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Carpal Tunnel Syndrome

Overview

Carpal tunnel syndrome is a condition in which the nerve supply to a certain portion of your hand gets compressed. The carpal tunnel is a narrow passage on the palm side of the hand. The nerve that gets compressed is known as the median nerve, which supplies to your thumb, index finger, middle finger, and part of the ring finger. Repetitive motions of the wrist, secondary health conditions, or genetic predisposition can lead to the occurrence of this disease. Treatment options can reduce symptoms and restore the functions of your wrist and hand. 

Causes

There are multiple causes of carpal tunnel syndrome. Any anatomical deformity, swelling, or repetitive motions of the wrist can compress the median nerve. One of the most common causes is inflammation in the wrist area, which can cause swelling and blood flow restriction. The nerve gets compressed due to swelling, which causes numbness and weakness in the hand. The inflammation-related conditions include diabetes, rheumatoid arthritis, thyroid dysfunction, trauma or injury to the wrist, or high blood pressure. Fluid retention due to menopause or pregnancy can also affect your wrist.

 

Another common cause of carpal tunnel syndrome is repeated movements of the wrist. This can also contribute to swelling and compression of the median nerve. Causes include positioning of the hands and wrists while using a keyboard/mouse, working with a high vibration tool, playing piano, or other activities that overstretch your wrist. 

Risk Factors And Epidemiology

Lifestyle factors such as having a sedentary routine, high intake of salt, smoking, and increased weight can heighten the risk of carpal tunnel syndrome. Certain occupations can also increase the risk of this condition, including office work that requires prolonged typing, assembly line work, manufacturing, and construction work. You may develop carpal tunnel syndrome if you already have a medical condition that may cause inflammation and swelling such as diabetes, rheumatoid arthritis, etc. Any fracture or injury that reduces the size of the carpal tunnel can also compress the median nerve in the future.

 

Carpal tunnel syndrome usually occurs in the age range of 30 to 60 years. 5 to 10% of the general population have this disease. Women are three times more likely to be affected by this condition than men. This is because women have a small carpal tunnel by default. Pregnancy and menopause also increase the risk among women due to fluid retention. 

Signs And Symptoms

The typical symptoms of carpal tunnel syndrome are numbness and weakness in the areas supplied by the median nerve. You may experience a tingling sensation in your thumb, index finger, middle finger, and ring finger whenever the nerve is compressed. In moderate to severe cases, the sensation may feel like an electric shock. These sensations usually travel upwards from your wrist to hand. They can occur at any time but are predominant when you hold something such as a phone, book, steering wheel, etc. Pain and tingling sensation can also disrupt sleep. The numbness may become prolonged over time. The normal functions and strength of your wrist and hand are also affected. You may not be able to hold or grip things tightly and often drop objects. 

Diagnosis

History is required before proceeding toward examination and diagnostic tests. Your doctor will follow up with a physical inspection of the affected hand or hands to check strength and grip. Your symptoms may get triggered during the examination when the wrist is bent or tapped. Imaging tests such as x-ray or ultrasound can confirm the anatomy of the carpal tunnel and show compression of the median nerve. Nerve conduction tests are done to measure the conduction of electrical signals through the median nerve. If the conduction is slower than normal, it can be a sign of carpal tunnel syndrome. Electromyography can also be done to check for damage to the muscles controlled by the median nerve. 

Differential Diagnosis

The symptoms of carpal tunnel syndrome can resemble many other diseases. Some of the examples include cervical radiculopathy, Raynaud phenomenon, volar radiation ganglion, arthritis, amyloidosis, fibrosis of flexor tendons, etc. History and diagnostic studies can aid in achieving an accurate diagnosis. 

Treatment

Conservative treatment options are preferred in the early stages of carpal tunnel syndrome. If you have mild to moderate symptoms, some changes in your routine activities can help, such as avoiding triggering activities, taking breaks to rest your hands, and applying an ice pack on your wrist to reduce swelling. Wrist splinting can also be done to relieve pressure on the median nerve. Medications can help with the pain of this condition but won’t improve grip or strength. If you have serious symptoms of carpal tunnel syndrome, a surgery called carpal tunnel surgery is considered. It can be done by endoscopic method or performed as an open surgery. This surgery relieves the pressure on your median nerve and restores functions.

 

Analgesics such as ibuprofen, naproxen, and other NSAIDs can be taken to reduce inflammation and pain. If oral medications are not enough, you may be given a corticosteroid injection in the wrist. This can relieve pain and some pressure off the nerve. 

Prognosis

The prognosis depends on the severity of the disease and other medical conditions. Conservative treatment options can only help to a certain extent. Surgery outcome is good in most cases, although some complications may occur. Underlying medical conditions may cause the recurrence of this disease. 

Prevention

Carpal tunnel syndrome can be prevented to some degree by adopting a few occupational and lifestyle changes. If your work involves overstretching or repetitive wrist motions, try to take frequent breaks in between. Keep your wrists at elbow level when typing or using a mouse. Improve your posture and stretch your neck, arms, wrists, and hands during intervals.