carpal tunnel syndrome

What is Carpal tunnel syndrome?

Carpal tunnel syndrome (CTS) occurs when the median nerve that runs from the forearm to the palm is squeezed at the wrist. The carpal tunnel, the hard, narrow passage of ligaments and bones at the base of the hand, houses the median nerve and finger tendons. The median nerve provides sensation for the palm and index finger, middle finger, and part of the ring finger (but not the little finger). It also controls some small muscles at the base of the thumb.

Sometimes, thickening of irritated tendons or other inflamed linings can narrow the tunnel and compress the median nerve. The result may be numbness, weakness or sometimes pain in the hands and wrists (some people may feel pain in the forearms and arms). CTS is the most common and well-known compressive neuropathy, in which a peripheral nerve of the body is compressed or squeezed.

What are the symptoms of carpal tunnel syndrome?

Symptoms usually begin gradually, and the fingers are often numb or tingling, especially the thumb, the index and the middle fingers. Some people with CTS say their fingers feel useless and swollen, although there is obviously almost no swelling. Symptoms usually first appear on one or both hands at night. The dominant hand is usually the first to be affected and produce the most severe symptoms. People with CTS may feel the need to "shake" their hands or wrists when they wake up. As symptoms worsen, people may feel tingling during the day, especially during certain activities, such as talking on the phone, reading a book or newspaper, or driving. Weak hands can make it difficult to grasp small objects or perform other manual tasks. Under chronic and/or untreated conditions, the muscles at the base of the thumb may wear down. Some people with very severe CTS cannot be sure of the hot or cold touch, and they may burn their fingertips without knowing it.

What are the causes of carpal tunnel syndrome?

Carpal tunnel syndrome is usually the result of a combination of factors that increase the pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself. Contributing factors include wrist trauma or injury that causes swelling, such as sprains or fractures, overactive pituitary gland, hypothyroidism, and rheumatoid arthritis. Other possible causes of compression include problems in the wrist joints, repeated use of vibrating hand tools, fluid retention during pregnancy or menopause, or cysts or tumors in the tunnel. In many cases, a single cause cannot be determined.

Who is at risk of carpal tunnel syndrome?

Women are three times more likely to suffer from carpal tunnel syndrome than men. People with diabetes or other metabolic disorders that directly affect the body's nerves and make them more susceptible to compression are also at high risk. CTS generally only occurs in adults.

Workplace factors can cause existing pressure or damage to the median nerve. The risk of CTS is not limited to personnel in a particular industry or job. Compared to data entry personnel, personnel working on the assembly line (such as manufacturing, sewing, finishing, cleaning, and meat packing) can be more informative.

How is Carpal tunnel syndrome diagnosed?

Carpal tunnel syndrome diagnosed

Early diagnosis and treatment are important to avoid permanent damage to the median nerve.

Physical examination of the hands, arms, shoulders, and neck can help determine whether the patient’s main complaint is related to daily activities or underlying illness. The doctor can rule out other conditions similar to the carpal tunnel syndrome. Check the wrist for tenderness, swelling, warmth, and discoloration. The sensitivity of each finger should be assessed, and the muscles at the base of the hand should be checked for strength and signs of atrophy. Routine laboratory tests and x-rays can reveal fractures, arthritis and diseases that damage the nerves, such as diabetes.
Certain tests can produce symptoms of CTS. In the Tinel test, the doctor taps or presses the median nerve in a person's wrist. When the finger tingles or produces a sensation similar to an electric shock, the test result is positive. The wrist flexion test or Phalen consists of asking the person to keep the forearm upright by pointing the fingers down and pressing the back of the hands. If you feel one or more symptoms in your fingers within 1 minute, such as increased tingling or numbness, it indicates carpal tunnel syndrome. The doctor may also ask the individual to try exercises that cause symptoms.
Electrodiagnostic Tests can help confirm the diagnosis of CTS. In nerve conduction studies, electrodes are placed on the hand and wrist. Give a small electric shock and measure the speed at which the nerve transmits impulses. In EMG (electromyography), a fine needle is inserted into the muscle; the electrical activity seen on the screen can determine the severity of the median nerve injury.
Ultrasound may show an abnormal size of the median nerve. Magnetic resonance imaging (MRI) can show the anatomy of the wrist, but so far, it has not been particularly helpful in diagnosing carpal tunnel syndrome.

How to treat Carpal tunnel syndrome?

The treatment of carpal tunnel syndrome should be started as soon as possible under the guidance of a doctor. The underlying cause must be treated first, such as diabetes or arthritis.

Non-surgical treatment

Splint. The initial treatment is usually to wear a splint at night.

Avoid daytime activities that may cause symptoms.
Some people with mild discomfort may wish to take frequent breaks at work and give their hands a break.
If the wrist is red, warm, and swollen, a cold compress may help.
Over-the-counter medication. In special cases, a variety of anti-inflammatories can relieve pain. Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and other over-the-counter pain relievers, can provide some short-term relief from discomfort, but have not been proven to treat CTS.
Prescription medication. Corticosteroids (such as prednisone) or the lidocaine can be injected directly into the wrist or taken orally (in the case of prednisone) to reduce the pressure on the median nerve that has mild or intermittent symptoms. However, diabetics and those who may be susceptible to diabetes should know that long-term use of glucocorticoids can make it difficult to regulate insulin levels.
Alternative therapies. Acupuncture has benefited some people, but their effectiveness has not been proven. One exception is yoga, which has been shown to reduce pain and improve grip strength in patients with CTS.

Surgical treatment

Carpal tunnel release is one of the most common surgical procedures in the United States. Surgery usually involves cutting the ligaments around the wrist to reduce pressure on the median nerve. Surgery is usually performed under local or regional anesthesia (involving some sedatives) and the patient does not need to be hospitalized overnight. Many people need to have the surgery on both hands. Although all carpal tunnel surgeries involve cutting ligaments to release pressure on the nerves, surgeons use two different methods to do this.

Open release surgery, the traditional procedure used to correct carpal tunnel syndrome, involves making a 2-inch incision in the wrist and then cutting the carpal ligament to enlarge the carpal tunnel. This procedure is usually performed on an outpatient basis under local anesthesia, unless there are unusual medical conditions.
Endoscopic surgery can allow faster functional recovery and alleviate postoperative discomfort than the traditional open release surgery, but it may also have a higher risk of complications and require additional surgery. The surgeon makes one or two incisions (about half an inch) in the wrist and palm, inserts the camera connected to the tube, looks at the nerves, ligaments and tendons on the monitor, and cuts through the carpal ligament (the tissue that supports the joint). After the operation, the ligaments usually grow back together, leaving more space than before.

Although symptoms may be relieved immediately after surgery, full recovery from carpal tunnel surgery can take months. Some people may have infection, nerve damage, stiffness, and pain in the scar. Grip strength almost always decreases and will improve over time. Most people need to adjust their work activities within a few weeks after the operation, and some people may need to adjust their work responsibilities or even change jobs after the operation is restored. Recurrence of carpal tunnel syndrome after treatment is rare. Less than half of people report that their hands feel completely normal after the operation. Some residual numbness or weakness is common.

Results

For most patients, surgery will improve the symptoms of carpal tunnel syndrome. However, recovery can be gradual, and full recovery may take up to a year. If you have pain and weakness for more than 2 months, your doctor can refer you to a hand therapist who can help you maximize your recovery. If you have other conditions that cause pain or stiffness in your hands or wrists, such as arthritis or tendinitis, your overall recovery may be slower. In long-term cases of carpal tunnel syndrome, severe loss of sensation and/or muscle atrophy around the base of the thumb will result in slower recovery. For these patients, a complete recovery may be impossible.

Carpal tunnel syndrome hand exercises at home

If you have mild or moderate symptoms of carpal tunnel syndrome, you can benefit from some simple exercises. But keep in mind that the research on its usefulness is mixed. You will get the best results if you combine them with other treatments, such as wearing a brace and adjusting your activities to reduce pressure on your hands and wrists. When trying to do hand exercises for carpal tunnel syndrome, remember that this is not like going to the gym to lose weight. If it hurts, take a break. Pressing it will make your symptoms worse. Start slowly and easily and see how it goes. If you are not sure whether a certain activity is right for you, please consult your doctor.

Shake it out. This exercise is very simple. It is especially useful at night when symptoms may worsen. If you feel pain or numbness when you wake up, just shake your hands to relieve it.
Fist to stop sign.

Make a fist.
Slide your fingers up until they point to the ceiling, as if you were telling someone to stop.
Repeat 5-10 times.

Fist to fan.

Make a fist.
Spread your fingers as wide as possible.
Repeat 5-10 times.

Thumb touches.

One at a time, touch the tip of each finger with the tip of the thumb to form an O.
Repeat several times.

Basic Wrist Extension.

Sit at a table.
Rest your elbows and arms on the table, with your wrists hanging to the side and your palms facing up.
At first, your hands are in a neutral and straight position.
Bend your hand towards you and point your finger at the ceiling.
Hold for 5 seconds.
Return to a straight, neutral position.
Bend your hand away from you so your fingers point to the ground.
Hold for 5 seconds.
Return to a straight, neutral position.
Repeat 10 times.
Can be executed up to 3 times a day.

Wrist flexion and extension

Keep your arms straight in front of you, with your wrists and hands straight, palms down.
Bend your wrist so that your fingers point to the ground.
Use the other hand to increase the stretch and gently pull the fingers towards the body.
Hold for 15-30 seconds.
Return your wrist to a straight and neutral position, palm down.
Bend your wrist so that your fingertips point toward the ceiling.
With your other hand, gently pull your fingers back.
Repeat 10 times.
Can be run up to 3 times a day.

Tendon Slide. In this exercise, you will move your fingers and hands in many different positions. Take your time and move steadily from one position to another:

Begin with the elbow bent, the wrist straight, the fingers pointed towards the ceiling, and the thumb relaxed.
Bend the fingers inward so that they all bend in the middle of the knuckles, and the tip of the finger touches the top of the palm
Extend the fingers to form an L shape, while the hands and thumbs are still relaxed.
Bend your fingers downward so that the fingertips touch the palm. Make a straight fist with your thumb, then touch your index finger.
Curl fingers into a normal fist.
Repeat 10 times.
Do it two or three times a day.

Nerve slippage. As in the previous exercise, you will move a number of positions in this exercise. Move slowly and steadily:

Bend your elbows, make a fist toward you, and keep your wrists neutral.
Extend the fingers so that all fingers point upwards, the wrists are in a neutral position, and the thumbs point inward and upwards.
Bend your wrist so that your fingertips are away from you, and your thumb is still close to your fingers.
Stretch your thumb to the side.
Maintain this position, but move the forearm away.
Use the other hand to gently pull down the thumb to stretch it a bit. It only takes a few seconds to complete this operation.
Repeat three to five times.
Do it two or three times a day.

Wrist Resistance.

Sit at a table.
Place your forearms, wrists, and hands affected by the carpal tunnel syndrome on the table with your palms facing down.
Place your other hand on your knuckle at a 90-degree angle so that your hand will form a plus sign.
Raise your hands from below and resist. You will feel this in the muscles of your forearm.
Repeat several times a day.

Wrist curl.

Sit or stand.
Take a pound or a jar of beans.
With the elbows on both sides of the body, raise the forearms so that the arms are in an L shape. The forearm should be parallel to the floor.
Start with a straight, neutral position of the wrist, palm down.
Bend your wrist.
Return to a straight, neutral position.
Repeat 10 times.
Can be run up to 3 times a day.

Hand exercises to improve grip strength.

Tighten a pair of soft rubber socks or balls.
Hold for 5 seconds.
Repeat 10 times.
Can be executed up to 3 times a day.

How to prevent carpal tunnel syndrome?

Carpal tunnel syndrome

In the workplace, workers can perform stretching exercises, take frequent breaks and use the correct posture and wrist position. Wearing fingerless gloves will help keep your hands warm and flexible. Workstations, tools and handles can be redesigned to keep the worker's wrist in a natural position during work. Work can be rotated between workers. Employers can develop an ergonomic plan, which is the process of adjusting workplace conditions and job needs according to the capabilities of workers. However, research has not conclusively shown that these workplace changes can prevent carpal tunnel syndrome from occurring.

How does pregnancy affect your carpal tunnel?

When you are pregnant, your hormone levels can cause fluid retention, which can lead to bloating. In turn, this swelling puts pressure on the median nerve in the carpal tunnel, increases the pressure in the carpal tunnel, and sometimes causes pain in the wrist and hand.

This condition is most common in the third trimester, but it can also occur in the first trimester or after birth. In most cases, these symptoms will disappear after the baby is born.

Will it still hurt after pregnancy?

Carpal tunnel syndrome tends to resolve after birth and usually disappears. If you are still in pain after your baby is born, you may need to change the way you use your wrist. This can affect the way you hold and care for your baby with your hands, including the way you feed him. Consult your physical therapist, occupational therapist, or lactation consultant about strategies and techniques to minimize wrist pressure while holding a newborn. Try using a stroller so your arms can rest. If you have a brace or splint, it is also important that you continue to wear the brace or splint. Although carpal tunnel syndrome is common during pregnancy, 19 out of 20 women will recover within the first 6 weeks of their baby. If your symptoms persist after your baby is 6 weeks old, see your doctor.

Carpal tunnel syndrome treatment for pregnant women

Splint. The first line of treatment is to fix the wrist in a neutral position to limit the range of flexion or extension. A neutral wrist splint with a metal rod inside that prevents the wrist from moving up, down, or sideways, but allows the fingers to move is generally used. The splint can rest the median nerve and help reduce swelling, which can cure mild to moderate nerve damage. However, it is difficult to wear a splint all day and perform daily activities. Your doctor may recommend that you use it while you sleep and, if possible, during the day.
Occupational Therapy. Hand and wrist therapy can sometimes help relieve symptoms and prevent further nerve damage. A doctor or occupational therapist can develop a personalized plan for you. Therapies may include range of motion of the wrist and fingers, as well as strengthening exercises, massage, and nerve sliding techniques. Desensitization to reduce nerve pain, including alternating hot and cold baths can be recommended.
Medications. Local anesthetics may relieve symptoms, but these will not solve the source of the problem. Some patients may benefit from injections of pain relievers, which include a combination of steroids and local anesthetics around the median nerve under ultrasound guidance. However, if there are other therapies to try, avoid steroid use during pregnancy to avoid side effects. Consult your OB-GYN before using prescription, over the counter or topical medications.

Bottom line

Carpal tunnel syndrome is very frequent among the general population and with the right treatment plan your hand will go back to normal. Talk to your doctor if you suspect you might have carpal tunnel syndrome to start the treatment that is best for you.