Carpal tunnel syndrome- Symptoms, Diagnosis and treatment

 

 

Understanding Carpal tunnel syndrome

 

Carpal tunnel syndrome is a condition that happens when the median nerve is compressed or squeezed as it passes through the wrist. This happens when the carpal tunnel inside your wrist becomes inflamed. The median nerve controls some of the muscles that move the thumb and carries information back to the brain about sensations in your thumb and fingers.

When the nerve is squeezed it can cause tingling, numbness, pain or aching in the affected hand. Women are more likely than men to develop carpal tunnel syndrome. The condition affects people of all ages, but it’s more common in people over 50.



 

• Carpal tunnel syndrome may interfere with hand strength and sensation, and cause a decrease in hand function.


• Other conditions, such as arthritis, tendonitis and other nerve involvement, need to be ruled out before diagnosing carpal tunnel syndrome.


• Physicians can diagnose carpal tunnel syndrome by history of the symptoms, physical examination and electrical testing, and in some cases by use of ultrasound or MRI.

 

What causes it?

 

Carpal tunnel syndrome mainly occurs in patients who are pregnant, overweight or have various medical conditions, including thyroid disease, diabetes or arthritis, or injuries such as wrist fractures. It is still debated whether repetitive work activities cause carpal tunnel syndrome, but it is thought that some repetitive hand activities, especially motions that can produce vibrations, can worsen the symptoms. Just as frequently, the syndrome occurs on its own.

However, many other conditions also can be responsible for symptoms of pain, swelling, numbness or weakness in the hands, such as diseases of the nerves located anywhere from the neck to the wrist. The pain and swelling in the hand joints and wrists caused by arthritis also can be responsible. For example, pain at the base of the thumb is commonly caused by osteoarthritis. Tendonitis – an inflammation of the tendons that connect muscles to bones – can cause pain, swelling, and impaired use of the hand or wrist. Health care professionals should exclude these and other diseases before diagnosing carpal tunnel syndrome.

 

Symptoms

The main symptoms of CTS are:

 

Diagnosis

 

It is important to seek medical assistance when you first notice above mentioned symptoms. Do not wait for the pain to become intolerable. Before a doctor can recommend a course of treatment, (s)he will perform a thorough evaluation of the condition, including a medical history, physical examination and diagnostic test. The doctor will document symptoms and ask about the extent to which these symptoms affect daily living.

The physical examination will include assessments of sensation, strength and reflexes. These diagnostic studies may include:

• X-ray: To look at the bones of the wrist to determine if any abnormalities may contribute to CTS


• EMG/NCS (Electromyogram and Nerve Conduction Study): These tests show how the nerves and muscles are working together. They measure the electrical impulse along nerve roots, peripheral nerves and muscle tissues.

 

Treatment

Treatment aims to relieve symptoms and slow the progression of CTS by reducing pressure on the median nerve.People with mild symptoms may find their condition improves without treatment within a few months, especially if they are aged 30 years or under or if CTS occurs during pregnancy.

1. Things you can do at home

• Resting the hand and wrist: The more rest the hand and wrist get, the greater the chance of relieving the symptoms.


• Cold compress: Placing an ice pack on the wrist may help when the problem flares up, but ice should not be applied ice directly onto the skin.


• Controlling the triggers: If CTS stems from repetitive hand movements, the person should take breaks so the hand and wrist have time to rest and recover.


• Occupational therapy: A therapist can teach a person how to repetitive tasks differently.


• Wrist splints: These keep the wrist in the same position and prevent it from bending. They can be worn during sleep, but also during the day if they do not interfere with daily activities. Wrist splints are available over the counter at pharmacies. A doctor or pharmacist can advise about the best one to choose.

Most patients with mild symptoms who follow these strategies will notice an improvement within 4 weeks.

2. Pain Medications

The doctor may recommend corticosteroid injections to reduce inflammation. These are normally applied by injection, directly into the carpal tunnel. Tablets are available, but they are usually less effective. At first, the pain may increase, but it should start to reduce after 2 days. If the response is good, but symptoms return after a few months, another dose may be recommended. However, continued use of corticosteroids is not advisable, as there can be long-term adverse effects.

Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, may help relieve short-term pain. These may only help if the CTS is due to an underlying inflammatory condition, rather than repetitive use. Other treatments that may help include exercises and botox injections.

3. Surgery

The surgical procedure peformed for carpal tunnel syndrome is called a "carpal tunnel release." There are two different surgical techniques for doing this, but the goal of both is to relieve pressure on your median nerve by cutting the ligament that forms the roof of the tunnel. This increases the size of the tunnel and decreases pressure on the median nerve. It is done on an outpatient basis. The surgery can be done under general anesthesia, which puts you to sleep, or under local anesthesia, which numbs just your hand and arm. In some cases, you will also be given a light sedative through an intravenous  line inserted into a vein in your arm.

• Open carpal tunnel release. In open surgery, your doctor makes a small incision in the palm of your hand and views the inside of your hand and wrist through this incision. During the procedure, your doctor will divide the transverse carpal ligament (the roof of the carpal tunnel). This increases the size of the tunnel and decreases pressure on the median nerve.


• Endoscopic carpal tunnel release. In endoscopic surgery, your doctor makes one or two smaller skin incisions—called portals—and uses a miniature camera—an endoscope—to see inside your hand and wrist. A special knife is used to divide the transverse carpal ligament, similar to the open carpal tunnel release procedure.

The outcomes of open surgery and endoscopic surgery are similar. There are benefits and potential risks associated with both techniques. Your doctor will talk with you about which surgical technique is best for you.