Carpal tunnel syndrome is a medical condition in which the median nerve, which runs from the forearm to the hand, is compressed as it passes through the carpal tunnel in the wrist. This can cause a variety of symptoms, such as pain, tingling, numbness, and weakness in the hand and fingers.
Carpal tunnel syndrome is caused by a combination of factors, such as wrist anatomy, inflammation and swelling of surrounding tissues, and overuse or repetitive use of the hand and wrist. Some people may also be at higher risk due to factors such as age, female sex, pregnancy, diabetes, and certain medical conditions such as rheumatoid arthritis.
Treatment for carpal tunnel syndrome may include conservative measures such as rest, splinting, and physical therapy. In more severe cases, surgical treatment may be needed to relieve pressure on the median nerve. It is important to seek medical attention if you experience symptoms of carpal tunnel syndrome, as early diagnosis and treatment can help prevent long-term complications.
Causes
Carpal tunnel syndrome can be caused by a variety of factors, including:
Anatomy of the wrist: Some people may have a narrower than normal wrist, which can make the carpal tunnel narrower and compress the median nerve.
Injuries: Wrist injuries, such as fractures, dislocations, and sprains, can cause inflammation and pressure on the median nerve.
Repetitive wrist use: Activities that involve repetitive use of the wrist, such as typing, using hand tools, or using a computer mouse, can cause inflammation and pressure on the median nerve.
Medical conditions: Some medical conditions, such as rheumatoid arthritis, diabetes, and obesity, can increase the risk of carpal tunnel syndrome.
Hormonal changes: Women may experience carpal tunnel syndrome during pregnancy or menopause due to hormonal changes occurring in the body.
Tumors or cysts: Tumors or cysts in the carpal tunnel can compress the median nerve and cause symptoms of carpal tunnel syndrome.
It is important to remember that carpal tunnel syndrome can have multiple causes, and that in some cases, a clear cause cannot be identified.
Clinical manifestations
Symptoms of carpal tunnel syndrome usually develop gradually and may include:
Pain: The pain may be constant or intermittent and may radiate to the forearm and hand.
Tingling or numbness: The tingling or numbness sensation in the hand and fingers, especially in the thumb, forefinger, middle, and middle of the ring.
Weakness: Weakness in the hand and fingers can make it difficult to hold small objects or perform activities that require strength with the hand.
Swelling sensation: Some people may feel that the hand is swollen, even if there is no visible swelling.
Difficulty making fine movements: Carpal tunnel syndrome can make it difficult to perform fine, precise finger movements, such as buttoning buttons or writing with a pencil.
The symptoms of carpal tunnel syndrome may be more pronounced during the night and may wake the person from sleep. In severe cases, loss of sensation and weakness in the hand and fingers may be permanent if carpal tunnel syndrome is not treated. It is important to seek medical attention if you experience any of these symptoms to get a proper diagnosis and treatment.
Diagnosis
The diagnosis of carpal tunnel syndrome is usually based on a combination of the patient’s medical history, physical examination, and diagnostic tests. Your doctor may do the following:
Medical history: The doctor will ask about the patient’s symptoms, when they started, and how long they have been present. They may also ask about the patient’s work and recreational activities that may be related to carpal tunnel syndrome.
Physical exam: The doctor may perform a physical exam to evaluate the patient’s tenderness, muscle strength, and reflexes.
Diagnostic tests: Diagnostic tests may include a nerve conduction test, which measures the speed and strength of electrical signals traveling through the median nerve, or an electromyography, which measures the electrical activity of muscles. These tests can help confirm the diagnosis and assess the severity of carpal tunnel syndrome.
X-rays: Sometimes, X-rays may be done to rule out other causes of pain and weakness in the wrist and hand.
It is important to seek medical attention if you experience symptoms of carpal tunnel syndrome, as early diagnosis and treatment can help prevent long-term complications.
Physical exam
Physical examination for carpal tunnel syndrome may include the following steps:
Inspection: The doctor will inspect the patient’s hand and wrist for signs of inflammation or swelling.
Palpation: Your doctor may apply pressure to your wrist and carpal tunnel to assess pain and tenderness.
Tinel test: The doctor may perform a Tinel test, which involves gently tapping the carpal tunnel area with a reflex hammer or fingers to assess whether the patient experiences pain, tingling, or numbness.
Phalen test: The doctor may perform a Phalen test, which involves flexing the patient’s wrist forward and holding it in that position for 60 seconds to assess whether the patient experiences pain, tingling, or numbness.
Evaluation of muscle strength: The doctor may evaluate the muscle strength in the patient’s hand and fingers for signs of weakness.
The physical exam can provide important information about the patient’s symptoms and help the doctor diagnose. However, additional diagnostic tests, such as a nerve conduction test, may be necessary to confirm the diagnosis and assess the severity.
Treatment
Treatment may include nonsurgical and surgical options, depending on the severity of symptoms and the underlying cause. Some common treatment options are:
Wrist splint: Wearing a wrist splint overnight can help relieve symptoms in mild cases.
Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help reduce inflammation and pain. In addition, corticosteroids can be injected into the wrist to reduce inflammation.
Physical therapy: Physical therapy can help improve strength and flexibility in the hand and wrist, which can relieve symptoms.
Lifestyle changes: Making changes in the way work is done or daily activities, such as taking frequent breaks and using ergonomic tools, can reduce strain on the wrist and prevent the progression.
Surgery: Surgery may be needed in severe cases or if symptoms do not improve with other treatments. The surgery involves cutting the ligament that presses on the median nerve to release pressure on the nerve.
It is important to seek treatment if you experience symptoms, as early treatment can help prevent long-term complications and improve quality of life.
