Carpal Tunnel Syndrome is a common neurological condition in which the median nerve gets entrapped in the carpal tunnel giving rise to many symptoms in hand. The median nerve is the nerve that runs from your forearm to the palm of your hand through the wrist. It provides sensation to the thumb, index, middle, and half of the ring finger and motor supply to a few muscles of the thumb.
The median nerve and tendons of the muscles that bend the fingers of the hand pas-pass together through the carpel tunnel which is a narrow passageway. Thickening or swelling of tendons traveling through the carpel tunnel can increase pressure in that rigid pathway and cause compression of the median nerve. This condition normally affects the dominant hand first.
Risk Factors of Carpal Tunnel Syndrome
- Associated with diseases such as diabetes, thyroid disorders, inflammatory arthritis Pregnancy
- Alcoholism
- Increased use of vibrating hand tools
- Tumors in the carpel tunnel
- Obesity
- Injury to the wrist as fractures and sprain
- Female sex
- Aging
- Imbalance of thyroid or pituitary hormones
- Some occupations involve an increased amount of movement in the wrist.
Clinical Features of Carpal Tunnel Syndrome
- Numbness or tingling in the fingers of the hand mainly in the thumb, index, and middle fingers.
- Waking up at night from pain and tingling sensation.
- Holding the hand out of the bed provides pain relief.
- A feeling of clumsiness in hand when picking up small objects or when carrying heavy objects.
- Later, after the disease is progressed can present as weakness in the movements of some muscles.
- Increased tingling sensation and pain when engaging in some activities, including the involvement of fingers as buttoning a shirt.
Diagnosis of Carpal Tunnel Syndrome
Initially, the doctor will assess you through the history by asking for clinical features suggestive of Carpal Tunnel Syndrome. Then you will be examined for a few clinical features. There are two special tests that will be performed by doctors on the wrists of patients. In Tinel test the doctor will tap on the median nerve of the wrist, which will give a tingling sensation along its pathway. In the Phalen, the test doctor will ask you to hold your forearms while pressing the backs of your hands together, which will give a tingling sensation within a time period of 1 minute. These signs will suggest Carpal Tunnel Syndrome.
Also, special investigations of blood will be done to identify any underlying diseases such as diabetes mellitus or arthritis which can cause carpel tunnel syndrome.
A nerve conduction study is a special diagnostic test that reveals the functioning of nerves and could be used to diagnose Carpel Tunnel Syndrome.
Treatment for Carpal Tunnel Syndrome
Pharmacological Management
- In the early stages, symptoms can be managed by achieving short-term pain relief through Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and other nonprescription pain relievers.
- If you have mild pain corticosteroids can be injected into the wrist or taken orally to relieve pain which is caused by swelling and inflammation of the Carpal Tunnel.
Surgical Management
After initial management, if symptoms are not relieved next option is carpel tunnel release surgery which is a very common procedure done under local anesthesia. It can be done as an open-release surgery or as an endoscopic surgery.
Lifestyle Management
- You must get breaks in between work which includes hand exercises when you get the pain and rest the hand for a while until symptoms fade away.
- Wearing a splint, especially at night can help relieve symptoms in the early stages.
- There are special exercises that can be done to your hand which will relieve symptoms.
- Engaging in Yoga and alternative therapies such as acupuncture can be helpful as well.
- Getting occupational therapy which will help you to engage in your occupation without complicating the disease.
References
- Bailey and Love’s Short Practice of Surgery- 27th Edition
- Kumar and Clerk’s Clinical Medicine -8th Edition- Parveen Kumar, Michael Clark
- Oxford Handbook of Clinical Medicine – 10th Edition
- Browse’s Introduction to the Symptoms and Signs of Surgical Disease – 4th Edition – Norman L. Browse, John Black, Kevin G. Burnand and William E.G. Thomas
