What is a carpal tunnel?
The wrist has a set of eight small bones, known as carpal bones. A band of tissue (or retinaculum) stretches over the front of the wrist. The carpal tunnel is the gap between this band and the carpal bones. The carpal tunnel allows the tendons that connect the forearm muscles to the fingers to pass through. A major nerve (median nerve) to the hand also travels through this tunnel before splitting into smaller branches in the palm.
The median nerve is responsible for the sensation in the thumb, index and middle fingers, and part of the ring finger. It also regulates the movement of the small muscles at the base of the thumb.
What is carpal tunnel syndrome?
The median nerve in the carpal tunnel may get squeezed (compressed) and cause a range of symptoms. This is called carpal tunnel syndrome. It affects people of different ages, but it is more frequent in: Women in their late 50s. Carpel tunnel syndrome is also more likely in people who are overweight. It also tends to run in families. Pregnant women have a higher chance of getting it.
What causes carpal tunnel syndrome?
The cause is usually unknown. The carpal tunnel pressure may rise and squeeze (compress) the median nerve, cutting off its blood supply. This impairs the median nerve’s function and leads to the symptoms.
Following are the potential risk factors for carpal tunnel syndrome:
It may be partly due to genes. Carpal tunnel syndrome is more likely if a close relative (parent, sibling) also has or had it.
When Hand/wrist movement is repeated often, such as: Working in a garden or in jobs that need strong or frequent hand grip/exertion, using hand tools that vibrate. Using a computer mouse may be related to carpal tunnel syndrome.
Obesity.
Pregnancy: Fluid retention from pregnancy especially in 3rd trimester
Diabetes mellitus
Hypothyroidism
Ganglion cysts, tumour, scar tissue
Inflammatory arthritis like rheumatoid arthritis
Osteoarthritis
Fractures or trauma to the wrist
What are the symptoms of carpal tunnel syndrome?
The symptoms may come and go at first and only at night. As the condition worsens, they may stay constant and cause hand muscles to shrink and weaken. The usual symptoms are:
Lack of feeling, heat, prickling, electric shock feeling, pain in the thumb, index, middle, ring fingers.
People with this condition often have trouble sleeping and need to shake their hand to ease the symptoms.
The symptoms may get worse by holding the hand or arm in certain positions, such as raising the arm or bending the wrist like when using a phone. They may also be more noticeable after doing the same hand or wrist movements over and over.
Poor coordination and strength of hand with problems doing simple things like fastening clothes & opening lids.
Dropping things/ trouble gripping objects firmly in hand because of weakness.
A burning sensation or pain may spread to forearm, upper arm.
How is carpal tunnel syndrome diagnosed?
A proper medical history with physical examination of hand, arm, shoulders, and neck is mandatory.
Pain specialist may order tests such as electrodiagnostic studies (nerve conduction studies and electromyography) and ultrasound. Electrodiagnostic studies can help assess how severe and likely the condition is. Plain X-ray may be helpful if there is a possibility of bone or joint disease/ structural problems. Magnetic Resonance Imaging can detect rare causes of CTS such as ganglion or bony abnormality and these can affect the treatment plan.
How is carpal tunnel syndrome treated?
The treatment of Carpel tunnel syndrome (CTS) varies depending on how severe the symptoms are. In cases that are not too serious, pain specialist may suggest the non-surgical approach which should lead to recovery in a few weeks. This involves,
Nonsurgical options
Splint or Brace: A splint or brace will prevent you from moving or flexing the wrist while you heal. Research has found that a neutral wrist splint is more effective in easing symptoms than a splint in extension position. This method, along with other treatment methods, can be very helpful in pregnancy. But some people may not get used to the splint.
Physical therapy: Some research supports that physical therapy methods can treat CTS well. These methods involve several sessions.
Oral pain medications (NSAIDS) as when required.
Pain Intervention:
Ultrasound guided carpel tunnel intervention:
This means injecting a small amount of steroid around the median nerve under direct ultrasound guidance. Wrist injections may ease swelling of the hurt nerves and the tough cover and speed up the healing process.
This procedure usually includes carpal ligament fenestration and median nerve hydro-dissection.
Surgery
It is the last option if all other treatment fails.
Dr. Chinmoy Roy is a well-known pain expert and author of multiple medical books who is available at Rajarhat Pain Clinic, Newtown, Kolkata. He has an extensive experience of USG and FLUORO guided pain procedures.
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