Carpal tunnel syndrome

Summary

Carpal tunnel syndrome is a condition that occurs when the middle nerve in the hand, which runs through the bones in the carpal tunnel, is inflamed, pinched, or pressed. This leads to pain, tingling, burning and weak thumb strength. Repetitive efforts, injuries, cysts and trauma to the wrist lead to the syndrome.
Diagnosis is typically made by evaluating the patient’s medical history and what has led to the condition. The disease usually resolves spontaneously after a few days with less strain on the wrist. However, some cases can lead to complications with loss of hand muscle movement, change in sensitivity and loss of thumb strength.

The doctor suggests the treatment depending on the severity of the symptoms. In some cases, surgery is indicated. Massage with arnica ointment and immersion of the hand in hot and cold water alternately improves the symptoms.
To prevent this, avoid constant efforts on the wrist and hand and always stretch periodically if the activity lasts for long periods.

Definition

Carpal tunnel syndrome, also known as carpal tunnel, carpal tunnel or carpal tunnel syndrome, is the disease that affects the median nerve that passes through the wrist region, called the carpal tunnel. The median nerve is the main nerve in the hand. The median nerve is one of the three branches of the nerve of the hand. Its function is to give the thumb, index and middle finger sensory capabilities, in addition to moving the thumb.

The carpal tunnel does not extend to the wrist and passes through the palm side. It is made up of eight small carpal bones and a ligament called the flexor carpi. The median nerve passes through the carpal tunnel.

Epidemiology

In the United States, an estimated 3.1% of workers suffer from carpal tunnel syndrome.1.

In 2020, a leading Swiss specialist magazine2 estimated the prevalence of carpal tunnel syndrome at 3 to 5% of the general population.

It is estimated that women are more affected than men, especially after the age of 50.

Causes

Carpal (or carpal) tunnel syndrome is caused by pressure on the median nerve. The syndrome does not always have obvious and apparent causes. On the other hand, one of the causes is the median nerve is compressed, which causes sensory disturbances in the innervated motor areas. Sensory perceptions often do not correspond to reality. Nerve irritation is also reflected by tingling, pain, numbness, or burning sensations. The thumb also loses its resistance.

Trauma, tumors and cysts in the wrist can cause compression of the median nerve. People who engage in intense and interactive manual activities are also victims, such as bricklayers, sawmills, cutters, polishers, cashiers, violinists and computer workers. In fact, the more repetitive effort, the more chances of developing the syndrome. The swelling caused by this repetition strangles the median nerve. Sometimes the carpal tunnel narrows due to interactive support with the palm, for example on a table, or after hyperextending the wrist. One of the causes of carpal tunnel syndrome is too much pressure.

Risk factors:
Factors such as gender, age, family predisposition, stress, obesity, smoking and excessive alcohol consumption increase the risk of developing carpal tunnel syndrome. This also happens in some diseases, such as thyroid disease, diabetes, pregnancy, rheumatism and chronic kidney failure . Taking certain medications can be a risk factor. Some studies have shown a link between carpal tunnel syndrome and the use of anastrozole , a drug used to treat breast cancer.

Symptoms

Usually, the patient complains of night tingling, burning, pain, numbness or shock in the fingers (all including the thumb, but not the little finger).
These signs can ascend to the forearm, upper arm or shoulder. The disease causes the patient to misrecognize objects when touching them with the fingertips, which are innervated by the damaged nerve, when they have their eyes closed.
The pain can be so severe that it can wake the patient.

These symptoms disappear within minutes of shaking hands. However, they intensify when nerve compression persists.
The patient may experience a kind of weakness in the hands, which is characterized by a difficulty in picking up certain objects, with a tendency to drop them.
More advanced damage results in loss of sensation, muscle atrophy, dry skin of fingertips, weakness of thumb strength. Simple actions such as squeezing objects, hand sewing and buttoning shirts can become difficult.
Note that these signs, usually bilateral, appear only in areas of sensory and motor innervation of the middle nerve.

In the vast majority of cases, the little finger is not affected, because this finger is innervated by the ulnar nerve, which does not pass through the carpal tunnel.

Diagnosis

In most cases, the physical examination of the patient combined with specific tests allows the identification of carpal tunnel syndrome. There is talk of diagnosis based on clinical symptoms.
Some tests may be performed, such as the Phalen’s test, to confirm a suspected diagnosis. This test is positive when a wrist flexion position held (eg 2 fists towards each other) for 30 to 60 seconds triggers tingling, pain or numbness in the fingers innervated by the median nerve (thus without the little finger).
However, tests such as electromyography, X-ray, computed tomography and blood tests confirm and differentiate the diagnosis. They are also used to assess the severity of nerve damage and to make a therapeutic decision.

When to see a doctor?

It’s wise to see a doctor if you have signs and symptoms of carpal tunnel syndrome that are interfering with your normal activities and sleep patterns, as the Mayo Clinic website explains . Permanent damage to nerves and muscles can occur if not treated properly.

Complications

Spontaneous healing of carpal tunnel syndrome is common. If pain persists, proper treatment restores wrist function after 3 to 6 months. If no action is taken, the disease can lead to complications such as irreversible paralysis of the small muscles in the thumb and a loss of skin sensation.

Surgical intervention can be performed and is necessary in some cases, and it rarely leaves scars. Bruises, open wounds and infectious complications will be dealt with by the healthcare professional.

This means that irreversible damage to the median nerve is possible without proper treatment.

Treatments

The choice of treatment depends on the diagnosis of the disease . The doctor may prescribe manual therapy , physiotherapy, drug injections , medication taken by mouth, splint or bracing In more advanced cases, it is possible to perform a corticoid injection that can be repeated later, which allows to relieve the median nerve. However, this type of treatment should not last longer than 1 to 3 years.

Relapses , which are common, often require surgery with or without endoscopy.

Wrist splinting is usually the first therapy performed.    

Medications used orally to relieve pain and inflammation are primarily non -steroidal anti  inflammatory drugs ( NSAIDs) such as ibuprofen and aspirin .

Therapy requires in all cases resting the wrist with removal of the cause, interruption or reduction of activities causing nerve damage .

Acupuncture can often help with carpal tunnel syndrome.

Surgery Information
– According to the Mayo Clinic , surgery involves relieving pressure on the median nerve by cutting the ligament that runs through it.
– Surgery is often considered a necessary therapeutic option, especially when symptoms are severe. However, more than a third of operated patients are unable to return to work during the 8 weeks following surgery for carpal tunnel syndrome, according to a study published in the Journal of Orthopedic & Sports Physical Therapy ® (JOSPT®). Recovery can take months, specialist help (eg physiotherapist) seems beneficial.
– According to the Mayo Clinic , in an online article published in April 2019, symptoms improve in more than 90% of patients after carpal tunnel surgery. However, the number of people who experience complete relief of symptoms after surgery may be less than 50%. Patients with severe symptoms before surgery are the ones who improve the most after surgery, but this group also tends to have the most residual symptoms.

Effectiveness of physical therapy compared to surgery (study)
Physical therapy has been shown to be as effective as surgery to treat carpal tunnel syndrome, according to a study published in March 2017 in the journal   Journal of Orthopedic & Sports Physical Therapy® (JOSPT®)🇧🇷 Researchers from Spain and the United States showed that after 1 year of follow-up, patients with this syndrome who received physiotherapy obtained results comparable to those who underwent surgery. In addition, patients who received physical therapy improved more quickly during the first month after starting treatment compared to those who underwent surgery. Scientists indicate that physical therapy includes manual therapies on the neck, median nerve and stretching.

Herbal medicine

You can ease the pain by massaging twice a day into your wrist and the base of your palm with a little arnica ointment . Treatment should be discontinued when the pain ends.
In addition, soaking the hand and wrist in hot water for 3 minutes in cold water for 30 seconds, alternating three times, relieves pain.

– According to an Iranian study, carried out in 2015 by the Fasa University of Medical Sciences, in Fasa (Iran), the essential oil (in English oil ) of chamomile makes it possible to reduce symptoms and functional status in patients with severe manifestations of Down syndrome carpal tunnel. This double-blind research with placebo control was carried out with 26 people with carpal tunnel syndrome in an advanced or severe stage. This study was published in the scientific journal Complementary Therapies in Clinical Practice in November 2015.
Read the research summary in English here

Tips and Prevention

– Take breaks regularly, if possible every hour take a 5 minute break. Do light stretches on the wrist and hands.

– Reduce your strength and relax your grip. If your job involves frequent use of a keyboard, tap the keys gently.

– Add protection to certain objects, such as the steering wheel, bike handle or pen. If possible soft protection, for example foam base to reduce pressure on the wrist and hand.

– Use gloves for manual work.

– Alternate the use of your hands if possible and give your body frequent breaks to relax and stretch your upper limbs.

– Practice relaxation methods.

– In case of surgery, after treatment: 1) Apply cold to the injury to reduce pain. 2) Do not wet the bandage. 3) Move your fingers gently every hour. 4) Refrain from wrist work for a few weeks.

– Avoid exposing wrists to repetitive microtrauma and other risk factors.

– Follow the advice of the ergonomist.

– Choose tools that match your size and your hands.

– Adjust its position close to the material used.

– Whenever handling your computer keyboard, make sure your forearms and hands are in a straight line.

– Place your wrists on flat surfaces that are not too hard.

– Hold objects with your full hand.

– Keep your hands warm. The cold can favor pain in the hands.

– At night, you can wear a splint on your wrist, this is a way to limit the pain. Be careful not to over-tighten.

– Taking vitamin B6 can help in the fight against carpal tunnel syndrome.

Please contact your doctor:

– If after surgery: the pain persists, the fingers become cold or the skin changes color; if you notice a sensitivity problem or difficulty moving your fingers.

– If the symptoms last for several weeks.

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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