Carpal Tunnel Syndrome
What is carpal tunnel syndrome?
This is a condition of the hand affecting the nervous supply of the wrist. It comes about as a result of the median nerve getting squeezed or pinched before it supplies the palm. This affects sensation and wrist movements and may progressively get painful with time. It is the commonest cause of hand neuropathy and has to be ruled out wherever a patient comes with numbness and pain of the hand.
Symptoms start gradually and are progressive in nature. Early symptoms are mild and may be ignored for sometimes. Tingling and numbness in the thumb could be the first symptoms. The index and middle fingers may also be affected at this stage. Hand and wrist discomfort is also common. Other symptoms of carpal tunnel syndrome include:
- Itchiness on the palm and especially on the thumb
- Swollen hand and finger sensation although there is no visible swelling.
- Numbness and tingling that is worse when constantly grasping an object.
- Little finger spared from the symptoms affecting the rest of the palm
- Hand weakness with a tendency to drop objects.
- Muscle wasting.
- Inability to differentiate temperature status of an object.
- Can affect one or both hands.
Causes and risk factors
Carpal tunnel syndrome is caused by the compression of the median nerve as it enters the wrist from the forearm. This compression may be due to a number of factors but sometimes the exact cause cannot be pinpointed. However, there are risk factors that have been identified to increase chances of getting this condition. Some of these include:
- Gender. Women are up to three times more likely to get the problem than men
- Diabetic patients
- People suffering from other metabolic disorders like hypothyroidism
- Rheumatoid arthritis patients
- Trauma and fractures of the wrist
- Those working in repetitive work situations like assembly and packing lines.
- People with anatomically small carpal tunnel
- Edema conditions as seen in pregnancy, menopause or in various disease conditions
- Extensive use of the computer (but this point is controversial)
A detailed history of the illness and a comprehensive physical examination of the patient will very likely make the diagnosis of carpal tunnel syndrome obvious. Physical examination includes tests like the Tinel test and the Phalen (wrist flexion) test. Diagnostic tests include:
- Wrist X-ray to rule out other wrist conditions or injuries.
- Electromyography to test wrist muscles’ integrity
- Nerve conduction tests
- Ultrasound imaging
- Magnetic Resonance Imaging – MRI
Management of carpal tunnel syndrome
The outcome is best if treatment is started as early as possible. The treatment can be surgical or non-surgical. The surgery can be open or endoscopic in nature. Non-surgical measures include:
- Splinting the wrist
- Use of common non-steroidal anti-inflammatory drugs – NSAIDs
- Use of corticosteroids
Physiotherapy plays an important role during active management of this condition and also in the prevention stage. A physiotherapist can train those at risk on the type of exercises to perform either at hope or at their place of work. Physiotherapy measures include:
- Stretching exercises
- Use of corrective splints
- Heat or ice therapy
- Hand therapy techniques
- Ultra-sound treatment
- Mobilization of the carpal bone
- Gliding exercises for tendon and nerves
- Looking for sources of possible referred pain
Carpal tunnel syndrome can be a disabling condition if left untreated but if diagnosed early, physiotherapy can correct the condition before it gets worse.