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Carpal Tunnel Syndrome

carpal tunnel syndrome

Carpal tunnel syndrome can cause pain and other symptoms in the hand. It is caused by pressure on a nerve in the wrist. Treatment is usually effective.

What is the carpal tunnel?

There are eight small bones called carpal bones in the wrist. A ligament (also called retinaculum) lies across the front of the wrist. Between this ligament and the carpal bones is a space called the carpal tunnel. The tendons that attach the forearm muscles to the fingers pass through the carpal tunnel. A main nerve to the hand (median nerve) also goes through this tunnel .The median nerve gives feeling to the thumb, index and middle fingers, and half of the ring finger. It also controls the movement of the small muscles at the base of the thumb

What is carpal tunnel syndrome?

This syndrome is a set of symptoms which is thought to be caused by compression of the median nerve in the carpal tunnel. Most cases occur in people aged in their 40s and 50s, but it can occur at any age. It is also common during pregnancy. Women are affected 2-3 times more often than men.

What are the symptoms of carpal tunnel syndrome?

Pins and needles: This is typically the first symptom to develop. The index and middle fingers are usually first to be affected.
Pain in the same fingers may then develop. The pain may travel up the forearm.

Numbness of the same finger(s), or in part of the palm, may develop if the condition becomes worse.

Dryness of the skin may develop in the same fingers.

Weakness of some muscles in the fingers and/or thumb occurs in severe cases. This may cause poor grip and eventually lead to muscle wasting at the base of the thumb.

Symptoms can vary from person to person from mild to severe. One or both hands may be affected. Typically, symptoms are worse at night and may wake you up.

The symptoms may be eased for a while by raising the hand up or hanging it down. Flicking the wrist may also give relief. Symptoms persist all the time if the condition becomes severe.

What causes carpal tunnel syndrome?

In most cases it is not clear why it occurs. It is thought that some minor changes occur in the tendons and/or other structures going through the carpal tunnel. Carpal tunnel syndrome is more common in manual workers, especially with jobs using a lot of wrist movement such as scrubbing or wringing. So, overuse of the hand may be a factor in some cases to trigger the changes in the structures in the carpal tunnel, leading to this condition developing.

There seems to be some hereditary (genetic) factor. About 1 in 4 people with carpal tunnel syndrome has a close family member (father, mother, brother, sister) who also has or had the condition.

Bone or arthritic conditions of the wrist such as rheumatoid arthritis or wrist fractures may lead to carpal tunnel syndrome.
Various other conditions are associated with carpal tunnel syndrome. For example: pregnancy, obesity, an underactive thyroid, diabetes, the menopause, other rare diseases, and a side-effect of some drugs.

Rare causes include cysts, growths, and swellings coming from the tendons or blood vessels passing through the carpal tunnel.

Do I need any tests?

Often the symptoms are so typical that no tests are needed to confirm the diagnosis.

If the diagnosis is not clear then a test to measure the speed of the nerve impulse through the carpal tunnel may be advised (nerve conduction test). A slow speed of impulse down the median nerve will usually confirm the diagnosis.

What are the treatment options for carpal tunnel syndrome?

General measures

Try not to over-use your wrist by excessive squeezing, gripping, wringing, etc. If you are overweight, losing some weight may help. Painkillers may be prescribed to ease the pain. If the condition is part of a more general medical condition (such as arthritis) then treatment of that condition may help.

A wrist splint

A removable wrist splint (brace) is often advised as a first active treatment. The aim of the splint is to keep the wrist at a neutral angle without applying any force over the carpal tunnel so as to rest the nerve. This may cure the problem if used for a few weeks.

A steroid injection

An injection of steroid into, or near to, the carpal tunnel is an option. With variable success rates with steroid injections. It is not clear how steroids work in this condition. Steroids are known to reduce inflammation. Steroids also reduce the effect of other chemicals, which may play a part in increasing the pressure within the carpal tunnel.

Surgery

A small operation can cut the ligament over the front of the wrist and ease the pressure in the carpal tunnel. This usually cures the problem. It is usually done under local anaesthetic. You will not be able to use your hand for work for a few weeks after the operation.

Which is the best treatment for me?

A nonsurgical option may be advised if symptoms are mild. For example, if symptoms come and go and mainly consist of tingling, pins and needles or mild discomfort. A splint may work but a steroid injection is probably the most effective nonsurgical treatment.Surgery gives the best chance of long-term cure. It is quite a common operation. It is done if symptoms persist despite other treatments, or if symptoms are severe and the nerve is in danger of permanent damage.

Carpal tunnel syndrome during pregnancy

Symptoms commonly go after the baby is born. Therefore, a nonsurgical treatment, such as a splint, is usually advised at first. Surgery is an option if symptoms persist


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