Carpal tunnel syndrome is a progressively painful hand and arm condition caused by a pinched nerve in your wrist. This condition affects many individuals and sometimes the symptoms can be very distressing and uncomfortable.
What is carpal tunnel syndrome?
The carpal tunnel is a narrow passageway on the palm side of your wrist made up of bones and ligaments. The median nerve, which controls sensation and movement in the thumb and first three fingers, runs through this passageway along with tendons to the fingers and thumb. When it’s pinched or compressed the result is numbness, tingling, weakness or pain in the hand, called carpal tunnel syndrome.
What are some symptoms of carpal tunnel syndrome?
Symptoms of carpal tunnel syndrome will vary from one individual to another. The severity of the symptoms can also vary. The symptoms might develop slowly. The following are some symptoms:
Pain and tingling
For many individuals the symptoms at first might only be noticed at night or when you first wake up in the morning. The feeling is similar to the “pins-and-needles” sensation you get when your hand falls asleep. During the day, you may notice pain or tingling when holding things, like a pen or a book, or when driving. Shaking or moving your fingers usually helps.
Weakness
As carpal tunnel syndrome progresses, you may begin to notice weakness in your thumb and first two fingers, and it may be difficult to make a fist or grasp objects. You may find yourself dropping things, or you may have trouble doing things like holding a utensil or buttoning your shirt.
Sensation problems
Carpal tunnel syndrome can also cause a feeling of numbness in the hands. Some people feel like their fingers are swollen, even though no swelling is present, or they may have trouble distinguishing between hot and cold.
What causes carpal tunnel syndrome?
In most cases there is usually not one definitive cause of carpal tunnel syndrome. In the hand the carpal tunnel is narrow and rigid, and anytime there is swelling or inflammation in the area, the median nerve can be compressed and cause pain. Symptoms may be present in one or both hands. (Usually symptoms develop in the dominant hand first.)
Who gets carpal tunnel syndrome?
Women are three times more likely than men to get carpal tunnel syndrome. Certain conditions can also increase your risk. These include:
• Diabetes, gout, hypothyroidism, and rheumatoid arthritis
• Pregnancy
• Sprain or fracture of the wrist
Could your job be to blame?
It is a common belief that frequent typing can lead to carpal tunnel syndrome, but there is scant scientific evidence for this. Carpal tunnel syndrome is three times more common among assembly line workers than it is among data-entry personnel — and frequent use of vibrating hand tools increases the risk. In contrast, a 2001 study found that even heavy computer use — up to seven hours a day — did not make people more likely to develop carpal tunnel syndrome.
What happens without treatment?
At first, symptoms of carpal tunnel syndrome come and go, but as the condition worsens, symptoms may become constant. Pain may radiate up the arm all the way to the shoulder. Over time, if untreated, carpal tunnel syndrome can cause the muscles on the thumb side of your hand to waste away (atrophy). Even with treatment, strength and sensation may never be completely restored.
What conditions resemble carpal tunnel syndrome?
A few conditions have symptoms that can mimic carpal tunnel syndrome. These include:
• Injury to a muscle, ligament or tendon
• Arthritis of the thumb or wrist
• Nerve problems such as diabetic neuropathy
Your doctor will examine you and do tests to rule out other health conditions.
Diagnosing carpal tunnel syndrome
There are several tests your doctor will perform to see if you have carpal tunnel syndrome. To confirm the diagnosis, your doctor will order nerve conduction tests.
Treatment
Treatment will vary from one individual to another often depending on the severity of symptoms. If there is an underlying medical disorder this should be treated. Various forms of treatment are available and include the following:
Rest and Immobilization
Once you have been seen and diagnosed by your doctor, your doctor may advise resting the hand and wrist and wearing a brace to limit movement. Night use is important to prevent the wrist from curling during sleep, which can make your symptoms flare up. Non-steroidal anti-inflammatory drugs, along with cold compresses, can reduce pain.
Medications
When carpal tunnel symptoms are more severe, your doctor may recommend corticosteroids by injection or by mouth. Steroids can temporarily reduce inflammation around the median nerve and ease your symptoms. Injection of a local anesthetic such as lidocaine can also relieve symptoms. Other things that may help include diuretics, also known as “water pills,” which reduce swelling, and vitamin B6 supplements.
Surgery
If surgery is needed, it is typically done on an outpatient basis under local anaesthesia. The ligament overlying the top of the carpal tunnel is cut to relieve pressure. The healed ligament will allow more space in the carpal tunnel. Sometimes the procedure is done endoscopically, using a tiny camera inserted through a very small incision to guide the procedure. Pain and weakness usually resolve within two months after surgery, but it may take six months to a year to recover completely.
Strengthening exercises
Once carpal tunnel symptoms subside, a physical therapist can teach you stretching and strengthening exercises to help prevent pain, numbness, and weakness from coming back. A physical or occupational therapist can also teach you the correct ways to perform tasks so that the median nerve doesn’t become inflamed again, causing your symptoms to return.
Can carpal tunnel be prevented?
Though there is no definitive way to prevent carpal tunnel syndrome, these things can help:
• Good posture
• Stretching hands and wrists regularly
• Taking frequent rest breaks to shake arms and legs, lean back, and change position throughout the work day
Conclusion
The number of cases of carpal tunnel syndrome appears to be increasing. Individuals with symptoms suggestive of this syndrome should see their health care provider as there are various treatment options now available to help relieve symptoms.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor who has over thirty years in clinical practice. Dr Hodge has a medical practice in the Johnson Building in The Valley.
