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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. 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?

  1. Pins and needles sensation, tingling or burning in part, or all, at index and middle finger area. This is typically the first symptom to develop.
  2. Pain in the same fingers may then develop. The pain may travel up the forearm.
  3. Numbness of the same finger(s), or in part of the palm, may develop if the condition becomes worse.
  4. Dryness of the skin may develop in the same fingers.
  5. 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. Symptoms tend to come and go at first, often after you use the hand. 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. Carpal tunnel syndrome is more common in manual workers, especially with jobs using a lot of wrist movement such as scrubbing or wringing. There seems to be some hereditary (genetic) factor.

Bone or arthritic conditions of the wrist such as rheumatoid arthritis or wrist fractures may lead to carpal tunnel syndrome. Various other conditions: pregnancy, obesity, an underactive thyroid, diabetes and menopause. Rare causes include cysts, growths, and swellings coming from the tendons or blood vessels passing through the carpal tunnel.

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.

Not treating may be an option
In up to 1 in 4 cases the symptoms go without treatment within a year or so

A wrist splint
A removable wrist splint (brace) is often advised as a first active treatment.A splint may be a bit cumbersome to use during the daytime. However, it is common to wear a splint just at night, which is often sufficient to ease symptoms.

A steroid injection
An injection of steroid into, or near to, the carpal tunnel is an option.

Surgery

A small operation can cut the ligament over the front of the wrist and ease the pressure in the carpal tunnel.

Other treatments

Over the years, a wide range of other treatments have been advocated. None of these treatments has good research evidence to support its use and so they are not commonly advised.

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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