Carpal Tunnel Syndrome: Symptoms, Causes & Treatment

Carpal Tunnel Syndrome

A narrow passage is present near the palm, known as the carpal tunnel. The median nerve passes through this passage and reaches the fingers and thumb. Due to various causes, the median nerve is compressed in the tunnel leading to carpal tunnel syndrome. The patients with this condition experience numbness, weakness, and tingling in the hands. It is also known as median nerve compression.

The carpal tunnel syndrome symptoms start gradually. They may appear and disappear during the initial stage of the disease. The symptoms are most common at night.  However, the condition worsens and occurs more frequently if not treated. Symptoms of carpal tunnel syndrome are:

1. Pain that travels towards the shoulder
2. Feeling of numbness, tingling, burning, and pain in thumb and ring, index, and middle fingers.
3. A Shock-like sensation (occasionally)
4. Loss of proprioception leading to dropping of things
5. Challenging to do fine movements such as buttoning of clothes.
6. Reduced feeling in the thumb and fingers
7. Reduced strength and coordination between thumb and other fingers. 
8. Swelling in the hand
9. Feeling of change in temperature in hands (hot and cold hands)
10. Numbness and tingling in the middle of the night and first thing in the morning

Causes of carpal tunnel syndrome include:

1. Wrist fracture that narrows the carpal tunnel
2. Rheumatoid arthritis as it causes swelling and inflammation of joints
3. Hereditary, as the carpal tunnel is narrow in some people and it runs in families
4. Pregnancy, as it may cause swelling
5. Repetitive motion for a long time
6. Underlying conditions, such as diabetes and thyroid disorders.

Many factors increase the risk of Carpal tunnel syndrome. Such as:

1. Increasing age (with age, the median nerve tends to weaken)
2. Injury to the wrist or trauma such as sprain and fracture
3. Repetitive motions of the hands or wrists 
4. Excessive alcohol consumption
5. Hand or wrist deformity
6. Having a small carpal tunnel which can be genetic or hereditary
7. Being female. Women have three times more risk for carpal tunnel than men.
8. In women, risk increases during pregnancy, breastfeeding, or menopause due to changes in hormones.
9. Having certain conditions such as hypothyroidism, diabetes, neurological disorders, or overactive pituitary gland
10. Frequent exposure to cold temperature and vibrations of the hands
11. Tumour in the wrist

1. Physical examination: The doctor will examine your hand and wrist and perform several physical tests. The doctor will ask about signs and symptoms and medical history. The fingers and wrist will be inspected for numbness, tingling, pain, and sensations.
2. Tinel’s sign:  The physician will tap over the median nerve at the wrist to check the sensation in the fingers. 
3. Phalen test or Wrist flexion test:  In this test, the elbow is rested on the table, and the wrist is allowed to fall freely. The numbness is felt in 60 seconds if you have Carpal tunnel syndrome.
4. X-rays: The physician orders the x-rays of the wrist and fingers if there is limited motion.
5. Electromyography (EMG):  It determines how wells the median nerve is working and how much it is in control. It also includes nerve conduction studies.
6. Ultrasound: It produces a 3D image of the hand. It shows narrowing of carpal tunnel and the size of the median nerve.
7. Electrodiagnostic tests: The electrodes are placed on the hand and wrist in this test. Small electric shocks are applied, and nerve impulse is measured. It helps to confirm the diagnosis of carpal tunnel syndrome. It also provides information about the severity of the disease.

Both non-surgical and surgical methods are used for the treatment. Non-surgical methods are usually used during the early stage of the disease when the symptoms are less severe. Some of the treatment methods are:

1. Wearing braces and splinting: It prevents bending of the wrist and keeps it in a normal position. In addition, it reduces the pressure on the nerve in the carpal tunnel.
2. Activity changes:  It includes doing some other activities or taking a break when your hands or wrists are in the same position for an extended period. It is beneficial when your job includes repetitive motion of hand or wrist.
3. Nonsteroidal anti-inflammatory drugs (NSAIDs): The doctor prescribes medication which provides relief from pain and inflammation, such as ibuprofen. These medications manage symptoms at an early stage.
4. Steroid injection: The doctor injects a steroid injection in the carpal tunnel. It relieves symptoms temporarily. 
5. Ice therapy: The doctor also advises using ice or cold packs. It reduces swelling and pain in the wrist and improves sensations in the hand and fingers.
6. Nerve gliding exercises: These exercises ensure smooth gliding and sliding movement of tendons in the carpal tunnel. It provides relief from pain and allows the fingers to function normally.
7. Carpal tunnel surgery: Doctors make a small incision of the size of around 1cm on the palm. The carpal ligament is identified and cut to release the median nerve from compression. The procedure is done under local anaesthesia with/without sedation. The patient immediately feels the relief of symptoms after the surgery. The patients resume their routine life immediately after the surgery and the sutures are removed on the tenth day. 

The complications in the treatment of carpal tunnel syndrome are rarely seen. Some of the risks and complications included are:

1. Permanent impairment and disability
2. Chronic hand and wrist pain
3. Recurrence of carpal tunnel syndrome
4. Decreases mobility of the wrist and hand

Disease Progression

Carpal tunnel syndrome progress through three stages, which are:

Stage 1: This stage is characterised by numbness, pain, and tingling, primarily at night. It can be relieved by shaking the hand.

Stage 2: This stage is characterised by symptoms that also occur during the day. It is due to some prolonged position and repetitive hand movement. There is weakness in the hands. Dropping things also get common.

Stage 3: It is the most severe stage with muscle and nerve damage. It is characterised by the weakening of muscles stimulated by median nerve damage.