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Carpal Tunnel Syndrome

Carpal Tunnel Syndrome

The carpal tunnel is an anatomical region located at the level of the wrist, delimited by the wrist bones and ligaments. One of the structures that passes through this tunnel is the median nerve, which controls the movement and sensation in the fingers. Carpal tunnel syndrome is a clinical condition that occurs when the median nerve becomes compressed within this tunnel, resulting in symptoms and discomfort.

What are the symptoms and findings?

Carpal tunnel syndrome presents a range of symptoms that may worsen over time. These include:

  1. Tingling/numbness: Patients describe tingling and numbness in the fingers and/or hand. Typically, the index, middle, and ring fingers are affected, while the little finger remains unaffected. The affected fingers may experience a sensation similar to an electric shock. Numbness and tingling sensation may radiate from the wrist towards the forearm. Symptoms often manifest while holding a steering wheel, phone, or newspaper. They may wake the patient up from sleep. Patients may try shaking their hands to alleviate the symptoms.

  2. Weakness: Individuals may experience weakness and loss of grip strength in the hand. They may occasionally drop objects they are holding. This weakness stems from the weakened muscles responsible for gripping, controlled by the median nerve.

What are the causes and risk factors?

Carpal tunnel syndrome caused by nerve compression or irritation within the carpal tunnel. Fractures, arthritis cause swelling, narrow tunnel, compress median nerve, leading to carpal tunnel syndrome. Often, carpal tunnel syndrome does not have a single cause. The combination of risk factors plays a role in its development.

Several factors have been associated with carpal tunnel syndrome.

Although they do not directly cause the syndrome. They can increase the risk of nerve irritation or damage.

Such as:

  1. Anatomical factors:  Fractures, dislocations, or arthritis can change carpal tunnel space and compress the median nerve. Individuals with a genetically smaller carpal tunnel are more prone to developing the syndrome.

  2. Gender: Carpal tunnel syndrome occurs more frequently in women. Because womens have smaller carpal tunnel space.

  3. Conditions that damage nerves: Certain chronic diseases like diabetes increase the risk of nerve damage, including damage to the median nerve.

  4. Inflammatory conditions: Rheumatoid arthritis and other conditions with an inflammatory component can affect the sheath surrounding the tendons in the wrist and put pressure on the median nerve.

  5. Medications: Some studies have shown a link between the use of certain medications for breast cancer treatment and carpal tunnel syndrome.

  6. Fluid changes in the body: Obesity is a risk factor. Changes in fluid retention increase pressure within the carpal tunnel, irritating the median nerve. This is common during pregnancy and menopause. Pregnancy-related carpal tunnel syndrome often resolves on its own after childbirth.

  7. Other medical conditions: Menopause, thyroid disorders, kidney failure, lymphedema, and certain other conditions can increase the likelihood of carpal tunnel syndrome.

  8. Occupational factors: Working with vibrating tools or performing repetitive wrist motions, especially in a cold work environment, can exert pressure on the median nerve or worsen existing nerve damage. However, scientific evidence in this regard is contradictory. Some studies have examined the relationship between computer use and carpal tunnel syndrome. Mouse usage, not keyboard, is strongly associated with the condition, according to the findings. No consistent evidence supports the link between computer use and syndrome.

Diagnosis of Carpal Tunnel Syndrome

To determine whether or not someone has carpal tunnel syndrome and to make a diagnosis, a thorough history and certain tests are necessary. These include:

Symptoms: The patient’s complaints should be thoroughly questioned. For example, there is no direct association between carpal tunnel syndrome and the little finger. Any complaint specific to the little finger can rule out a diagnosis of carpal tunnel syndrome. Symptoms typically occur when holding a phone or newspaper, or while gripping a steering wheel. They also tend to occur at night and can wake you up or cause numbness in the morning.

Physical examination: Testing the sensation and muscle strength in the fingers is crucial for diagnosis. During the physical examination, bending the wrist, touching the nerve, or simply putting pressure on the nerve can trigger symptoms in many individuals.

X-ray: X-rays are recommended to rule out arthritis, fractures, or other causes of wrist pain. However, X-rays do not help in diagnosing carpal tunnel syndrome.

Ultrasound: Ultrasound can be used to obtain a good view of the bones and nerves. It can help determine if the nerve is compressed or not.

Electromyography (EMG): This test measures small electrical discharges produced in the muscles. During this test, a fine needle electrode is inserted into specific muscles to assess the electrical activity when the muscles contract and at rest. This test detects damage in the muscles controlled by the median nerve and can also exclude other conditions.

Nerve conduction study: It is a variation of electromyography. Two electrodes are taped to the skin. And a small shock is passed through the median nerve to see if the electrical impulses in the carpal tunnel are slowing down. This test is used to diagnose the condition and exclude other conditions.

Treatment Options

Carpal tunnel syndrome should be treated as early as possible once symptoms appear. In the early stages, simple things you can do for yourself to alleviate the problem. For example:

Take more frequent breaks to rest your hands. Avoid activities that worsen the symptoms. Apply cold packs to reduce swelling.

Other treatment options include wearing a wrist splint, medications, and surgery. Conservative treatments can help with mild to moderate recurring symptoms under ten months. If you are experiencing numbness in your hand, it is recommended to seek medical attention.

Non-Surgial Treatments 

If the condition is diagnosed early, non-surgical treatments can help the patient.

Wrist splint: It is a device that immobilizes the wrist while sleeping. It helps alleviate numbness and tingling symptoms at night. Even if you only wear the splint at night, it can help prevent daytime symptoms. Wearing a splint at night is a good choice during pregnancy. Because it doesn’t require the use of any medication to be effective.

Medications: Short-term pain relievers can help reduce symptoms.

Steroids: Steroid injections into the affected nerve area can alleviate swelling and pain in the median nerve. Treating arthritis can alleviate carpal tunnel syndrome caused by rheumatoid or inflammatory arthritis. However, this is not proven.

Surgial Treatments 

Surgery is appropriate if the symptoms are severe or do not respond to other treatments. Carpal tunnel surgery aims to relieve pressure on the median nerve by cutting compressing ligament.

While recovery process, the connective tissues gradually come back together and creating more space for the nerve. This healing process typically takes a few months. But the skin heals within a few weeks. Generally, after the ligament has healed, the patient is encouraged to use their hand. Initially, they gradually return to normal use of the hand by avoiding strong hand movements or excessive wrist positions. The resolution of pain or weakness after surgery can take several weeks to several months. If your symptoms are very severe, they may not completely disappear after surgery.

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