Carpel tunnel syndrome

Carpel tunnel syndrome - Narain Hospital

Carpel tunnel syndrome


Carpal tunnel syndrome, also termed median nerve compression, is a condition characterized by pain, numbness, tingling, or weakness in the hand and wrist due to a median nerve impingement in the wrist area.

The median nerve provides the nerve supply to the thumb, index and middle finger, and half of the ring finger. However, the little finger is generally not affected.

The carpal tunnel is a narrow canal situated in the wrist area, which permits the median nerve and tendons to attach with the hand and forearm.

Carpal tunnel comprises of following structures:

Carpal bones: These bones are situated at the bottom and sides of the tunnel. They are formed in a semi-circle.

Ligament: Situated above the carpal tunnel, the ligament holds the tunnel together because of its strength. Inside of the tunnel comprises the median nerve and tendons.

Median nerve: This nerve provides innervation to the fingers in the hand and strength to the base of the thumb and index finger.

Tendons: These are rope-like structures connecting muscles in the forearm to the bones in the hand. They allow movements in the fingers and thumb.

Symptoms usually start gradually and keep on increasing with activity.

Early symptoms include:

Numbness at night
Tingling in the fingers
Mild pain

Apart from these, other symptoms include:

Decreased feeling in the fingertips.
Difficulty using the hand for small activities that involve grasping and holding objects.

As the condition gets worse, symptoms include:

Severe fragility in the hand area.
Inability to carry tasks that require delicate motions.
Dropping objects more frequently.
Muscle Atrophy near the base of the thumb.

The pain in the carpal tunnel is due to excess, repeated pressure on the median nerve, thereby causing inflammation.

The prevalent cause of this inflammation is a cardinal medical condition that causes swelling in the wrist and, at times, restricted blood flow.

It can be due to:

Over straining the wrist because of repetitive motions, like typing
Conditions such as hypothyroidism, obesity, rheumatoid arthritis, and diabetes
Fracture of any trauma to the wrist

The doctor will go through the history given by the patient and then conduct specific special tests to determine the presence of carpal tunnel syndrome in the patient:

History of symptoms: The doctor will examine the pattern of the symptoms and the factors which aggravate the condition. Carpal tunnel syndrome symptoms are usually triggered during holding or grasping activities. They are bound to occur at night and tends to wake up the person with excruciating pain. The person may also notice the numbness in fingers on waking up in the morning.

Physical examination: The doctor does a physical exam of the patient by checking the strength of the muscles in hand. Special tests like Bending the wrist, tapping on the nerve with a hammer or simply pressing on the nerve can trigger symptoms in various patients.

X-ray: An X-ray of the affected wrist helps in the exclusion of other causes of wrist pain, such as arthritis or a fracture. However, X-rays do not help make a proper confirmation of this condition.

Electromyography: This test provides the measurement of tiny electrical discharges produced in muscles. The doctor performs the procedure by penetrating a thin needle electrode into specific muscle groups to access the electrical activity during the contraction and relaxation of muscles. This test can detect the amount of damage to the muscles controlled by the median nerve and rule out other conditions accordingly.

Nerve conduction study: It is a variant of electromyography. Here two electrodes are taped to the skin, and a small shock is passed through the median nerve to find out the response whether electrical impulses are reduced in the wrist area. Apart from this condition, this test is used to rule out any other conditions.

Treatment depends mainly on the symptoms and the severity of the condition that has progressed.

You might need:

Lifestyle changes: If a repetitive motion aggravates the symptoms, it is recommended to either take a break or modify the activity causing pain.
Exercises: Stretching or strengthening exercises certainly do help a lot. It is advised to consult a physiotherapist for treating this condition. The physiotherapist helps with nerve gliding exercises that make the nerve move better within the carpal tunnel.

Immobilization: Wearing a splint helps hold the wrist firmly in one place and decreases pressure on the nerves. Patients can keep wearing the splints at night also. It will help them sleep better.

Medication: The doctor will prescribe anti-inflammatory drugs or steroid shots to curb pain and swelling.

Surgery: If none of the above treatments works, surgery is the last option. The procedure is called carpal tunnel release, which increases the tunnel’s size and eases the pressure on your nerve. The surgeon starts this procedure by making an incision in the palm over the carpal tunnel and penetrating through the ligament to free the nerve and release the pressure.

Women are three times more susceptible to developing carpal tunnel syndrome than men. It is commonly diagnosed between the age group of 30 and 60 years.
Certain conditions increase the risk of aggravating this problem, like diabetes, high blood pressure, and arthritis.

Certain lifestyle factors that increase the risk for carpal tunnel syndrome include smoking, high salt intake, a sedentary lifestyle, and an elevated body mass index (BMI).

Specific jobs that involve more repetitive wrist movement include:

Keyboarding occupations.
Construction work.
Washing clothes or utensils.

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