Carpal Tunnel Syndrome

 

A condition that causes pain, tingling and numbness in the hand, more commonly at the base of the palm.

Causes: 

Caused due to compression of median nerve, a nerve which runs through the arm and pass through the carpal tunnel, a narrow passage surrounded by bones and ligaments at the base of the palm.

Symptoms: 

Characterized by tingling or numbness in fingers and move up to hand.

Diagnosis: 

The diagnosis is suspected based on the symptoms, and tests are performed to exclude other causes.

Symptoms

CHARACTERISTIC

COMMON

The symptoms usually starts gradually and cause discomfort in your wrist and the palm of your hand. The symptoms include:

• Numbness or tingling in the hand and arm associated with pain

• Pins and needles sensation

• Hand clumsiness and a tendency to drop things

• Hand pain at night

• Pain with the use of hand

• Weakness in the hand and wrist.

Causes

COMMON

The common cause is the pressure on the median nerve due repetitive usage of wrists, anatomy of the hand or other underlying conditions.

Risk factors include:

• Anatomic factors- a disattachment at the wrist or arthritis which can change the shape of the small bones in the wrist can alter the space within the carpal tunnel and put pressure on the median nerve

• Occupational factors: sewers, knitters, bakers, and carpenters are more likely to be affected

• Nerve-damaging conditions such as diabetes, increase the risk

• Inflammatory conditions such as rheumatoid arthritis

• Obesity and hypothyroidism are associated with the condition

• Gender- more common in women since they have a smaller carpal tunnel

• Tumors such as lipoma or ganglion that protrude onto the carpal tunnel

• Pregnancy

• Trauma

• A hereditary condition called Charcot-Marie-tooth disease.

Diagnosis

COMMON

IN SOME CASES

The diagnosis is suspected based on the symptoms, and tests are performed to exclude other causes.

Patient History

History of symptoms that may be indicative of the condition.

Physical Examination

Tenderness and swelling in hand, neck, shoulder and elbow are examined.

X-ray

This helps in excluding other causes.

EMG

Measures the electrical discharges produced in muscles.

Treatments

COMMONLY RECOMMENDED

IN SEVERE CASES

Mild cases resolve following few self-care practices. Medications and surgery may be necessary for severe cases.

MEDICATION

Nonsteroidal anti-inflammatory drugs (NSAIDs)

May be used to relieve pain.

Common drugs: Ibuprofen

Corticosteroids

Are used to relieve pain and decrease inflammation to help reduce pressure on the median nerve.

Common drugs: Cortisone

THERAPY

Physical therapy

Practice stretching exercises to improve function.

SURGERY

Endoscopic surgery

The surgeon cuts through the ligament guided by a camera attached to a tube-like device called endoscope.

Complications

The condition does not usually present complications. Complications if any, are a result of the surgical treatment procedure.

• Wound infection

• Scar formation

• Nerve or vascular injuries

Prevention

• Reduce the force and relax your grip

• Take frequent breaks-gently stretch and bend your hands and wrists periodically

• Watch your form. Do not hold your wrist bent up or down, a relaxed middle position is best

• Improve your posture to avoid compressing the nerves

• Make sure your computer mouse is comfortable and does not strain wrist