Carpal Tunnel

CAUSES

Carpal tunnel syndrome occurs when there is increased pressure on the median nerve at the wrist in the carpal tunnel. This occurs when the median nerve, which runs from the arm to the palm, is compressed or squeezed in the carpal tunnel, which is a narrow passageway at the base of the hand.
Symptoms usually begin slowly and can occur at any time. Early symptoms include numbness at night, tingling, and/or pain in the fingers (especially the thumb, index, and middle fingers). In fact, because some people sleep with their wrists curled, nighttime symptoms are common and can awake people from sleep. These nighttime symptoms are often the first reported symptoms. Shaking the hands helps relieve symptoms in the early stage of the condition.
Common daytime symptoms are tingling and decreased feeling in the fingertips. Patients also report difficulty handling small objects, grasping a steering wheel to drive, holding a book to read, writing, and using a computer keyboard.

As carpal tunnel syndrome worsens, symptoms become more constant. Weakness in the hand, inability to perform tasks that require delicate motions (such as buttoning a shirt), and dropping objects begin to occur. In the most severe condition, the muscles at the base of the thumb visibly shrink in size.
There are both conservative and surgical options for the treatment of carpal tunnel syndrome. The goal is to minimize pain and help you return to your usual activities as soon as possible.

Simple lifestyle changes may be all that is needed to relieve the symptoms of carpal tunnel syndrome. Dr Winder usually recommends that you make these changes and try nonsurgical treatments before exploring surgical options.
Carpal tunnel syndrome can happen due to repetitive movements, inflammation of hand tendons, or medical conditions that cause inflammation in the body, such as hypothyroidism, diabetes and rheumatoid arthritis. The condition is more common in women than in men. People most at risk are those with jobs or activities that involve repetitive finger use, especially those associated with high force, long-term use, extreme wrist motions, and vibration.

Preventing carpal tunnel syndrome can be as easy as adjusting your daily routine to reduce stress on your hands and wrists in the following ways:
• Minimize repetitive hand movements.
• Alternate between activities or tasks to reduce the strain on your hands and wrists.
• Keep wrists straight or in a neutral position.
• Avoid holding an object the same way for long.
• If you work in an office, adjust your desk, chair, and keyboard so that your forearms are level with your work surface.
• Wear a splint at night to keep your wrist straight while sleeping.

DIAGNOSIS

Dr Winder will discuss your symptoms and medical history and examine you. Next, tests are performed, which may include:
• Tinel’s sign. In this test, the physician taps over the median nerve at the wrist to see if it produces a tingling sensation in the fingers.
• Wrist flexion test (or Phalen test). In this test, the patient rests his or her elbows on a table and allows the wrist to fall forward freely. Individuals with carpal tunnel syndrome will experience numbness and tingling in the fingers within 60 seconds. The more quickly symptoms appear, the more severe the carpal tunnel syndrome.
• X-rays. X-rays of the wrist may be ordered if there is limited wrist motion, or evidence of arthritis or trauma.
• Electromyography (EMG) and nerve conduction studies. These studies determine how well the median nerve itself is working and how well it controls muscle movement.

If your hand or wrist feels numb or tingly, your doctor may order a nerve conduction study, which can determine if there is any nerve damage by measuring how fast an electrical impulse travels through a nerve.
Nerves can be thought of as electrical cables that carry messages between your brain and muscles. When a nerve is not working well, it takes too long to conduct those signals. During a nerve conduction test, the nerve is stimulated, and the time it takes to respond is measured. Several places along the nerve are tested, and the area where the response takes too long is likely to be the place where the nerve is compressed. The presence of carpal tunnel syndrome can be indicated by slower electrical responses in the carpal tunnel.

TREATMENT

Surgery is recommended when carpal tunnel syndrome does not respond to non-surgical treatments or has already become severe. The goal of surgery is to increase the size of the tunnel in order to decrease pressure on the nerves and tendons that pass through the tunnel.

Open release surgery is the most common surgical treatment for carpal tunnel syndrome and is performed as a day procedure. During this short procedure, a small incision is made in the wrist and releases a tight band of fibrous tissue inside the carpal tunnel called the transverse carpal ligament. This enlarges the carpal tunnel and reduces pressure on the median nerve.
Pain, numbness, or tingling in your hand and fingers usually decreases quickly. Depending on your profession, you may return to work in a few days. Complete recovery may take six weeks or longer.