Definition and Overview

Carpal tunnel syndrome refers to a condition that causes numbness, tingles, weakness, and pain in the hand brought about by pressure on the median nerve, which is found in the wrist. The wrist is connected to the forearm by several tendons and the median nerve; these all run through a small space called the carpal tunnel. The median nerve plays an important role in the wrist, as it controls the movement of the thumb and fingers, except the little finger.

Causes

Carpal tunnel syndrome is caused by pressure on the median nerve due to swelling. The swelling, in turn, may be caused by several reasons, such as:

  • Hypothyroidism
  • Diabetes
  • Rheumatoid arthritis
  • Pregnancy
  • Repeatedly bending the wrist downwards
  • Making the same movements with your wrist over and over
  • Forceful hand movements
  • Working for long hours in the same position
  • Working for long hours in an awkward posture
  • Hand-arm vibration

Some people are more susceptible to getting carpal tunnel syndrome because of their job or regular activities.

Key Symptoms


You may have carpal tunnel syndrome if you experience the following symptoms:

  • Tingling
  • Numbness
  • Weakness
  • Pain
  • Stiffness
  • Reduced strength and grip – This symptom, which could be moderate or severe, can make simple hand movements difficult. If left untreated, the condition may make daily activities such as holding a comb or a toothbrush extremely painful.
  • Loss of pinch strength
  • Atrophy – This symptom is characterized by thumb muscles becoming smaller and weaker.

These symptoms are usually felt in the arm, particularly between the hand and the elbow, as well as in the thumb, index finger, middle finger, and half of the ring finger. The symptoms may also get worse when you use your hand or wrist such as when gripping an object.

One sure indication is when you have problems with your other fingers that you don’t feel in your little finger; this is because a different nerve controls the feeling in your little finger. This may mean that only the median nerve is affected, and therefore rules out other reasons for your symptoms.

These symptoms usually become more pronounced at night, and may disappear temporarily when you shake your hand.

Who to See

If you feel these symptoms or your hand and wrist just don’t feel well, you may consult with your doctor to see if you are suffering from carpal tunnel syndrome. A family doctor or internist can diagnose the condition, but you can also consult a specialist.

To diagnose this condition, your doctor will ask about your daily routine, your work and other activities to determine the type of stress and strain that your arm experiences on a regular basis. If your arm is not prone to too much irregular movement, your doctor will ask if you recently had any accidents that affected your wrist, arm, or neck.

A physical examination of the affected wrist, hand, arm, all the way up the shoulders and neck will help your doctor better gauge the condition. If necessary, nerve and blood tests will be requested.

Types of Treatments Available

The type of treatment your doctor will recommend will depend on the severity of your condition. The first indicator is when there is any damage to the median nerve. The severity of your symptoms will also be considered. If symptoms are mild, home treatment is usually enough.

The following treatment options are available for carpal tunnel syndrome:

  • Home treatment - For home treatment, activities that strain your wrist and hand must be avoided or reduced. If such activities cannot be avoided, it is best to wear a wrist splint to prevent further damage to the carpal tunnel and median nerve.

  • Physical therapy - If you want to do physical therapy, you will be taught and guided on how to do proper stretching and range-of-motion exercises to provide relief for the median nerve.

  • Medications–If you prefer to take medications to relieve pain and swelling, your doctor can prescribe non-steroidal anti-inflammatory drugs (NSAIDs). You can also consider corticosteroids, either topical gels or injections into the carpal tunnel; discuss the pros and cons of this form of medication with your doctor.

  • Surgical options – It is possible to have surgery to treat carpal tunnel syndrome, but it is usually recommended only if other treatment options do not help, if you’ve been suffering from the condition for a long time, or if there is a risk or suspicion of nerve damage.

Treatment should be followed to prevent the problem from coming back. The following will help keep carpal tunnel syndrome at bay:

  • Avoid any activity that strains your hand, fingers, and wrist continuously or for long periods at a time.
  • Exercise your hands and arms to keep the muscles strong and flexible.
  • Practice using your hands and wrists in a way that spreads the pressure evenly.
  • Avoid bending or twisting the wrists for long periods.
  • Switch position when you are working.
  • Take short breaks.
  • Maintain proper posture.

If your work requires activities that may strain your hands and wrists, evaluate the ergonomics of your workspace and implement necessary changes.

Since carpal tunnel syndrome is an issue with the nerve in the wrist, it is considered as an orthopedic condition. Orthopedics is the branch of medicine that deals with problems of the bones, muscles, joints, tendons, ligaments, and nerves. Thus, for specialized treatment, you can see:

  • An orthopedist
  • A physical therapist
  • An occupational therapist
  • A hand surgeon

When Should You See An Orthopedist?

Go to an emergency room immediately if you suddenly lose the feeling in your arm. Otherwise, call your doctor or orthopedist if you:

  • Experience recurrent numbness, tingling, weakness, and pain in the hand that does not go away after 2 weeks
  • Are gradually losing feeling in your hand or fingers
  • Are unable to do simple hand movements
  • Are accidentally dropping things a lot
  • Are unable to pinch your index finger and thumb together
  • Are unable to use the thumb properly
  • Are unable to work due to your symptoms
    References:

  • Bugajska J., Goral AJ.,Szopinska IS. (2007). “Carpal tunnel syndrome in occupational medicine practice.” International Journal of Occupational Safety and Ergonomics.

  • Ibrahim I., Khan WS., Goddard N., Smitham P. (2012). “Carpal tunnel syndrome: A review of the recent literature.” Bentham Open, The Open Orthopaedics Journal.
  • Torpy J., Lynm C., Golub R. (2011). “Carpal tunnel syndrome.” The Journal of the American Medical Association.
  • Katz J., Simmons B. (2002). “Carpal tunnel syndrome.” The New England Journal of Medicine.
  • Middleton S., Anakwe R. (2014). “Carpal tunnel syndrome.” British Medical Journal.
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