A Simple Guide to Carpal Tunnel Syndrome

Where Is The Carpal Tunnel?

The word carpal is a medical term for the wrist; hence the carpal tunnel is located in your wrist. The tunnel floor is formed by the various small bones of your wrist while the various ligaments form the roof of the tunnel. Passing through this tunnel are the tendons which serves to connect the fingers to the muscles in your forearm. This is so that any contraction of the muscles in the forearm will then translate to movement of your fingers. The other important component that passes through the tunnel (just under the ligaments) is the median nerve, one of 3 major nerves that bring sensation and movements to our hand.

What is Carpal Tunnel Syndrome?

A syndrome refers to a constellation of symptoms (complaints from the patients) and signs which your doctor recognize as a particular disease or medical condition. In carpal tunnel syndrome, it is the compression of the median nerve which passes through the tunnel that give rise to a set of signs and symptoms.

How Do I Know If I Have Carpal Tunnel Syndrome?

As mention earlier, you can suspect that you might be having carpal tunnel syndrome if you experience these symptoms such as pain, aching, numbness or a tingling sensation over your thumb, index and middle fingers. These symptoms usually become worse when sleeping at night or when waking up in the morning. Patients also reported that doing certain activities such as writing, typing, knitting and various other postures adopted while doing housework such as the act of wringing dry a cloth, scrubbing, ironing will further aggravate the symptoms mentioned above. In contrast, hanging the affected hand out of bed or shaking it or even by immersing it in hot water will relieve the intensity of the pain. It is also not uncommon for the pain to extend all the way into the forearm.

What Are The Signs Of Carpal Tunnel Syndrome?

If the disease is in an early stage, your doctor will often not find any abnormal signs because the median nerve has yet to be seriously damaged. As the condition progresses, you might even notice your wrist becoming slightly swollen. Your doctor will be able to pick up a loss of sensation to light touch and pin prick over the thumb, index and middle fingers. The tingling of these fingers will be reproduced or become worse when the doctor taps the median nerve over your wrist. Other late signs include a loss of muscle bulk over the base of the thumb.

What Are The Causes Of Carpal Tunnel Syndrome?

In the majority of cases, there is usually no clear cut cause for the carpal tunnel syndrome that you are suffering from. Instead, it has been mostly attributed to having overworked your wrist. As mention before, the carpal tunnel in your wrist is actually very much a confined space but loaded with tendons, bones, and nerves. When working, we often adopt awkward positions or postures which are not that neutral to our wrist, hence placing repetitive stress and constant friction on the tendons when it moves against other components located within the carpal tunnel. This creates a vicious cycle, as the tendons become more inflamed and swollen, it will more likely generate more friction by crowding out the already narrowed space in the carpal tunnel. So with more friction, the tendons become more swollen until it finally compresses on the median nerve, giving rise to the symptoms and signs. On other occasions, the likely causes for your carpal tunnel syndrome will include arthritis of the wrist in particular rheumatoid arthritis, a fractured wrist leading to distortion of the carpal tunnel, fluid retention in pregnant woman, acromegaly (a condition where excessive growth hormone release leads to increase soft tissue growth), diabetes mellitus and long term hemodialysis. Besides that women, especially those in their middle age are more likely to get carpal tunnel syndrome when compared to men.

How Do Doctors Confirm The Diagnosis?

The diagnosis of carpal tunnel syndrome is often a clinical diagnosis. In other words, most doctors will diagnose it based on the symptoms that you are suffering from and the signs that they pick up from examining your wrist and fingers. If necessary, a nerve conduction test can be done to confirm the diagnosis. This test involves placing small electrodes on to the skin just above the wrist to stimulate the median nerve. If you have carpal tunnel syndrome, then your median nerve will be damaged, thus there will be a delay in the impulse reaching your thumb. This delay in conduction can be easily measured. The longer the delay, the more compressed is your median nerve.

Is There Any Treatment Available?

The type of treatment will depend on the severity of symptoms. If you only have mild to moderate carpal tunnel syndrome, often non-steroidal anti-inflammatory drugs will be useful especially if you have arthritis. However, long term ingestion of non-steroidal anti-inflammatory medication is not advisable as there are undesirable side effects when such pills are taken in the long run. So your doctor will most likely ask you to avoid movements such as wringing, squeezing, over gripping or any other movement which you find will aggravate the symptoms. A splint can also be made or purchased and the splint is often worn to keep the wrist in a neutral position at night. If despite all these measures, your pain still persist, then a steroid injection can be given directly into the carpal tunnel. This will often result in significant improvement of the symptoms within a few hours. This will usually last for several weeks and some patients are even cured for good. However, one still need to take precaution by avoiding the activities that you have identified to be able to aggravate the symptoms.

When Do I Need Surgery?

Some patients are so fed up with the constant pain and discomfort that they may ask for surgery to completely relieve them of any further suffering. But more often than not, patients will shiver with the mention of surgery and will try as far as possible to delay it. However, surgery may be needed if you have very severe and persistent symptoms despite treatment such as steroid injection. Weakness of the thumb, index and middle fingers to the extent of causing you to drop things is also an indication that surgery will be needed. The operation for carpal tunnel surgery is a simple one that can be done as an out-patient basis as it does not require general anesthesia. In other words, you do not need to stay overnight in the hospital to have the operation done. The operation will reduce the pressure on your median nerve, hence relieving you of any pain as well as the return of normal hand function in less than a month. However, for patients with symptoms that have persist for more than a year and with muscle wasting at the base of the thumb, there maybe only partial recovery.

So in conclusion, carpal tunnel syndrome is a common and treatable condition. The earlier the treatment is initiated, the better the outcome. So if you suspect something amiss with your wrist, go consult your doctor early now.