Carpal Tunnel Syndrome

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome causes pain, numbness, and a tingling feeling in the hand. It happens when the median nerve in the hand is compressed. The median nerve runs along the entire arm's length, but its primary functions are in the forearm and hands.

Associated Anatomy

The carpal tunnel is a narrow tube inside the wrist that allows the median nerve and tendons that allow movement of the hands. The median nerve gives movement and sensory functions to the forearm and hands. The carpal tunnel is made of small bones and ligaments.

Causes

Carpal Tunnel Syndrome is a result of continuous pressure on the median nerve.

Since the median nerve provides signals that allow the muscles to move and perform activities, any harm to it causes pain and discomfort.

Causes of carpal tunnel include:

  • Repetitive actions of moving the wrists and hands to do any activity.
  • Hormonal changes like pregnancy, thyroid imbalance, PCOS, and obesity can cause swelling in joints and put pressure on the median nerve.
  • Serve diseases like diabetes and arthritis can also compress the median nerve and cause carpal tunnel syndrome.

Symptoms of Carpal Tunnel Syndrome

Symptoms of Carpal Tunnel Syndrome include:

  • Numbness in fingers
  • Tingling in the thumb, or all fingers except the little finger.
  • Difficulty in doing small tasks by hand like picking up things, driving a car, writing, holding something for a long time
  • Shocked feeling in the fingers
  • Weakness in hands
  • Dropping things constantly
  • Difficulty in sewing or buttoning up shirts
  • Pain while bending the wrists

Possible Treatment Plans For Carpal Tunnel Syndrome

Before undertaking treatment options for carpal tunnel syndrome, it is necessary to understand the severity of the condition. A few ways carpal tunnel syndrome can be treated are:

  • Nerve Exercises - Stretching the fingers and moving your hands and forearms to loosen the muscles.
  • Immobilisation - the movement of the wrist or hands might aggravate the nerves and cause more pain. Wearing a splint can help keep the hands and wrist steady.
  • Activity changes - Sitting in one position for a long time can increase the frequency of pain. It is necessary to take plenty of breaks so that the muscles in the body can relax.
  • Medicines - If the wrists have swelled up too much or cause too much pain, doctors may prescribe pain medication, anti-inflammatory drugs, or steroids to help manage the symptoms.
  • Surgery - Carpal tunnel release is the last resort to treat carpal tunnel syndrome. The tunnel's size is increased surgically to release pressure on the median nerve.

Risk Factors

The risk of getting carpal tunnel syndrome increases if:

  • Your work involves making repetitive motions with your hand and stressing the muscles and tendons in the wrists and palms—for example, bakers, musicians, transcriptionists, factory workers, etc.
  • You are obese and have swollen hands and wrists.
  • You have a history of close family members having narrow carpal tunnels.
  • You have fractured your wrist, and there is swelling or pressure on the median nerve.
  • You are a woman, as women generally have narrow carpal tunnels compared to men.
  • You have been diagnosed with arthritis or have any other dislocation in your joints.
  • You are taking medications to tackle other severe illnesses like cancer.

Stages of Carpal Tunnel Syndrome

The severity of carpal tunnel syndrome can be classified into three stages.

Stage 1

Stage 1 is a mild stage of carpal tunnel syndrome. The patient may experience pain, numbness, and a slight tingly feeling in the wrists, especially at night. At night, the wrists may be folded or bent subconsciously during sleep. In this stage, hands may also be stiff, and patients may have difficulty bending their fingers.

Stage 2

Stage 2 is the moderate stage. The pain would be more severe in this stage, even during the day. There would be unsteadiness in the hands, and the patient would be unable to hold things steadily.

Stage 3

The 3rd stage is the most severe. Without treatment, the muscles in the wrist might atrophy and shrink. This compresses the median nerve in the wrist, and it stops sending signals to the brain.

Typical Tests

The most simple test to check for carpal tunnel syndrome is the tinel sign test. In this test, the doctor may tap the wrist palm side up or ask you to flex your hands in multiple ways.

To understand the severity of the syndrome, additional tests may be prescribed like,

  • Imaging tests like X-rays, sonograms, and even MRI scans can help look at the wrist's bones, muscles, and tendons.
  • Nerve conduction studies can help measure the signals sent by the brain to the hands to understand if the nerve signals are being compromised.
  • Electromyograms can help doctors study the electrical activity in the muscles.

Primary Prevention

Carpal Tunnel Syndrome can be prevented in the early stages with a few minor changes in your overall routine.

If your wrist starts aching, you need to take breaks to minimise the stress on your wrists. In addition, if your work involves continuous repetitive hand motions, it is critical to take breaks, relax the muscles, and relieve the pressure on the median nerve.

Secondary Prevention

In case carpal tunnel syndrome has already set in, secondary preventive measures can help reduce the condition's progression and reduce the necessity of surgery.

Secondary preventive measures include managing the severity of other illnesses like diabetes, PCOS, hypothyroidism, and others to reduce the pressure on the nerves.

Epidemiology

Carpal Tunnel Syndrome is one of the most common ailments that affects approximately 2.5-6% of the population.

Expected Prognosis

Carpal Tunnel Syndrome is one of the physical ailments that gets better with proper treatment. With proper care and lifestyle changes, it is possible to dial back the syndrome's progression without aggravating the condition even further.

In the case of severe carpal tunnel syndrome, patients may feel completely normal after surgery and with changes to their lifestyle and work.

Natural Progression

Carpal Tunnel Syndrome is mild when it is first detected. However, it becomes severe and difficult to treat without medicines and surgery, without preventive actions.

Recovery after surgery also depends on the condition of the median nerve. If the nerve is too compressed and damaged, it might be challenging to restore the nerve even after treatment.

Pathophysiology

The median nerve running along the arm's length passes through the carpal tunnel in the wrist. Swelling or constant pressure on the walls of the tunnel compresses the nerves and causes pain and restriction in hand movements.

Possible Complication

Carpal tunnel syndrome may be prevented and reversed with lifestyle changes, medications, or surgery. However, sometimes, the nerve damage might be too severe to treat and permanently impair function.

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