Carpal Tunnel Syndrome: Symptoms, Causes, Risks, Diagnosis, Treatment, Prevention and Outlook

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1Overview

The hands are used in a variety of ways. People play, type, write and do routine tasks with their hands. However, due to the wear and tear, and the repetitive movements our hands make, these may contribute to the development of carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is a disease that causes tingling, numbing and other signs and symptoms in hand. It happens when the nerve in the carpal tunnel is pinched.

In many instances, the pinching of the nerves results from the typical everyday activity that involves repetitive movements by the wrist. These include using vibrating hand tools, writing for long hours, playing a musical instrument and manual labor.

CTS affects the median nerve, which is found the forearm to the palm. The median nerve is responsible for providing feeling to the palm side of the thumb to the index, middle finger and ring finger.

Carpal tunnel syndrome worsens in time. That’s why it is important to detect and diagnose the disease early. The symptoms may be relieved by simple measures during the early stages of the disease. However, when the disease progresses, it may lead to the inability to do certain activities.

2Symptoms

Carpal tunnel syndrome usually begins slowly and gradually. The initial symptoms may include numbness or tingling in the thumb, middle and index fingers. These discomforts come and go.

The common symptoms of carpal tunnel syndrome include:

Numbness or tingling – People with carpal tunnel syndrome may have numbness or tingling sensations in the fingers and hands. This sensation is usually felt at the thumb, index finger and middle finger. Sometimes, the ring finger may be affected, too.

Weakness – People with carpal tunnel syndrome may feel weakness in the hand and there is a high risk of dropping objects. This is due to the numbness in hand and weakness of the pinching muscles of the thumb, which are controlled and manipulated by the median nerve.

3Causes

The carpal tunnel is a small and narrow passageway in the wrist formed by small wrist bones. Because of the boundaries of the tunnel is limited and rigid, it is hard for the carpal tunnel to increase in size or stretch.

The median nerve, which is normally found in the forearm, the carpal tunnel and the fingers. The nerve is responsible for providing the feeling in the thumb, index, middle and ring fingers. When the carpal tunnel narrows, it causes pressure on the median nerve, leading to the symptoms of carpal tunnel syndrome.

Many factors may cause carpal tunnel syndrome. The most common factor is the pressure on the median nerve. This pressure can come from inflammation or anything that makes the carpal tunnel narrower or smaller, including:

4Risk Factors

Many risk factors may increase the risk of developing carpal tunnel syndrome, including:

Hereditary – Some traits that run in families may have an impact on the carpal tunnel.
For instance, some people have narrower carpal tunnel than others, an anatomic characteristic that can be seen in families.

Anatomic factors – Some anatomic factors such as a dislocated or fractured wrist or arthritis may deform the space in the carpal tunnel or may place pressure on the median nerve.

Sex – Women are more likely to suffer from carpal tunnel syndrome than men.
This is maybe because the carpal tunnel is smaller in women than in men.

Repetitive use of hand – Performing repeated wrist and hand movements over a long period may irritate the tendons in the wrist, leading to inflammation and pain.

Pregnancy – Pregnant women are more likely to have carpal tunnel syndrome.
Moreover, hormonal changes may cause swelling in many parts of the body, including the wrists.

Obesity – Obesity may increase the risk of carpal tunnel syndrome.

Other health conditions – Other medical conditions are linked to the development of carpal tunnel syndrome. These conditions include rheumatoid arthritis, menopause, thyroid disorders and diabetes.

Workplace factors – Working with tools or work that requires repetitive flexing of the wrist may lead to increased pressure on the median nerve.

Body fluids alterations – Fluid retention may increase the pressure in the carpal tunnel. When this happens, it may irritate the median nerve. Fluid retention is common in menopause and pregnancy. Carpal tunnel syndrome linked to pregnancy may resolve on its own after childbirth.

5Diagnosis

Doctors can diagnose carpal tunnel syndrome through a combination of physical examination, history taking, and tests.

Physical examination – A physical examination involves testing the feeling in the fingers and the muscle strength of the affected hand. The physical examination includes a detailed evaluation of the hand, wrist, neck, and shoulders. This is to rule out the other causes of nerve compression. The doctor will also examine the wrist for signs of swelling, inflammation, and tenderness.

History of symptoms – The doctor will ask about the symptoms and their patterns.
For instance, since the median nerve does not provide sensation in the little finger, if there are symptoms that include the little finger, it might signal another underlying problem aside from carpal tunnel syndrome.

Electromyogram – This test measures the small electrical discharges produced in the muscles. The doctor who conducts the test will insert a thin needle electrode into the muscles to assess the electrical activity when muscles move.

Nerve Conduction Study – Two electrodes are taped to the skin and a small shock is passed through the median nerve. This will show if the impulses become slow when they pass through the carpal tunnel.

6Treatment

Carpal tunnel syndrome can develop gradually. For some people, this condition may worsen over long periods and without any form of treatment. However, here are the treatment options for carpal tunnel syndrome:

Nonsurgical TreatmentIf the condition is detected early on, the carpal tunnel syndrome can be relieved without the need for surgery.

Splinting or bracing – In some people, wearing a brace or splint at night may help prevent the wrist from bending. If you keep the wrist still or in a neutral position, it reduces the pressure on the median nerve.

Activity changes – The symptoms often worsen or occur when the hand or wrist are placed in the same position for long periods, especially when the wrist is extended or flexed. Make sure you modify or change these activities to slow the progression of the disease.

Nonsteroidal anti-inflammatory drugs (NSAIDs) – Medicines may help relieve pain and inflammation. Examples of NSAIDs include naproxen sodium and ibuprofen.

Corticosteroid injections – Corticosteroid or cortisone can relieve inflammation. This is injected into the carpal tunnel and it may help relieve pain and swelling.

Surgical TreatmentSurgery may be needed if the symptoms are already severe and the condition did not respond to the other treatments.

There are two techniques used in surgery of carpal tunnel syndrome:

Open surgery – This surgical procedure involves making an incision in the palm area over the carpal tunnel. The doctor will cut through the ligament to make the nerve free from compression.

Endoscopic surgery – The surgeon will use a device that’s like a telescope with a small endoscope. The doctor cuts through the ligament with just a small incision. This will lead to lesser pain and inflammation

7Prevention

To help prevent carpal tunnel syndrome:

  • Take care of your overall health by not smoking, maintaining a healthy weight and exercising regularly.
  • Take frequent breaks by stretching and bending the hands and wrists.
  • Stop any activity that may cause numbness or pain.
  • Switch hands or change positions when performing repetitive motions.
  • Have the correct posture
  • Wear a wrist splint or brace when you can’t control the movement of the wrist, especially when sleeping.
  • Limit your salt intake
  • Change the computer mouse with something that’s comfortable and does not put a strain on the wrist.
  • Keep the hands warm since there may be stiffness during cold climate.

8Outlook

Carpal tunnels syndrome can range from a minor inconvenience to a debilitating and disabling condition. Many cases of carpal tunnel syndrome are mild, but the symptoms do not last long. However, in more severe cases, the pain and swelling may become chronic. The muscles at the base of the thumb may have loss of sensation, and it could be permanent. As a result, simple jobs and works are more difficult.

Early detection and diagnosis are important to make sure the symptoms do not worsen and interfere with daily activities. The complications of untreated carpal tunnel syndrome may include permanent loss of sensation of the thumb, and clumsiness or dropping off items being grabbed.

Aside from the physical effects, people with carpal tunnel syndrome may have psychological and social effects. People who will lose the use of their hands may feel depressed and useless. On the other hand, their work may also be affected. Some may even lose their jobs, particularly those who are using their hands at work.

Treatments made early may reduce the risk of these serious complications. Thus, when a patient experiences the symptoms, it is important to seek medical help immediately.
This is to prevent the progression of the disease into severe symptoms.