Carpal Tunnel Syndrome

Carpal tunnel syndrome is caused by pressure on the median nerve as it travels through the carpal tunnel.

Anatomy

Watch the animated video.

Carpal Tunnel Syndrome Animation

What is the cause of carpal tunnel syndrome

Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve.

Contributing factors include

Repetitive hand movement, repeating the same hand and wrist motions or activities over a prolonged period of time may aggravate the tendons in the wrist, causing swelling that puts pressure on the nerve. Mechanical problems in the wrist joint, repeated use of vibrating hand tools
Trauma to the wrist that caused swelling, such as sprain or fracture
Hormonal imbalance – an overactive pituitary gland or an underactive thyroid gland, fluid retention during pregnancy or menopause
Rheumatoid arthritis
Heredity, there may be anatomic differences resulting in a narrowed carpal tunnel
Development of a cyst or tumour in the canal.

Symptoms for Carpal Tunnel Syndrome

Numbness, tingling, burning, and pain in the thumb and index, middle, and ring fingers
Occasional shock-like sensations that radiate to the thumb and index, middle, and ring fingers
Pain or tingling that may travel up the forearm toward the shoulder

If left unattended, it can result in damage to the median nerve and thus cause symptoms such as

Weakness and clumsiness in the hand, resulting in difficulty performing fine motor movements.
Dropping thing, resulting from weakness, numbness, or a loss of proprioception

Symptoms of carpal tunnel syndrome generally begin gradually and gets progressively worse over time. With patients experiencing symptoms that come and go at first. However, as the condition worsens, symptoms may occur more frequently or be continuous.

Night-time symptoms being very common, due to people bending their wrists during sleep, awakening the patient. During the day, repetitive movements or movements requiring the wrist to bend will aggravate the symptoms. Examples include using a mouse, driving, reading a book.

Many patients find that moving or shaking their hands helps relieve their symptoms.

Physical Exam

Pressing down along the median nerve on the inside of the wrist will cause numbness or tingling in the fingers (Tinel sign)
Wrist-flexion (Phalen test), press the back of the hands together while the wrists are bent, pointing the fingers down. Carpal tunnel syndrome is suspected if one or more symptoms, such as tingling or increasing numbness, is felt in the fingers within 1 minute.
Test sensitivity in the fingertips and hands by lightly touching them with cotton wool with the patient’s eyes closed.
Check for weakness in the muscles around the base of the thumb.
Look for atrophy in the muscles around the base of the thumb. In severe cases, these muscles may become visibly smaller.

Diagnostic tests

Nerve Conduction studies, this will help determine how well your median nerve is working and whether there is too much pressure on the nerve. This test will also help to exclude other nerve condition, such as neuropathy, or other sites of nerve compression.

Ultrasound, an ultrasound of the patient’s wrist may be helpful to evaluate the median nerve for signs of compression.
X-rays, X-rays may be ordered to exclude other conditions, such as arthritis, ligament injury, or a fracture

Non-surgical Carpal Tunnel Syndrome Treatment

Splinting, usually a splint worn at night.
Avoiding daytime activities that may provoke symptoms, take frequent breaks from aggravating tasks.
Anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, these provide temporary relief
Corticosteroids, such as prednisone or the lidocaine can be injected directly into the wrist to relieve pressure on the median nerve.

Surgical Carpal Tunnel Syndrome Treatment

Carpal tunnel release which involves severing a ligament around the wrist to reduce pressure on the median nerve. Many people require surgery on both hands. Almost always there is a decrease in grip strength, which improves over time. Recurrence of carpal tunnel syndrome following treatment is rare. Most patients say that their hands feel normal post surgery.

What are the Benefits of seeing Dr NM van der Berg, an Orthopaedic Surgeon Early?

Early diagnosis can make all the difference. It is essential you get treatment before permanent nerve damage sets in and you lose function of your hand.
Quicker recovery. Early treatment can help reduce the duration of symptoms and speed up the recovery process.
Improving hand function. Early treatment can help preserve hand strength and dexterity, reducing the risk of long-term hand disability.

In Conclusion, seeing Dr NM van der Berg early for Carpal Tunnel Syndrome can lead to better outcomes, less pain, and a quicker return to normal hand function.