Carpal Tunnel Syndrome

You’ve been plagued by pain, 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.

What is carpal tunnel syndrome?

Carpal Tunnel Syndrome (CTS) is a condition that occurs when pressure is applied on the median nerve and causes sensations of pain, numbness, tingling or weakness in the hand. The median nerve runs along the length of the arm and passes through a narrow passage in the wrist known as the carpal tunnel. If the nerve is compressed in this passage, the nerve might get damaged and symptoms occur. The median nerve is responsible for controlling the movement of your thumb and fingers, except for the little finger. Moreover, it transmits sensory information from the hand and fingers back to the brain.

Common Causes of CTS (Carpal Tunnel Syndrome)

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. Other causes include:

• Hypothyroidism
• Obesity
• Rheumatoid arthritis
• Repetitive movements such as typing
• Diabetes

Carpal Tunnel Syndrome Symptoms

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.

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.

When experiencing CTS in its early stages, you may notice your hands feeling numb as well as a tingling sensation. 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.

Symptoms could be worsened when holding heavy objects or bending your wrist. Many have reported that shaking their hands may relieve symptoms, but this doesn’t always make the numbness go away completely.

When CTS symptoms start to worsen, you might find yourself being unable to have a strong grip when holding objects as the muscles in your hand start to shrink. You may also experience muscle cramping and pain. Other common CTS symptoms include:

• Pain, tingling or numbness in your fingers and/or hand
• Weak hands
• Shock-like sensations in your fingers
• Burning or itching sensations in your palm, thumb, or index and middle fingers
• Sometimes the whole arm up to the shoulder is affected

Risk Factors

There are various factors that have been related to carpal tunnel syndrome over the years. These may not directly cause CTS, but do increase the risk of damage to the median nerve. Risk factors include:

• Wrist fractures or dislocation
• Arthritis that deforms small bones in the wrist
• Gender; CTS is more common in women as the carpal tunnel area is smaller in women than in men
• Chronic illnesses such as diabetes
• Inflammatory conditions such as rheumatoid arthritis
• Medications
• Obesity
• Pregnancy
• Thyroid disorders or kidney failure
• Workplace conditions that require prolonged and repetitive movement of the wrist, such as typing

Diagnosis

When CTS symptoms develop and start to become unbearable, it is recommended that you visit a doctor. They may conduct tests such as:

• Electromyograms, during which doctors will place a thin electrode into your muscle to measure its electrical activity
• Nerve conduction studies to measure the signals in the nerves of your arm and hand
• Ultrasound to look at your tissues and bones

Treatment and Prevention

Treatment for carpal tunnel syndrome will depend on the severity of your symptoms. Doctors may recommend that you:

• Make changes to your daily life to avoid repetitive and strenuous wrist movements
• Exercise and stretch more often to help nerves and muscles move better on a daily basis
• Wear a splint if your doctor has advised you to prevent your wrist from moving too much
• Take anti-inflammatory drugs or steroid injections to help reduce swelling and inflammation
• If treatments don’t pan out, you may be recommended to undergo surgery to increase the size of your carpal tunnel and ease pressure on your median nerve.

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. The treatment includes:

1. Nonsurgical Therapy: 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.
2. Nocturnal Splint (Wrist Splint): 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.
3. Surgery: 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).

Lifestyle Changes and home remedies

These steps may provide temporary symptom relief:

• Take short, frequent breaks from repetitive activities involving the use of the hands.
• Lose weight if you are overweight or obese.
• Rotate the wrists and stretch the palms and fingers.
• Take a pain reliever, such as aspirin, ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve).
• Wear a snug, not tight, wrist splint at night. You can find these over the counter at most drug stores or pharmacies.
• Avoid sleeping on your hands.

If pain, numbness or weakness recurs and persists, see your provider.

Alternative medicine

Integrate alternative therapies into your treatment plan to help you cope with carpal tunnel syndrome. You may have to experiment to find a treatment that works for you. Always check with your provider before trying any complementary or alternative treatment.

1. Yoga: Yoga postures designed for strengthening, stretching and balancing the upper body and joints may help reduce pain and improve grip strength.
2. Hand Therapy: Early research suggests that certain physical and occupational hand therapy techniques may reduce symptoms of carpal tunnel syndrome.
3. Ultrasound Therapy: High-intensity ultrasound can be used to raise the temperature of a targeted area of body tissue to reduce pain and promote healing. Research shows inconsistent results with this therapy, but a course of ultrasound therapy over several weeks may help reduce symptoms.

Recovery

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.

Summary

If you are experiencing symptoms of carpal tunnel syndrome and you are searching for the most experienced neurologist to diagnose the condition and provide the best treatment, the German neuroscience Center is your clinic of choice. Since more than 15 years GNC is the leading clinic for Neurology in the UAE. All our Carpal Tunnel experts are German Board Certified and have minimum professional experience of 25 years. If you are searching for the most trusted Carpal Tunnel experts, you came to the right place. Book your appointment here