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Carpal tunnel syndrome, often referred to as just carpal tunnel, is a condition that most typically results in numbness and tingling in the hands. It can range from being a minor inconvenience to a disabling condition, depending on its cause, persistence, and the particular manifestation of the condition in a particular individual.
The carpal tunnel is a narrow passageway bound by ligaments and bones at the base of the hand, which houses the median nerve and tendons that control movement of the fingers. When this tunnel swells due to inflammation or some other factor, the median nerve, which runs from the forearm into the palm of the hand, can become compressed, causing numbness, tingling, pain, and eventually hand weakness. These are the hallmark symptoms of carpal tunnel. The dominant hand is usually affected first and produces the most severe pain.
Various factors can contribute to carpal tunnel, including anatomy of your wrist, underlying conditions or disease, and possibly personal patterns of hand use.
The good news is that, for most people who develop carpal tunnel, proper treatment can very often relieve the tingling and numbness and restore wrist and hand function back to normal.
Carpal tunnel syndrome typically results from a number of factors that increase pressure on the median nerve and tendons in the carpal tunnel. Usually, genetic predisposition is a factor in the development of carpal tunnel, but there are a number of contributing factors:
A number of factors are associated with the development of carpal tunnel syndrome—while each factor does not cause carpal tunnel, there is increased risk of carpal tunnel associated with each. Among them:
The jury is still out whether extensive computer use and carpal tunnel have a connection—there is, as of yet, not enough quality and consistent evidence to state that this is a definitive risk factor.
Early diagnosis and treatment is key to avoiding permanent damage to the median nerve. The first step is likely a careful review of the history of your symptoms. Your doctor will ask about the pattern of your symptoms. For instance, the median nerve does not provide sensation to the pinky finger, so any symptoms in that finger likely indicate a problem other than carpal tunnel. You will also be asked about the timing of your symptoms, do you feel numbness or tingling at night, or when you grip the handlebar of your bike? This will help your doctor assess the genesis of your symptoms.
Next is a physical exam of the hands, wrists, arms, shoulders, and neck to see if the symptoms are indeed being caused by carpal tunnel or by some other condition that can mimic the effects of carpal tunnel, like thoracic outlet syndrome. Your doctor will look at your medical history, and will work to rule out other possible underlying causes. Your wrist will be looked at for:
Your doctor will likely perform a Tinel test—where he or she presses or taps the median nerve to see if they can cause tingling in the fingers. If tingling or shock-like sensations do occur, the test is considered to be positive. Another test—called the Phalen or wrist-flexion test—works by putting pressure on your median nerve to see if symptoms of carpal tunnel syndrome arise. This test is performed by having you hold your forearms upright—fingers pointing down—and with the backs of your hands pressed together. Carpal tunnel syndrome is suggested if one of more of the following symptoms occur within one minute:
Diagnosis of carpal tunnel syndrome is often confirmed via use of electro-diagnostic test, the most common used to confirm carpal tunnel are:
Other tests that may be used to confirm carpal tunnel include:
Magnetic resonance imaging or MRI is not useful in diagnosis of carpal tunnel syndrome, but scans can show the anatomy of the wrist, which may be useful to rule out other possible causes for the symptoms.
If carpal tunnel syndrome is confirmed, then you will likely be referred to a hand specialist or hand surgeon, or a neurologist that deals specifically with this type of condition.
The symptoms of carpal tunnel syndrome usually begin gradually, and tend to get worse with time.
Symptoms often manifest in one or both hands during the night, since so many people sleep with flexed wrists, a position that can aggravate the median nerve. A person with carpal tunnel may wake repeatedly throughout the night, feeling like they need to “shake out” their wrists or hands. As symptoms worsen, tingling and increased numbness may be felt throughout the day, and when carpal tunnel syndrome becomes more severe, decreased grip strength may make grasping small objects or even making a fist difficult. In chronic, untreated cases, there can be muscular atrophy and loss of sensation to the fingers.
The prognosis for carpal tunnel syndrome is very good—milder cases often respond to non-surgical care, like bracing, stretching, and steroid injections. More advanced cases of carpal tunnel syndrome can be treated very effectively with surgery.
If you have carpal tunnel syndrome, consider the following tips:
Screening for carpal tunnel syndrome is not regularly done, per se, if symptoms arise, then a physical examination with your doctor, along with possible confirmation via electrodiagnostic tests, and additional confirmation by imaging will be done to see if you have carpal tunnel syndrome.
While there are no proven ways to prevent carpal tunnel syndrome, there are ways to minimize stress on your hands and wrists. Here are some of the top precautions you can take:
Carpal tunnel syndrome should be treated as early as possible to help avoid long-term damage. If underlying causes are causing the carpal tunnel symptoms, they should be treated first.
Initial treatment typically involves:
The next step in treatment is to try non-surgical treatment for symptom alleviation.
Non-surgical treatments
Drugs – Certain medications can ease the pain, swelling, and discomfort associated with carpal tunnel syndrome.
Wrist splinting – A splint that holds your wrist still while you sleep can help relieve nighttime symptoms of tingling and numbness. Nocturnal splinting may be a good option if you’re pregnant and have carpal tunnel syndrome.
Exercise – Stretching and strengthening exercises can be helpful for those whose symptoms have abated. A physical or occupational therapist, who is trained to use exercises and therapeutic massage to treat physical impairments, can help show you how to do the exercises for maximum benefit.
Yoga – has been shown to reduce pain and improve grip strength among patients with carpal tunnel syndrome.
Surgery
Carpal tunnel release is one of the most common surgical procedures in the United States—every year, more than 500,000 people in the United States undergo surgeries for carpal tunnel syndrome. Studies show that 70 – 90% of patients who undergo surgery for carpal tunnel syndrome were free of nighttime pain afterward.
Surgery for carpal tunnel is generally recommended if symptoms persist for 6 months or more. The procedure involves cutting through the ligament that presses down on the carpal tunnel, essentially turning the carpal tunnel into the carpal trench. This reduces pressure on the median nerve. Surgery is done under local anesthesia and does not require an overnight hospital stay. Many patients require bilateral surgery on both hands. The following are types of carpal tunnel release surgery:
Open release surgery. This is the traditional surgical procedure used to correct carpal tunnel syndrome. It consists of making an incision up to 2 inches in the wrist, then cutting the carpal ligament to enlarge the carpal tunnel. The procedure is generally done under local anesthesia on an outpatient basis.
Endoscopic surgery. This is a newer sort of carpal tunnel syndrome surgery, and may allow faster functional recovery and less postoperative discomfort than traditional open release surgery. The surgeon makes two incisions (about ½ inch each)—one in the wrist and one in the palm. The surgeon then inserts a camera attached to a tube that allows him or her to observe the tissue on a screen, and to cut the carpal ligament in a precise manner. Endoscopic surgery, done under local anesthesia like open-release, is effective and minimizes scarring and scar tenderness. Patients report less pain with the endoscopic surgery—likely due to the incision not involving the palm, which is rich in nerve endings. Endoscopic surgery generally allows individuals to resume some normal activities in a short period of time. It may take longer to do the operation, however, and may be more expensive.
While carpal tunnel syndrome symptoms may be relieved immediately after surgery, however full recovery from the surgery may take months. During the healing process after the surgery, the ligament tissues gradually grow back together while allowing more room for the nerve than existed before.
All surgeries carry risks. Risk factors for carpal tunnel syndrome surgeries include infection, nerve damage, stiffness, and pain at the scar. Occasionally the wrist loses strength and other complications from surgery may arise. Patients should undergo physical therapy after surgery to restore wrist strength. Some patients may need to adjust job duties or even change jobs after recovery from surgery.
Recurrence of carpal tunnel syndrome following surgical treatment is rare—with the majority of those undergoing the procedure recovering completely.
These treatment modalities have been shown to be very effective for those that suffer from carpal tunnel syndrome:
A few simple things can help you get some temporary relief from carpal tunnel syndrome symptoms:
If numbness, tingling, or weakness persists, please see your doctor.
If you have persistent signs and symptoms that suggest carpal tunnel syndrome, especially if the symptoms interfere with your sleep and/or normal, please go see your doctor. Don’t leave the condition untreated—chronic untreated carpal tunnel syndrome can lead to permanent nerve and muscle damage.
For more information on carpal tunnel visit:
National Institute of Neurological Disorders and Stroke
American Chiropractic Association
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