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Carpal Tunnel Syndrome

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Carpal Tunnel Syndrome

You’ve been plagued by numbness and tingling in your fingers and wrist. You are waking up at night with a “pins and needles” sensation in one hand? There might be other explanations, but the symptoms suggest you may have carpal tunnel syndrome. Is it dangerous? No. But to ignore the symptoms may cause damage of the nerve and the muscles. What is to do?

Causes

In carpal tunnel syndrome (CTS), one of the nerves to the hand (the median nerve) becomes compressed as it passes through the wrist. There are different causes which can lead to CTS like occupational overstressing of the hands, injuries at the wrist with malposition of the carpal bones, arthritis, pregnancy, diabetes, overweight and others. Also a genetic predisposition is discussed. In many cases, no single cause can be identified. It may be that a combination of risk factors contributes to the development of the condition.

Signs & Symptoms

The typical symptoms are numbness or tingling in the thumb, index, middle and ring finger, later pricking and painful paraesthesias. Sometimes the whole arm up to the shoulder is affected. This happens during the night or after awaking in the morning; but also with certain hand positions like keyboard typing, holding a phone or reading a newspaper, cycling or motor biking.

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The symptoms are intensified by overloading the hands by repetitive manual work. At the beginning the discomfort can be reduced by “shaking” the hands. Later a persistent numbness may occur. Left untreated, carpal tunnel syndrome can lead to constant pain and to permanent nerve and muscle damage that could severely limit your ability to use your hands.

Diagnosis

If you have persistent signs and symptoms, especially if they interfere with your normal activities and sleep patterns, you should see your neurologist.

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  • Your doctor will conduct a neurological examination. Tests with pressure on the median nerve at the wrist, produced by bending the wrist (Phalen`s maneuver) or tapping on the nerve (Tinel`s sign) can bring on the symptoms in many people. Important is to prove the feeling in your fingers and the strength of the muscles in your hand. Nerve conduction studies (an electrodiagnostic test) can pinpoint damage to the median nerve by measuring how fast electrical impulses move through it. Up to 10 percent of people with carpal tunnel syndrome, however, test is normal when this method is used. Other examinations like electromyogramm, SEPs (sensory evoked potentials), ultra sonic or MRI might be necessary to rule out other conditions like nerve root irritation or compression at the cervical spine.

Treatment

Fortunately, for most people who develop carpal tunnel syndrome, proper treatment usually can relieve the tingling and numbness and restore wrist and hand function, especially if you catch the condition early.

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Nonsurgical therapy is possible if you have mild to moderate symptoms and the neurological examinations do not show an extensive damage at the median nerve. Medication with anti-inflammatory drugs (NSAIDs) may help relieve pain from carpal tunnel syndrome only in the short term.

The most effective conservative treatment is nocturnal splinting with a specially wrist splint. If you use it, avoid wearing it all day, since that can weaken your muscles in your wrists and hands. Wearing it all night, however, is recommended. This should be done at least for 3 month.

If the symptoms persist or the nerve conduction velocity becomes worse, surgery has to be considered. Two main types of surgery are used to relieve the pressure on the nerves inside the carpal tunnel: open carpal tunnel release and the newer endoscopic carpal tunnel release. Both are outpatient procedures performed under local anesthesia (the surgeon cuts the ligament along the middle of the palm and inner wrist). Most people make a full recovery, but in some cases (fewer than 5 percent) carpal tunnel syndrome recurs after surgery. This happens more commonly following the endoscopic procedure, which often doesn’t open up the tunnel as fully as open release.

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