What Is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome is a syndrome in which pressure on the median nerve of the wrist leads to feelings of numbness, tingling, weakness or muscle damage in the hands and fingers.
Pathophysiology of Carpal Tunnel Syndrome:
The carpal tunnel is an area of the hand and wrist, where the median nerve enters the hand. The median nerve runs from your forearm in to the palm of your hand, and controls feeling in the palm and fingers. It also controls impulses to the hand that allow fingers and thumb to move.
Certain activities put pressure on this area, causing inflammation of the ligaments surrounding the nerve. On the other side of the nerve is bone.
Inflammation can also occur when tendons thicken or if there is injury to the wrist. When inflammation occurs, the median nerve becomes compressed, causing numbness, tingling, and shooting pain from the palm in to the forearm.
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What Are The Symptoms of Carpal Tunnel Syndrome?
The symptoms of carpal tunnel syndrome are typically progressive.
Typically the thumb, pointer, and middle fingers are the first affected in those who have carpal tunnel syndrome.
Most people who have carpal tunnel syndrome begin to notice tingling, or a "pins and needles" feeling in their fingers or hand - it may also be described as "itchiness" or "burning feelings."
While actual swelling is uncommon in cases of carpal tunnel syndrome, some people feel as though their fingers are "swollen and useless." These symptoms most generally start - and are noticed - overnight, when people sleep with their wrists flexed.
As the symptoms of carpal tunnel progress, the numbness and tingling may be observed during the day.
As carpal tunnel syndrome worsens, the affected hand or hands may begin to hurt as the strength of grip is decreased. This type of pain is often described as shooting up the forearm. The weakened grasp may make it difficult to grasp small objects or engage in manual work.
Additionally, the muscles in the hand and thumb may begin to weaken and deteriorate.
Risk Factors for Carpal Tunnel Syndrome:
Carpal tunnel syndrome is often caused by a combination of factors that lead to a compression and deterioration of the tissue surrounding the median nerve and hand muscles.
It is generally believed that carpal tunnel syndrome is a congenital disorder - that a person may simply have a smaller carpal tunnel area.
Several other risks for developing carpal tunnel include:
- Injury or trauma
- Over-activity of the pituitary gland
- Hypothyroidism
- Rheumatoid arthritis
- Mechanical problems in the wrist
- Repeated use of vibrating tools
- Fluid retention
- Cysts or tumors
There is mixed data regarding repetitive motion and its relationship to carpal tunnel syndrome.
Certainly it can result in disorders like bursitis and tendinitis, writer's cramp, or pain. However, these disorders are not symptoms of carpal tunnel syndrome.
Other risk factors include:
- Gender: Women are more likely to develop carpal tunnel syndrome than men. Possibly because women tend to have smaller hands.
- Hand dominance: Typically the dominant hand is affected first.
- Assembly like work: The manual use of hands may be a factor in increased risk of developing carpal tunnel syndrome.
Diagnosis of Carpal Tunnel Syndrome:
Early diagnosis is important with this disorder as it is important to reduce the potential amount of damage to the median nerve and hand.
Carpal tunnel syndrome is often diagnosed by a combination of clinical symptoms and testing.
Testing includes electro-diagnostic tests, in which electrodes are placed on the hand and wrist, to measure pulses along the nerve. Other tests involve the placement of a small needle in the muscle to determine the amount of damage to the nerve.
Physical exams include the use of tapping on the nerve areas to test for tingling or a shock-like sensation. Other methods include attempting to induce symptoms of carpal tunnel syndrome. The wrist is examined for tenderness and the fingers are tested for sensation.
Finally, imaging testing such as MRIs and ultrasound may be used to visually examine the wrist area for damage.
Treatment for Carpal Tunnel Syndrome:
There are several treatment options for carpal tunnel syndrome. If the carpal tunnel syndrome is due to a medical condition such as injury or arthritis, those conditions should be treated before assessing the carpal tunnel.
Abstinence is often used to allow the wrist a period of complete rest, to determine if this will alleviate symptoms. Avoiding activity or immobilization with a splint will reduce the bending and flexing in the wrist. Cold packs will also assist with the reduction in swelling.
Non-surgical Options to Treat Carpal Tunnel Syndrome:
- The primary non-surgical option in treating carpal tunnel syndrome includes the use of anti-inflammatory drugs. They may ease symptoms and treat the pain. Corticosteroids may also be used to reduce the inflammation in the area, if that is present.
- Exercise, such as physical therapy to strengthen and stretch the hand and wrist is often helpful.
Surgical Options to treat Carpal Tunnel Syndrome:
If exercise and medications do not help with the symptoms of carpal tunnel syndrome, surgery may be considered. There are two surgical methods employed.
- Open Release Surgery consists of making a 2 inch incision along the wrist, to cut open the carpal ligament. This releases the carpal tunnel and increases the space in the area. This is a procedure performed under general anesthesia.
- Endoscopic Surgery is becoming more and more popular as it often allows for less pain and a faster recovery. The surgeon will make two small incisions in the wrist and palm in order to place a camera on a tube in to the wrist, to observe the area. Then using small tools, the carpal ligament is cut to allow for an enlargement of the carpal tunnel.
Full recovery from surgery can take months and include exercises and therapy, although immediate symptoms may be relieved immediately following surgery.
A continued regiment of exercise, stretching, and moderation may be key in preventing carpal tunnel syndrome.
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Additional Resources About Carpal Tunnel Syndrome:
The National Institute of Neurological Disorders and Stroke - This webpage includes a comprehensive look at the cause, symptoms, diagnosis, and treatment of carpal tunnel syndrome.
US National Library of Medicine - This webpage contains information about the causes and risk factors of carpal tunnel syndrome.
The Chronic Pain Association - This is a website dedicated to research and education about chronic pain and conditions associated with chronic pain.
National Institude of Arthritis and Musculoskeletal and Skin Diseases - This website is dedicated to arthritis and musculoskeletal issues that result in pain.
