CARPAL TUNNEL SYNDROME

What Is Carpal Tunnel Syndrome?


The medical term “Carpal Tunnel Syndrome” refers to a medical condition that arises due to the compression of the median nerve in the wrist (Saint-Lary, Rébois, Mediouni, & Descatha, 2015). The median nerve usually travels through the wrist at the carpal tunnel. This runs the length of the arm and ends in the hand. This median nerve controls the movement and feeling of all the fingers except the little finger. Ultimately, this compression causes numbness, tingling, or weakness in the hand.

What Are The Common Symptoms Of Carpal Tunnel Syndrome?

The signs and symptoms of carpal tunnel syndrome start gradually and include the following (CM, JD, Nelson, & RA, 2014):

  •     Tingling and numbness: People with CTS may experience tingling, numbness, and burning in their fingers or hands, particularly the thumb, index, middle fingers, and radial half of the ring finger, because these fingers receive motor and sensory functions from the median nerve. This sensation can travel from the wrist to the arm and these symptoms can happen while driving, talking on the phone, or reading the newspaper. Many individuals try to ease their symptoms by “shaking out” their hands. Over time, the numb sensation may persist permanently.
  •     Ache and discomfort: Patients usually feel these more proximally in their forearm or upper arm. Some studies found that the compression at the level of the thoracic outlet or where the median nerve crosses between the two heads of the pronator teres in the forearm might cause symptoms like wrist or hand discomfort and loss of grip strength. 
  •     Weakness: The characteristic neuropathic symptoms (NS) of carpal tunnel entrapment syndrome include numbness and paresthesias in the median nerve. While left untreated, weakness and atrophy of the thumb muscle occur due to insufficient nerve stimulation. The patient may notice themselves dropping objects during this time, which peaks at night and in the morning.

What Are The Common Causes Of Carpal Tunnel Syndrome?

Pressure on the median nerve causes carpal tunnel syndrome. This nerve goes from your forearm to the hand through a tube in your wrist called the carpal tunnel. Except for the little finger, it gives a feeling to the palm side of our thumb and fingers. This also sends nerve impulses to the muscles at the base of the thumb to move (motor function). Anything that irritates or compresses the median nerve can cause carpal tunnel syndrome. A wrist fracture, as well as swelling and inflammation induced by rheumatoid arthritis, can restrict the carpal tunnel and irritate the nerve.

Several conditions might increase the risk of irritation or damage to the median nerve, causing carpal tunnel syndrome. These include obesity, anatomical factors, genetics, repetitive wrist work, pregnancy, rheumatoid arthritis, previous injuries like fractures of the wrist, nerve-damaging conditions like diabetes, changes in body fluid, other medical conditions like menopause, thyroid disorders, kidney failure, etc. Several careers tend to result in CTS, such as long-term computer work or working with vibrating tools that require a powerful grip. Several studies found an association between computer use and carpal tunnel syndrome.

How Do Neurosurgeons Diagnose Carpal Tunnel Syndrome? 

If the signs and symptoms of carpal tunnel syndrome interfere with the usual activities and sleep habits, see the physician right away. Without therapy, permanent nerve and muscle damage might ensue. Initial diagnosis of CTS depends upon the clinical signs, symptoms, and specific physical tests. Physicians can confirm CTW with further electrodiagnostic tests (Huntley & Shannon, 1988). 

Physical examination of patients for CTS includes Phalen’s maneuver, which includes flexing the wrist gently, Tinel’s sign which detects median nerve irritation, The Durkan test or carpal compression test, or hand elevation test. Thus, if history and physical examination suggest CTS, neurosurgeons will suggest performing an electrodiagnostic test with nerve conduction studies and electromyography. 

How Do Neurosurgeons Treat Carpal Tunnel Syndrome?

Treatment of carpal tunnel syndrome depends on the symptoms and condition of a patient. Most patients find relief from carpal tunnel syndrome by following through with conservative treatment. These procedures include (Feng et al., 2021):

  •     Lifestyle Changes: This includes taking breaks more often from activities that cause joint pain.
  •     Exercises: This includes stretching and strengthening the wrist. Several exercises may help the patient to move the nerve better within the carpal tunnel.
  •     Immobilization: This includes wearing a splint to keep the wrist from moving and to lessen pressure from the nerves. Wearing splints during the night can help to get rid of numbness or tingling. 
  •     Medication: This includes taking anti-inflammatory drugs or steroid injections to curb swelling and relieve pain.
  • Surgery: If the above treatment fails, neurosurgeons may perform surgery to increase the size of the tunnel and ease the pressure on the median nerve. For more information, please contact us.

References

Cazares-Manríquez, M. A., Wilson, C. C., Vardasca, R., García-Alcaraz, J. L., Olguín-Tiznado, J. E., López-Barreras, J. A., & García-Rivera, B. R. (2020). A review of carpal tunnel syndrome and its association with age, body mass index, cardiovascular risk factors, hand dominance, and sex. Applied Sciences (Switzerland), 10(10). https://doi.org/10.3390/app10103488

CM, G., JD, L., Nelson, A., & RA, H. (2014). Carpal tunnel syndrome:  A review of the literature with recommendations for further research. Fl J Pub Health, (January 1996), 1–17.

Feng, B., Chen, K., Zhu, X., Ip, W. Y., Andersen, L. L., Page, P., & Wang, Y. (2021). Prevalence and risk factors of self-reported wrist and hand symptoms and clinically confirmed carpal tunnel syndrome among office workers in China: a cross-sectional study. BMC Public Health, 21(1), 1–10. https://doi.org/10.1186/s12889-020-10137-1

Huntley, D. E., & Shannon, S. A. (1988). Carpal tunnel syndrome: a review of the literature. Dental Hygiene, 62(7), 316–320. https://doi.org/10.7759/cureus.7333

Saint-Lary, O., Rébois, A., Mediouni, Z., & Descatha, A. (2015). Carpal tunnel syndrome: Primary care and occupational factors. Frontiers in Medicine, 2(MAY), 1–4. https://doi.org/10.3389/fmed.2015.00028