What is Carpal Tunnel Syndrome?
This condition is known as Carpal Tunnel Syndrome and occurs when the median nerve, running from the forearm into the palm of the hand, becomes compressed or pinched at the wrist.
Compression typically occurs at the narrow passageway known as the carpal tunnel due to the compression caused by bones and ligaments in the wrist. It mediates the sensations of the thumb, index, and middle fingers, and some motor functions in the hand. Symptoms of CTS commonly include numbness, tingling, weakness, or pain in the hand and wrist.
Many claim that these symptoms worsen at night or with repetitive movements of the hands. It is commonly associated with activities involving frequent wrist motion, like typing or using a mouse, and can also result from conditions such as arthritis or repetitive stress injuries. If left untreated, Carpal Tunnel Syndrome can lead to permanent nerve damage and muscle weakness.
Symptoms of Carpal Tunnel Syndrome
The symptoms of Carpal Tunnel Syndrome tend to come in degrees and are either on one or both hands. Some symptoms include:
- Numbness or Tingling: Usually on the thumb, index, and middle fingers, or at times, on the whole hand.
- Pain: Pain and aching in the wrist, hand, or the forearm that can extend to the elbow or the shoulder.
- Weakness: Weak in the hands, which prevents holding things or gripping them appropriately. This may cause a lot of difficulty in doing work.
- “Pins and Needles” Sensation: Dribbling or “pins and needles” in the fingers, particularly at night.
- Nighttime Aggravation: Symptoms worsen at night time or in the morning upon waking up.
- Decreased Sensitivity: Inability to feel touch or distinguish different textures, particularly in the involved fingers.
Causes of Carpal Tunnel Syndrome
Increased pressure on the median nerve through the carpal tunnel within the wrist is responsible for causing Carpal Tunnel Syndrome. The pressure may arise as a result of a variety of contributing factors among them include:
- Repetitive Hand Movements Activities or work related to the repetition of a motion that involves the flexion and extension of the wrist, such as typing, using a mouse, assembly line work, or playing certain musical instruments, can contribute to CTS.
- Wrist Anatomy: In some individuals, a weaker carpal tunnel is inherently formed, increasing the chance for nerve entrapment, especially if certain conditions are met.
- Injury or Trauma: A fracture or dislocation of the wrist can distort the anatomy of the carpal tunnel and put a wrench on the median nerve.
- Inflammatory Conditions: Rheumatoid arthritis or tendinitis can induce inflammation in the tendons that encircle the median nerve, placing extra pressure inside the carpal tunnel.
- Pregnancy: Fluid retention during pregnancy will cause swelling and may compress the carpal tunnel on the median nerve, causing irritation.
- Diabetes: The diabetic patient has a higher tendency for nerve damage generally termed as neuropathy; this tends to weaken the median nerve and cause it to be more susceptible to compression.
- Obesity: Excess body weight will lead to increased pressure across the carpal tunnel because of swelling or anatomical alterations.
- Genetic Factors: The possibilities of CTS tend to occur in some individuals due to a family history or anatomical traits.
Risk Factors of Carpal Tunnel Syndrome
Risk factors for Carpal Tunnel Syndrome (CTS) are:
- Repeated Hand and Wrist Movements: Jobs or activities requiring frequent typing, gripping, or wrist motions.
- Gender: Women have a higher chance of developing CTS, due to probably smaller carpal tunnels.
- Age: CTS is more common in people over 40.
- Health Conditions: Diabetes, rheumatoid arthritis, hypothyroidism, and obesity can increase the risk.
- Pregnancy: Hormonal changes and fluid retention may cause temporary CTS.
- Injury: History of previous wrist fractures or trauma due to changes in the structure of the carpal tunnel.
- Genetic: Hereditary predisposition to CTS and/or small carpal tunnel space.
Diagnosis of Carpal Tunnel Syndrome
- Carpal Tunnel Syndrome diagnosis includes careful clinical evaluation, patient’s history, and diagnostic tests. Main steps include:
- Medical History: The doctor will ask about symptoms – numbness, tingling, and pain – and any repetitive activity or underlying health condition (e.g., diabetes, arthritis).
- Physical Examination: A physical checkup is primarily aimed at observing the power and a sense in the hand and wrist. The physician may undertake specific tests, including:
- Tinel’s Sign: Lightly tapping over the median nerve at the wrist to ascertain whether this induces numbness or pain in the fingers.
- Phalen’s Maneuver: Keeping the wrists flexed for approximately a minute to determine whether it elicits symptoms of numbness or pain.
- Nerve Conduction Studies: These tests measure the velocity of electrical conduction through the median nerve to determine the extent of nerve compression.
- Electromyography: This measures the electrical activity of muscles in order to evaluate the involvement of nerves.
- Ultrasound or MRI: Imaging studies may be ordered to eliminate other possibilities and to better outline the structure of the carpal tunnel.
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Treatment of Carpal Tunnel Syndrome
The treatment of carpel tunnel syndrome depends upon the doctors and how they treat it:
- Non-Surgical Treatments:
- Wrist Splints: Putting the wrist in a neutral spot with a splint at night, gives the median nerve a break from pressure.
- Activity Changes: Stopping or changing repeated actions and taking breaks often helps stop symptoms from getting worse.
- Physical therapy: Doing specific wrist and hand exercises, plus learning good posture and work habits, lowers the pressure on the nerve.
- Medication
- Non-steroidal Anti-Inflammatory Drugs (NSAIDs): These drugs, like ibuprofen cut down on pain and swelling.
- Corticosteroid Shots: Doctors inject steroids into the carpal tunnel to give short-term relief by reducing swelling.
- Cold Packs: Putting ice on the wrist helps with swelling and pain during flare-ups.
- Better Work Setup: Changing how you set up your desk, like where you put your keyboard and how high your chair is, can help avoid more wrist injuries.
- Surgical Treatment Approaches
In circumstances where such conservative treatments are not capable of alleviating the signs and symptoms of the condition, or where the conditions are very severe, surgery may be highly recommended. The most common surgical operation involves cutting the transverse carpal ligament, which compresses the median nerve and improves the size of the carpal tunnel to reduce the pressure. There are two surgical procedures that can be performed in this case.
- Open Surgery: This is the type of surgical procedure in which an incision is made on the wrist to reveal the ligament and allows its come off.
- Endoscopic Surgery: Endoscopic surgery consists of small incisions and a small camera, through which guided surgery is performed.
- Post-surgery recovery includes therapy directed towards improvement of strength and range of motion in the wrist that had the surgery.
- Complementary Treatment:
There can be unaccustomed occurrences of some other medicine like acupuncture, chiropractic or laser to ease the symptoms.
Nevertheless, non-invasive strategies can be quite helpful if they are enlisted in the initial stages of the condition. However, in case such treatment is not sought, CTS culminates to irreversible injury to the nerves and or muscle atrophy hence the need for diagnosis and appropriate care in good time.
Prevention of Carpal Tunnel Syndrome
Preventive approaches to Carpal Tunnel Syndrome (CTS) Ergonomic Changes: Adjust the heights of tables and chairs in such a way that the hands and elbows are easily supported while working with the keyboard and the mouse.
- Rest Periods: This is also typically done in most activities involving repeated motions which tend to be more demanding and less pleasant.
- Wrist Posture: Avoid excessive bending or overextending the wrist and incorporate splints in order to maintain a straight position for the wrists in case of extended activities.
- Stretching and Strengthening Exercises: Engaging in kinesthetics which involves alternative muscle groups to the controlling hand to decrease overuse.
- Minimize Repetitive Actions: Change or alternate work processes in a way that limits or avoids excessive wrist actions.
- Healthy Living: Manage related risk factors like diabetes, overweight, or history of arthritis that may precipitate the development of CTS.
Conclusion
Carpal Tunnel Syndrome, or CTS, is a very prevalent ailment affecting the day-to-day living of almost all people. And carried too far, it will revolutionize your day to day life.
The good thing is that with early diagnosis and proper management treatment included, the symptoms can be delt with or even reversed completely and hence nerve impairment cannot take place allowing an individual to live her or his full potential.
This is why, Goyal Hospital Jaipur once again is explaining its position regarding the accurate diagnostics and effective non-invasive treatment of CTS followed by necessary surgical procedures whenever the condition requires it.
The Whole Team does their best to provide Quality, Patient Centered Care – including Strategies to Prevent Recurrence and Targeted Treatments aimed to relieve symptoms related to carpal tunnel syndrome.
In the event that one has symptoms of the Carpal Tunnel Syndrome or is a relative of such a person, the in and out professional that is an evaluation and treatment should be sought.
