A tunnel in your wrist
Carpal tunnel syndrome is caused by compression of the median nerve that runs through the wrist, leading to a host of symptoms that affect the hand.
IMAGINE someone gripping your wrist, hard. After about 30 seconds, your palm will start feeling numb. About a minute later, a painful tingling sensation creeps up your fingers.
Now imagine having to live with such pain on a daily basis. Unpleasant, no?
This is what many sufferers of carpal tunnel syndrome have to go through daily.
Carpal tunnel syndrome is a term used to describe compression of the median nerve within the carpal tunnel.
The carpal tunnel is a space within the wrist “created” by the ligament that runs across the front of the wrist and the bones (carpal bones) of the wrist, hence the term carpal tunnel.
Within this tunnel lie the tendons of the forearm muscles (these attach the aforesaid muscles to the fingers) as well as the main nerve to the hand, the median nerve.
Compression of the median nerve affects movement as well as sensation in parts of the hand.
Finding a cause
The condition is often associated with pregnancy, the menopause, obesity, an underactive thyroid, diabetes, and even certain drugs. It is speculated that the water retention (oedema) that occurs in some of these conditions may affect the wrist and lead to the syndrome.
In many cases of carpal tunnel syndrome, no cause can be ascertained. Some have theorised that changes in the tendons or other structures in the tunnel could lead to the condition.
It has been observed that the condition more commonly afflicts those who move their wrists a lot. Hence, activities that may increase the risk of carpal tunnel syndrome include typing (those who spend lots of time on the computer are probably most at risk), playing certain musical instruments, using hand tools that vibrate, and so on.
It has been speculated that genes may play a role, as it has been observed that approximately one in four sufferers have a family member who has or have had the condition.
Rheumatoid arthritis of the hands and wrist as well as wrist fractures may also lead to the syndrome.
It is estimated that about one in 1,000 people develops this syndrome each year. Most cases occur in people who are in their 40s and 50s, but it can occur at any age. Women are affected up to five times more frequently than men.
Signs and symptoms
There are a few tell tale signs of carpal tunnel syndrome. These include:
Tingling and numbness (pins and needles) in the digits supplied by the median nerve (thumb, index and middle fingers). Pain in the same fingers may then develop.
The numbness and tingling may also affect the palm of the hand.
Sometimes, the pain can extend to the elbow.
Sometimes, poblems with fine finger movements can occur. A common complaint is a weak grip. Dryness of the skin may develop in the same fingers.
Muscle atrophy (wasting of the muscles) is seen in late cases.
Diagnosing carpal tunnel syndrome
Usually, careful clinical examination is adequate. Tapping over the median nerve at the wrist may cause pain to shoot from the wrist to the hand (this is called Tinel’s sign). Another tell tale sign is when bending the wrist forward all the way for 60 seconds. Numbness, tingling, or weakness will ensue (this is called Phalen’s test).
Electrodiagnostic studies may be required in doubtful cases, or in instances where there is simultaneous compression of the nerve in other areas.
Sometimes, an x-ray may be required to rule out bony conditions that may have precipitated the problem.
As there are many conditions that may initiate the symptoms of carpal tunnel syndrome, such as malaligned fracture at the wrist, swelling due to infection or injury, tumours, these may have to be ruled out.
Systemic conditions like obesity, diabetes mellitus and thyroid dysfunction are sometimes associated with this condition, hence they need to be taken into consideration.
Treating the condition
In mild cases, conservative treatment with splinting may afford relief. Try the splint at night for several weeks. If this doesn’t help, wear it during the day also. Hot and cold compresses may also help.
Painkillers such as the non-steroidal antiinflammatory drugs (NSAIDs) like ibuprofen or naproxen might help.
Other medications that can be used are corticosteroid injections, given into the carpal tunnel area. This may relieve symptoms for a while.
If there is no muscle atrophy, and symptoms are not worsening, a repeat of two to three injections is reasonable.
For those with severe, prolonged symptoms or with muscle atrophy, surgery is indicated. The procedure involves cuting into the ligament that is pressing on the median nerve. Depending on how long the nerve compression has been occurring and its severity, such surgery is successful most of the time. Full healing usually takes a few months.
It is important to seek help early. Remember that early and accurate diagnosis makes conservative treatment effective.
When symptoms are severe or muscle atrophy has set in, surgery offers the best chance for recovery.
It is also a good idea to make changes in your work or recreational activities. For example, if you’re spending lots of time in front of the computer, the use of special devices such as keyboards, different types of computer mouse, and cushioned mouse pads is recommended.
You should not ignore the condition. If left untreated, the median nerve can be damaged, causing permanent weakness, numbness, and tingling.
For more information, visit www. quillorthopaedic.com.