Carpal Tunnel Syndrome
More About Carpal Tunnel Syndrome
Carpal tunnel syndrome, or CTS, is a condition in which a nerve in your wrist becomes compressed, causing severe pain and stiffness in your hand and entire arm. This occurs when the median nerve in your wrist becomes compressed. The carpal, which is called carpus in English, means wrist in Hindi. The word carpus is derived from the Greek word. Medically, the carpus is a group of eight small bones surrounding the wrist. These bones are located on both sides of the wrist, connecting the hand to the elbow. Nine to ten tendons and one nerve (the median nerve, which lies between the elbow and wrist) pass through the tunnel. All of these nerves pass through the carpal bone and are supported by a strong ligament called the flexor retinaculum. CTS can often manifest as more than one symptom, which is why it's called a syndrome.
Stages of Carpal Tunnel Syndrome
The severity of carpal tunnel syndrome is assessed in five stages, including abnormal tingling in the hand, loss of sensation, and weakness of the thumb muscles. Let's explore these stages.
Stage 1: Nocturnal paraesthesia can be felt in any part of the hand, especially where the median nerve passes.
Stage 2: This condition can occur at any time of the day and causes frequent stiffness in the hand.
Stage 3: Sensation is lost in the area where the median nerve passes.
Stage 4: Weakness and failure of the muscles below the thumb.
Stage 5: Widespread paralysis or loss of muscle mass of the muscles below the thumb, causing the thumb to no longer function properly.
Symptoms of Carpal Tunnel Syndrome
Anyone suffering from CTS will experience pain, numbness, or pins and needles (like a pins and needles) where the median nerve passes. The median nerve runs through the outer half of the hand, including the thumb, index finger, middle finger, and half of the ring finger. As the disease progresses, the affected hand and fingers become increasingly difficult to grasp, and the muscles on the outer side of the hand also become damaged. Sometimes, severe pain may occur in the front of the elbow and wrist.
Causes of Carpal Tunnel Syndrome
Nerve compression is not something that is impossible to diagnose. In such cases, CTS is called idiopathic. This syndrome often results from a wrist injury or medical conditions that compress the median nerve in the wrist, such as arthritis, diabetes, osteoporosis, hypothyroidism, obesity, and sometimes even pregnancy. CTS is also seen in patients who take period-advancing pills or take medication to treat epilepsy. Lipomas and lumps in the wrist can also put pressure on the nerve, leading to carpal tunnel syndrome.
It is observed that CTS symptoms usually appear in the middle of the night. These symptoms can sometimes appear on one or both wrists. Nowadays, this condition is commonly associated with computer use and is the most familiar form of computer-related injury, called CRI. This injury is caused by excessive wrist use. It most often occurs in people who type on a computer or chat on the phone all day. This results from overuse and stress on the tendons in the wrist, thumb, or shoulder. This type of injury is called repetitive strain injury (RSI).
Risk Factors for Carpal Tunnel Syndrome
There are some risk factors associated with this condition that you need to know about.
Heredity: It runs in some families, causing some people to have changes in the structure of the carpal tunnel or the size or location of the nerve.
Age: This condition is more common in people after the age of 50.
Gender: This condition is more common in women than in men.
Hormonal Changes: Certain hormonal changes during pregnancy may increase the risk of CTS in women.
Weight: Overweight people are at higher risk for CTS.
Habits: Smoking and alcohol.
Occupations: People with certain occupations are at higher risk for CTS, such as computer users, transcriptionists, factory workers, butchers, barbers, janitors, musicians, drivers, and cashiers.
How to Prevent Carpal Tunnel Syndrome
In this condition, patients need to make lifestyle changes to reduce symptoms and ensure treatment is effective. Since this condition is caused by overuse of the wrist, patients should take frequent breaks during work and rest the painful area, especially when experiencing discomfort. If symptoms persist, consult a doctor.
Using a gadget to keep your wrist straight can help prevent excessive pressure on the wrist. Wearing a splint at night can help keep your wrist in the correct position. Avoid undue stress on the thumb. To do this, use your entire hand and fingers to grasp an object.
To relieve CTS-related symptoms and pain, rest whenever you're at home, and don't forget to exercise if the pain is mild. Exercise can help build muscle strength and reduce symptoms.
Finally, timely treatment of CTS is essential. Ignoring symptoms will only lead to further damage.
Diagnosis of Carpal Tunnel Syndrome
The symptoms of CTS are very distinctive, so they're not difficult to diagnose. A doctor can assess the patient's past medical history or use the Durkan test or Tinel's sign (a pins-and-needles sensation). Symptoms can also be evaluated using the Phalen test, a physical examination that confirms CTS. An X-ray may be recommended to rule out injury or arthritis. Doctors may also recommend a nerve conduction velocity test (NCV) to diagnose this condition. An electromyogram (EMG) can measure electrical activity in the muscles to show muscle damage. An ultrasound can also be performed to check for compression of the median nerve.
The difference between wrist and hand pain is diagnosed as follows:
De Quervain's tendonitis: Pain experienced when making a fist or shaking hands.
Trigger finger: Pain and stiffness experienced when bending the thumb and other fingers.
Arthritis: Pain experienced due to swollen or stiff joints.
Carpal Tunnel Syndrome Treatment
When a person is diagnosed with this condition, there is no need to panic, as there are several treatment options. These can be divided into non-surgical and surgical options. With lifestyle changes, this condition is quite easy to treat. Non-surgical options are suitable for cases where the patient has a less severe form of CTS. These non-surgical options include:
Splints: Braces and splints are recommended to support the wrist, especially at night.
Physiotherapy and exercise: Once diagnosed, patients are typically prescribed CTS-specific exercises to tone the muscles in their upper limbs to reduce the severity of symptoms. The purpose of these exercises is to widen the carpal tunnel to create space for the affected nerve.
Steroid injections: These injections help reduce inflammation and temporarily alleviate symptoms. However, they are not considered a permanent or long-term treatment.
If non-surgical methods do not alleviate symptoms, surgery may be recommended. Surgical options for CTS include:
Surgical carpal tunnel release: This surgery, also known as open surgery or endoscopic, involves dividing the retinaculum to create more space for the nerve. This surgery is performed for patients who have not responded to other treatment options. To date, it is the only permanent solution to the problem.
The results of this operation are generally good, and the likelihood of symptoms returning is very low. Your grip should begin to improve within 2-3 months of surgery. However, a serious complication of the operation is stiffness in your thumb.
Avoid Carpal Tunnel Syndrome by Improving Your Lifestyle
This condition is a factor in many of our daily activities, so to prevent future recurrences, we should take effective measures, such as changes in our workplace. We should focus on maintaining proper body posture. Special attention should be paid to maintaining the position of the hand and wrist. You should take frequent breaks from work, as excessive strain on the wrist can lead to this condition. Proper positioning while sleeping. Furthermore, evaluating and properly using equipment at work can help reduce the risk of CTS.
Surgery-related key points and complications
Recovery from surgery is relatively short. Stitches are removed a few days after surgery. Symptoms should be relieved approximately 14 days after the removal of the stitches. Most people recover well and can resume normal activities after approximately 6 weeks. Regular rest, stretching exercises, and correct wrist posture can all help.
Complications
If you leave this condition untreated, you may develop a lifelong problem that may be irreversible, causing unbearable pain, stiffness, and muscle weakness.
Alternative Treatments for Surgery
Yoga has proven to provide relief for some people with this condition. Yoga has proven to be a form of alternative treatment that has proven beneficial in reducing pain and improving strength.
