Carpal Tunnel Syndrome
Carpal tunnel syndrome is caused by pressure on the median nerve. The carpal tunnel is a narrow passageway surrounded by bones and ligaments on the palm side of the hand. When the median nerve is compressed, symptoms can include numbness, tingling, and weakness in the hand and arm.
CTS is a common neurological disorder that occurs when the median nerve, which runs from your forearm into the palm of the hand, becomes pressed or squeezed at the wrist. You may feel numbness, weakness, pain in your hand and wrist, and your fingers may become swollen and useless.
Carpal tunnel syndrome symptoms usually start gradually and include:
- Tingling or numbness. You may notice tingling and numbness in the fingers or hand. Usually the thumb and index, middle or ring fingers are affected, but not the little finger. You might feel a sensation like an electric shock in these fingers.The sensation may travel from the wrist up the arm. These symptoms often occur while holding a steering wheel, phone or newspaper, or may wake you from sleep.
Many people “shake out” their hands to try to relieve their symptoms. The numb feeling may become constant over time.
- Weakness. You may experience weakness in the hand and drop objects. This may be due to the numbness in the hand or weakness of the thumb’s pinching muscles, which are also controlled by the median nerve.
Carpal tunnel syndrome is caused by pressure on the median nerve.
The median nerve runs from the forearm through a passageway in the wrist (carpal tunnel) to the hand. It provides sensation to the palm side of the thumb and fingers, except the little finger. It also provides nerve signals to move the muscles around the base of the thumb (motor function).
Anything that squeezes or irritates the median nerve in the carpal tunnel space may lead to carpal tunnel syndrome. A wrist fracture can narrow the carpal tunnel and irritate the nerve, as can the swelling and inflammation caused by rheumatoid arthritis.
Many times, there is no single cause of carpal tunnel syndrome. It may be that a combination of risk factors contributes to the development of the condition.
Diagnosis of Carpal tunnel syndrome
Orthopedic Specialist at Shreya Hospital may ask you questions and conduct one or more of the following tests to determine whether you have carpal tunnel syndrome:
- History of symptoms. Your Doctor will review the pattern of the symptoms. For example, because the median nerve doesn’t provide sensation to the little finger, symptoms in that finger may indicate a problem other than carpal tunnel syndrome.Carpal tunnel syndrome symptoms usually occur while holding a phone or a newspaper or gripping a steering wheel. They also tend to occur at night and may wake you during the night, or you may notice the numbness when you wake up in the morning.
- Physical examination. During physical examination, Doctor will test the feeling in the fingers and the strength of the muscles in the hand.Bending the wrist, tapping on the nerve or simply pressing on the nerve can trigger symptoms in many people.
- X-ray. Specialist might recommend an X-ray of the affected wrist to exclude other causes of wrist pain, such as arthritis or a fracture. However, X-rays are not helpful in making a diagnosis of carpal tunnel syndrome.
- Ultrasound. In some cases ultrasound of your wrist to get a good picture of the bones and nerve. This can help determine whether the nerve is being compressed.
- Electromyography. This test measures the tiny electrical discharges produced in muscles. During this test, your provider inserts a thin-needle electrode into specific muscles to evaluate the electrical activity when muscles contract and rest. This test can identify damage to the muscles controlled by the median nerve, and also may rule out other conditions.
- Nerve conduction study. In a variation of electromyography, two electrodes are taped to the skin. A small shock is passed through the median nerve to see if electrical impulses are slowed in the carpal tunnel. This test may be used to diagnose the condition and rule out other conditions.
Treatment of Carpal tunnel syndrome
Orthopedic Specialist practicing at Shreya Hospital can treat Carpal Tunnel Syndrome as early as possible after symptoms start. In the early stages, simple things that you can do for yourself may make the problem go away. For example:
- Take more-frequent breaks to rest the hands.
- Avoid activities that make symptoms worse.
- Apply cold packs to reduce swelling.
Other treatment options prescribed by the Orthopedic Surgeon include wrist splinting, medications and surgery. Splinting and other conservative treatments are more likely to help if you’ve had only mild to moderate symptoms that come and go for less than 10 months. If you have numbness in your hands, you need to see a Orthopedic Surgeon.
If the condition is diagnosed early, nonsurgical methods may help improve carpal tunnel syndrome, including:
- Wrist splinting. A splint that holds the wrist still while you sleep can help relieve nighttime symptoms of tingling and numbness. Even though you only wear the splint at night, it can also help prevent daytime symptoms. Nighttime splinting may be a good option if you’re pregnant because it does not involve the use of any medications to be effective.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as ibuprofen (Advil, Motrin IB, others), may help relieve pain from carpal tunnel syndrome in the short term.There isn’t evidence, however, that these drugs improve carpal tunnel syndrome.
- Corticosteroids. Your Doctor may inject the carpal tunnel with a corticosteroid such as cortisone to relieve pain. Sometimes the provider uses an ultrasound to guide these injections.Corticosteroids decrease inflammation and swelling, which relieves pressure on the median nerve. Oral corticosteroids aren’t considered as effective as corticosteroid injections for treating carpal tunnel syndrome.
If carpal tunnel syndrome is caused by rheumatoid arthritis or another inflammatory arthritis, then treating the arthritis may reduce symptoms of carpal tunnel syndrome. However, this is unproved.
Surgery of Carpal tunnel syndrome
Surgery may be appropriate if symptoms are severe or don’t respond to other treatments.
The goal of carpal tunnel surgery is to relieve pressure by cutting the ligament pressing on the median nerve.
The surgery may be performed with two different techniques:
- Endoscopic surgery. Your surgeon uses a telescope-like device with a tiny camera attached to it (endoscope) to see inside the carpal tunnel. Your surgeon cuts the ligament through one or two small incisions in the hand or wrist. Some surgeons may use ultrasound instead of a telescope to guide the tool that cuts the ligament.Endoscopic surgery may result in less pain than does open surgery in the first few days or weeks after surgery.
- Open surgery. Your surgeon makes an incision in the palm of the hand over the carpal tunnel and cuts through the ligament to free the nerve.