Dr Dulcy on carpal tunnel syndrome
GRADUAL: NUMBNESS OR TINGLING IN THE HAND AND WRIST ARE SIGNS TO LOOK OUT FOR
Treat it as soon as possible and avoid putting further strain on hands and wrists.
Carpal tunnel syndrome is numbness, tingling, weakness and other problems in your hand because of pressure on the median nerve in your wrist. Proper treatment usually relieves the tingling and numbness and restores wrist and hand function.
The median nerve and several tendons run from your forearm to your hand through a small space in your wrist called the carpal tunnel. The median nerve is responsible for controlling movement and feeling in your thumb and first three fingers.
See your doctor if you have persistent signs and symptoms suggestive of carpal tunnel syndrome that interfere with your normal activities and sleep patterns. Per- manent nerve and muscle damage can occur without treatment. Pressure on the median nerve causes carpal tunnel syndrome. This pressure can come from swelling or anything that makes the carpal tunnel smaller. Many things can cause this swelling, including:
Illnesses such as hypothyroidism, rheumatoid arthritis, and diabetes.
Making the same hand movements over and over, especially if the wrist is bent down (your hands lower than your wrists), or making the same wrist movements over and over. Pregnancy. A wrist fracture can narrow the carpal tunnel and irritate the nerve, as can the swelling and inflammation resulting from any joint abnormalities.
RISK FACTORS
These include:
Anatomic factors. A wrist fracture or dislocation, or arthritis that deforms the small bones in the wrist
People with smaller carpal tunnels may be more likely to have carpal tunnel syndrome. Gender. Carpal tunnel syndrome is generally more common in women. This may be because the carpal tunnel area is relatively smaller in women than in men. Nerve-damaging conditions. Some chronic illnesses, such as diabetes, increase your risk of nerve damage, including damage to your median nerve.
Inflammatory conditions. Illnesses that are characterised by inflammation, such as rheumatoid arthritis, can affect the lining around the tendons in your wrist and put pressure on your median nerve.
Obesity. Being obese is a significant risk factor for carpal tunnel syndrome.
Alterations in the balance of body fluids. Fluid retention may increase the pressure within your carpal tunnel, irritating the median nerve.
Other medical conditions. Certain conditions, such as menopause, obesity, thyroid disorders and kidney failure, may increase your chances of carpal tunnel syndrome.
Workplace factors. It’s possible that working with vibrating tools or on an assembly line that requires prolonged or repetitive flexing of the wrist may create harmful pressure on the median nerve or worsen existing nerve damage.
SYMPTOMS
Carpal tunnel syndrome symptoms usually start gradually. The first symptoms often include numbness or tingling in your thumb, index and middle fingers. Carpal tunnel syndrome may also cause discomfort in your wrist and the palm of your hand. Common symptoms include:
Tingling or numbness. You may have tingling and numbness in your fingers or hand. Sometimes there is a sensation like an electric shock in the fingers.
The sensation may travel from your wrist up your arm. These symptoms often occur while holding an object. The sensation may wake you from sleep.
Many people “shake out” their hands to try to relieve their symptoms. The numb feeling may become constant over time.
Weakness. You may experience weakness in your hand and drop objects. This may be due to the numbness or weakness of the thumb’s pinching muscles, which are also controlled by the median nerve.
DIAGNOSIS
Diagnosis is made by conducting: History taking and examination.
Symptoms usually occur while holding an object or waking up during the night.
The examination tests the feeling in your fingers and the strength of the muscles in your hand.
Bending the wrist, tapping on the nerve or simply pressing on the nerve can trigger symptoms in many people.
X-ray. Some doctors recommend an X-ray of the affected wrist to exclude other causes of wrist pain, such as arthritis or a fracture.
Electromyogram. This test measures the tiny electrical discharges produced in muscles. This test can identify muscle damage and also may rule out other conditions.
Nerve conduction study. A small shock is passed through the median nerve to see if electrical impulses are slowed in the carpal tunnel.
TREATMENT
Treat carpal tunnel syndrome as early as possible after symptoms start.
Take more frequent breaks to rest your hands. Avoiding activities that worsen symptoms and applying cold packs to reduce swelling also may help. Other treatment options in-
clude wrist splinting, medications and surgery. Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs may help relieve pain from carpal tunnel syndrome in the short term. However, they are not proven to improve carpal tunnel syndrome.
Corticosteroids. Corticosteroids decrease inflammation and swelling, which relieves pressure on the median nerve. Oral corticosteroids aren’t considered as effective as corticosteroid injections for treating carpal tunnel syndrome.
If carpal tunnel syndrome is caused by rheumatoid arthritis or another inflammatory arthritis, then treating the arthritis may reduce symptoms of carpal tunnel syndrome. Surgery. Surgery may be appropriate if your symptoms are severe or don’t respond to other treatments. The goal of carpal tunnel surgery is to relieve pressure by cutting the ligament pressing on the median nerve.
LIFESTYLE AND HOME REMEDIES
These steps may provide temporary symptom relief. If pain, numbness or weakness recurs and persists, see your doctor: Take short breaks from repetitive activities involving the use of your hands. Lose weight if you are overweight or obese. Rotate your wrists and stretch your palms and fingers. Wear a snug, not tight, wrist splint at night. You can find these over-the-counter at most pharmacies. Avoid sleeping on your hands. Integrate alternative therapies into your treatment plan to help you cope with carpal tunnel syndrome. You may have to experiment to find a treatment that works for you. Always check with your doctor before trying any complementary or alternative treatment.
Yoga. Yoga postures designed for strengthening, stretching and balancing the upper body and joints may help reduce pain and improve grip strength.
Physiotherapy and Occupational therapy. The therapy techniques may reduce symptoms of carpal tunnel syndrome.
Ultrasound therapy. High-intensity ultrasound can be used to raise the temperature of a targeted area of body tissue to reduce pain and promote healing. Research shows inconsistent results with this therapy, but a course of ultrasound therapy over several weeks may help reduce symptoms.