Carpal tunnel syndrome

Carpal tunnel syndrome is among the most common conditions affecting the hand.

What is a carpal tunnel?

The carpal tunnel is a narrow tube or passageway in your wrist on the palm side of the hand. The carpal tunnel includes many parts including the carpal bones, ligaments, median nerves and tendons. This tunnel is responsible for connecting the median nerve and tendons to the hand and forearm.

Carpal tunnel syndrome is a condition caused by excessive pressure on the median nerve (within the wrist) leading to numbness, pain, tingling, and weakness. The median nerves provide sensation to the thumb, index and middle finger while the small finger is least affected.

Carpal tunnel syndrome causes varying symptoms that differ from one man to another. Several other conditions may contribute to existing hand pain. Some common conditions that cause hand pain are De Quervain’s tendinosis, trigger finger and arthritis. 

The symptoms of carpal tunnel syndrome in the arm develop gradually over time. Early carpal tunnel syndrome symptoms are:

• Numbness at night 
• Tingling sensation 
• Pain in the fingers

These symptoms also vary between daytime and nighttime. Most people experience troubling symptoms during the night in their sleep.

Daytime carpal tunnel syndrome symptoms are characterised as:

• Tingling (Especially in the fingers)
• Decreased sensation in the fingertips
• Inability to use your hand to its full potential such as decreased strength of hand to hold objects, difficulty in grasping a steering wheel, and/or using a keyboard

As mentioned above, these signs and symptoms worsen over time and become more constant. Worsening symptoms present as:

• Excessive weakness in hands 
• Dropping even light objects 
• Inability to perform even delicate motions

The primary cause of carpal tunnel syndrome is the narrowing of the carpal tunnel. Due to increased narrowing, pressure on the median nerve and tendons increase causing them to swell. This swelling, in turn, restricts any sensations in the thumb, forefinger and middle finger.

Carpal tunnel syndrome can affect anyone, irrespective of the fact that whether or not they use their wrist excessively. Despite its equivalent incidence, it is unusual that tunnel syndrome affects younger people (younger than 20 years old).

However, people whose work involves repetitive finger use are more likely to develop tunnel syndrome. The following group of individuals are at a greater risk of being affected by carpal tunnel syndrome:

• Those who have high-force and long-term use of hand 
• Those who do extreme wrist motions or vibrations 
• History of carpal tunnel syndrome 
• Pregnancy 
• Hemodialysis 
• Wrist dislocation and fracture 
• Hand or wrist deformity 
• Arthritis 
• Thyroid disease
• Diabetes 
• History of alcoholism 
• Tumour in the carpal tunnel 
• Advanced age

Carpal tunnel syndrome (carpal tunnel syndrome doctor) is usually diagnosed when a person presents with the above-given signs and symptoms or for the treatment of another underlying orthopedic condition. A range of tests and procedures are done to diagnose this tunnel syndrome.

Common tests and procedures include:

• Tinel’s sign – A test in which the doctor taps over the median nerve to evaluate the tingling sensation. 
• Wrist flexion test – The wrist flexion test, also known as the Phalen test, is a test in which the patient rests his/her elbow on the table and allows the hand to fall freely. This test allows your doctor to evaluate the sensation of numbness or tingling within 60 seconds. 
• X-rays – X-rays allow your doctor to examine any abnormalities and find out the signs of arthritis.

Carpal tunnel syndrome can be treated surgically or through medication. The ideal treatment plan devised for you will depend on the severity of your symptoms, your age, and your overall health.

Non-surgical methods are used as the first line of treatment. These methods include:

• Wearing a wrist splint 
• Medication 
• Making adjustments to your environment by raising or lowering your chair, moving your keyboard, changing your wrist position
• Applying heat compression 
• Exercises

The surgical approach to treating carpal tunnel syndrome is indicated when the non-surgical treatments deem ineffective. In this surgery, the size of the carpal tunnel is increased in order to decrease the pressure on the median nerve and tendons.