause, thyroid issues, kidney failure, or lymphedema.
- Workplace factors: Working with vibrating equipment or on an assembly line that needs lengthy or repetitive wrist flexing may put damaging strain on the median nerve or worsen existing nerve injury, especially if done in a chilly environment.
However, the scientific data is mixed, and these factors have not been proven to be direct causes of carpal tunnel syndrome.
Several studies have been conducted to determine whether there is a link between computer use and carpal tunnel syndrome. Some data suggests that mouse use, rather than keyboard use, may be the issue. However, there hasn't been enough high-quality, consistent evidence to support extensive computer use as a risk factor for carpal tunnel syndrome, despite the fact that it may produce a different type of hand pain.
HOW IS CARPAL TUNNEL SYNDROME DIAGNOSED?
To evaluate whether you have carpal tunnel syndrome, your physician may ask you questions and perform one or more of the following tests:
- Symptoms in the past: Your doctor will examine the pattern of your symptoms. Because the median nerve does not supply feeling to the little finger, problems in that finger could indicate something other than carpal tunnel syndrome.
Carpal tunnel syndrome symptoms typically appear while holding a phone, a newspaper, or a steering wheel. They also tend to happen at night, and you may be awakened by the numbness when you wake up in the morning.
- Physical examination: A physical examination will be performed by your provider. He or she will assess the feeling in the fingers as well as the strength of the hand muscles.
Many patients get symptoms when they bend their wrist, tap on the nerve, or just press on the nerve.
- X-ray: Some healthcare experts advise getting an X-ray of the affected wrist to rule out other reasons of wrist discomfort, such as arthritis or a fracture. X-rays, on the other hand, are ineffective in diagnosing carpal tunnel syndrome.
- Ultrasound: An ultrasound of your wrist may be recommended by your provider to obtain a clear picture of the bones and nerve. This can aid in determining whether the nerve is crushed.
- Electromyography: This test detects the minute electrical discharges that occur in muscles. During this test, your provider will place a thin-needle electrode into certain muscles to assess electrical activity as the muscles contract and rest. This examination can detect injury to the muscles controlled by the median nerve while also ruling out other possibilities.
- Nerve conduction analysis: Two electrodes are taped to the skin in a version of electromyography. A mild shock is administered through the median nerve to determine whether electrical impulses in the carpal tunnel are delayed. This test may be used to diagnose the illness as well as rule out alternative possibilities.
WHAT ARE THE TREATMENTS FOR CARPAL TUNNEL SYNDROME?
Carpal tunnel syndrome should be treated as soon as symptoms appear. Simple things you can do for yourself may alleviate the problem in the early stages. As an example:
- Take more regular rests to allow your hands to rest.
- Avoid activities that aggravate your symptoms.
- To minimize swelling, apply cold packs.
Wrist splinting, medicines, and surgery are also alternatives for treatment. If you've only experienced mild to severe symptoms that come and go for less than 10 months, splinting and other conservative treatments are more likely to assist. If you have numbness in your hands, you should consult a doctor.
Nonsurgical therapy
Nonsurgical procedures, such as: If the condition is detected early, nonsurgical methods such as:
- Splinting of the wrist: A splint that holds the wrist stationary while you sleep can help reduce tingling and numbness at night. Even if you just use the splint at night, it can help prevent symptoms throughout the day. If you're pregnant, nighttime splinting may be a viable alternative because it doesn't require the use of any medications to be effective.
- NSAIDs (nonsteroidal anti-inflammatory drugs): In the short term, NSAIDs such as ibuprofen (Advil, Motrin IB, and others) may help reduce pain from carpal tunnel syndrome.
However, there is no evidence that these medications improve carpal tunnel syndrome.
- Corticosteroids: To ease pain, your provider may inject a corticosteroid such as cortisone into the carpal tunnel. The clinician may use an ultrasound to guide these injections at times.
Corticosteroids reduce inflammation and edema, releasing pressure from the median nerve. For treating carpal tunnel syndrome, oral corticosteroids are not as effective as corticosteroid injections.
If rheumatoid arthritis or similar inflammatory arthritis is the cause of carpal tunnel syndrome, treating the arthritis may alleviate symptoms. This, however, remains unproven.
Surgery
If symptoms are severe or do not respond to previous therapies, surgery may be necessary.
The purpose of carpal tunnel surgery is to relieve pressure on the median nerve by cutting the ligament that is pressing on it.
The procedure can be conducted using one of two methods:
- Endoscopic surgery: To see within the carpal tunnel, your surgeon will use an endoscope, which is a telescope-like equipment with a tiny camera attached to it. The ligament is severed by the surgeon through one or two tiny incisions in the hand or wrist. Some surgeons may utilize ultrasound instead of a telescope to guide the cutting tool.
In the first few days or weeks after surgery, endoscopic surgery may cause less discomfort than open surgery.
- Open surgery: To liberate the nerve, your surgeon makes an incision in the palm of your hand over the carpal tunnel and cuts through the ligament.
Before surgery, discuss the risks and benefits of each approach with your surgeon. Surgical risks include:
- Incomplete ligament release
- Infections of the wound
- Scar development
- Neurological or blood vessel injuries
During the healing process following surgery, the ligament tissues gradually re-grow, making more room for the nerve. Internal recovery takes several months, whereas skin healing takes only a few weeks.
After the ligament has healed, your provider will normally advise you to use the hand again, gradually returning to regular use while first avoiding vigorous hand motions or extreme wrist positions.
After surgery, soreness or weakness may last several weeks to a few months. If your symptoms were severe, they may not totally resolve following surgery.