Carpal tunnel syndrome is a common condition that causes pain, numbness, and tingling in the hand and arm. The condition occurs when one of the major nerves to the hand — the median nerve — is squeezed or compressed as it travels through the wrist. 

Most cases of carpal tunnel syndrome are caused by a combination of factors. However studies show that women and older people are more likely to develop the condition.
Other risk factors for carpal tunnel syndrome include:

  • Heredity. This is likely an important factor. The carpal tunnel may be smaller in some people or there may be anatomic differences that change the amount of space for the nerve—and therefore these traits can run in families.
  • Repetitive hand use. Repeating the same hand and wrist motions or activities over a prolonged period of time may aggravate the tendons in the wrist, hence causing swelling that puts pressure on the nerve.
  • Hand and wrist position. Indeed doing activities that involve extreme flexion or extension of the hand in and wrist for a prolonged period of time can increase pressure on the nerve.
  • Pregnancy. Hormonal changes during pregnancy can cause swelling.
  • Health conditions. For example diabetes, rheumatoid arthritis, and thyroid gland imbalance are conditions that are associated with carpal tunnel syndrome.

Symptoms

Symptoms of carpal tunnel syndrome may include:

  • Numbness, tingling, burning, and pain—primarily in the thumb and index, middle, and ring fingers
  • Occasional shock-like sensations thus radiate to the thumb and index, middle, and ring fingers
  • Pain or tingling that indeed may travel up the forearm toward the shoulder
  • Weakness and clumsiness in the hand—this may make it difficult to perform fine movements such as buttoning your clothes
  • Dropping things—due to weakness, numbness, or a loss of proprioception (awareness of where your hand is in space)
Carpal tunnel syndrome

 

In most cases, the symptoms of carpal tunnel syndrome begin gradually—without a specific injury. Many patients find that their symptoms come and go at first.

However, as the condition worsens, symptoms may occur more frequently or may persist for longer periods of time.

If diagnosed and treated early, the symptoms of carpal tunnel syndrome can therefore be relieved without surgery. If your diagnosis is uncertain or if your symptoms are mild, your doctor will recommend nonsurgical treatment first.

Treatments may include:

Bracing or splinting. Wearing a brace or splint at night will keep you from bending your wrist while you sleep. Keeping your wrist in a straight or neutral position reduces pressure on the nerve in the carpal tunnel. It may also help to wear a splint during the day when doing activities that aggravate your symptoms.

Activity changes. Symptoms often occur when your hand and wrist are in the same position for too long—particularly when your wrist is flexed or extended.
If your job or recreational activities aggravate your symptoms, changing or modifying these activities can help slow or stop progression of the disease. In some cases, this may involve making changes to your work site or work station

Nonsteroidal anti-inflammatory drugs (NSAIDs). Medications such as ibuprofen and naproxen can help relieve pain and inflammation.

Nerve gliding exercises. Some patients may benefit from exercises that help the median nerve move more freely within the confines of the carpal tunnel. Specific exercises may be recommended by your doctor or physiotherapist.

Steroid injections. Corticosteroid, or cortisone, is a powerful anti-inflammatory agent that can be injected into the carpal tunnel. Although these injections often relieve painful symptoms or help to calm a flare up of symptoms, their effect is sometimes only temporary. A cortisone injection may also be used by your doctor to help diagnose your carpal tunnel syndrome.

Surgical Treatment

If nonsurgical treatment does not relieve your symptoms after a period of time, your doctor may recommend surgery.

The decision whether to have surgery is based on the severity of your symptoms—how much pain and numbness you are having in your hand. In long-standing cases with constant numbness and wasting of your thumb muscles, surgery may be recommended to prevent irreversible damage.
Carpal tunnel is best caught early to prevent irreversible damage to the nerves of the hand and for a better outcome. It is best to seek medical advice as early as possible and get the necessary care.

References

  1. OrthoInfo.com
  2. Manual of Musculoskeletal system.

Written By:
Joy W. Waihenya
Physical Therapist
Chiropractic & Physiotherapy Health Centre

Carpal tunnel syndrome- pain and numbness in the hand.

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