Carpal tunnel syndrome is a common condition that causes a collection of symptoms, such as pain, paralysis, and tingling in the affected hand and arm. It occurs when the median nerve, one of the major nerves that supply the hand and arm and runs through the carpal tunnel, gets trapped and is squeezed. The carpal tunnel is a small, inflexible way of ligament and bones at the base of the hand.
Carpal tunnel syndrome commonly happens in people in their late 50s, especially women and in both men and women in their late 70s. It is also more frequent in people who are overweight and in pregnant women.
Causes and Risk Factors of Carpal Tunnel Syndrome
In most instances, the cause of carpal tunnel syndrome is unknown. Various factors and medical conditions are identified to be linked with carpal tunnel syndrome directly or indirectly. A combination of factors that increase irritation and pressure on the medical nerve are given below:
- Genetic factor: one of the most important risk factors. Studies have shown 1 in 4 people with carpal tunnel syndrome have an affected close family member.
- Sex: Women have comparatively small carpal tunnel hence carpal tunnel syndrome is more prevalent in women.
- Trauma or injury to wrist: trauma causes swelling of the muscle of the wrist which can squeeze the median nerve causing carpal tunnel syndrome.
- Repetitive hand use: overuse and repeating the same hand and wrist movements for a long period damages the tendons in the wrist which causes inflammation and pressure on the medicine nerve.
- Nerve-damaging conditions: Chronic medical diseases, such as diabetes, can have harmful effects on nerves, including the medical nerve.
- Inflammatory disorders of bone: In rheumatoid arthritis and other inflammatory conditions, there is inflammation of the tendons of the wrist and squeezes the median nerve.
- Workplace factors: works that involve repeated usage of the wrist or vibrating tools are responsible for increasing stress on the median nerve which results in damage to it.
- Other medical conditions: menopause, kidney failure, and seldom menopause can increase the risk for developing carpal tunnel syndrome.
Signs and Symptoms of Carpal Tunnel Syndrome
In the majority of cases, the symptoms start slowly and come and go, normally after using the hand. Mostly, symptoms are worse at night. Symptoms occur from time to time or remain all time, as the condition gets severe.
The typical symptoms, people with carpal tunnel syndrome may exhibit are as follows:
- Hand and wrist pain.
- Feeling of insensitivity, tingling, during and pain in the thumb and index, middle, and ring fingers.
- Shock-like feelings running through the thumb and index, middle, and ring fingers.
- Finding it difficult to perform fine movements such as buttoning clothes, tying shoelaces due to the weakness and clumsiness of the hand.
- Poor grip due to long-term weakness of muscles of the fingers and/or thumb.
Sometimes, these symptoms go away when raising the hand or hanging it down, or shaking the hand. Tapping the wrist may also provide some relief.
Diagnosing Carpal Tunnel Syndrome
People usually see their doctors when the symptoms begin to interfere with their normal daily activities, work, and sleep habits. Doctors can diagnose this condition after taking a complete medical history and doing complete physical check-ups.
A thorough physical examination of the hands, arms, shoulders, and neck can assist to rule out other conditions that resemble carpal tunnel syndrome. The wrist, in particular, is checked for tenderness, swelling, hotness, and discoloration. All the fingers are tested for sensation and signs of wasting.
Routine laboratory tests and X-rays are done to rule out other causes of wrist pain, such as arthritis or a broken bone, nerve-damaging condition like diabetes.
Electrophysiological tests help to measure how well the median nerve is working and if there is too much pressure on the nerve. It can also exclude other nerve conditions which is the reason for the symptoms. Tests include:
- Nerve conduction tests: it involves applying wires on the hand and wrist. The speed of the nerve impulse through the carpal tunnel is noted after little electrical shocks are passed through the median nerve.
- Electromyogram (EMG): It requires a thin-needle electrode to be inserted inside specific muscles. It measures the electrical discharges that originated in muscles and assesses damage in the muscles supplied by the median nerve.
Treatment of Carpal Tunnel Syndrome
Though carpal tunnel syndrome is a gradual process, it becomes severe over time and may hinder everyday activities. Hence, early evaluation and treatment are very important to prevent permanent damage to the median nerve. In up to 25% of cases, there is no need for treatment especially in people less than 30 years of age.
Treatment of carpal tunnel syndrome usually starts by treating existing medical causes such as diabetes or arthritis. For mild to moderate cases, a trial of conservative or nonsurgical treatment is tried. It usually takes two to six weeks to benefit from conservative therapy.
Nonsurgical treatment:
- Using a wrist brace or splint.
- Taking pain-killers like ibuprofen and naproxen helps to decrease inflammation and pain.
- Avoiding or changing the activities that aggravate the symptoms, or taking short breaks.
- Nerve gliding workouts are simple hand and finger movements that ease the median nerve to move easily.
- Steroids such as corticosteroid, or cortisone, are injected, usually ultrasound-guided, by the doctor into a carpal tunnel which reduces inflammation and swelling, which releases the trapped median nerve. These are very effective treatments for carpal tunnel syndrome and can delay the necessity of surgery.
Surgical treatment:
Surgical treatments are reserved for those who do not get better with above mentioned conservative therapies and if the symptoms are more severe and if there is wasting of thumb muscles.
The surgery commonly known as carpal tunnel release is done. The aim is to release the pressure created on the median nerve by cutting the top of the carpal tunnel. It is an outpatient procedure and done under local anesthesia, which simply dulls your hand and arm, in most patients. Sometimes, it is done under general anesthesia, which puts you to sleep. Patients are allowed to go home on the same day if there are no major complications.
Some of the common complications that can arise are bleeding, contamination, or nerve damage. The recovery after the surgery usually takes 2 to 3 months and may take up to 1 year for a full recovery. Recurrence following treatment is rare.
Ongoing Clinical Trials for Carpal Tunnel Syndrome
Lots of research has been done in the past in the field of carpal tunnel syndrome to know the exact cause of it or the best treatment for it. There are still many clinical trials that are ongoing and recruiting patients for their studies.
Some studies are comparing the existing treatments of carpal tunnel syndrome. Some are checking the effectiveness of corticosteroid injection. Few are assessing the functional capacity of the patients after undergoing surgery. While few of the studies are focused on newer treatment modalities of carpal tunnel syndrome.
One of the studies currently ongoing and recruiting is about a new treatment, Theraworx foam, a magnesium sulfate superficial lotion, which is applied on the skin for symptomatic relief of muscle cramps and spasms.
Another interesting study that is currently going on is the efficacy of a high voltage pulse current in the non-invasive treatment of carpal tunnel syndrome using a device named Avazzia Pro-Sport Ultra device. It will compare this device’s efficacy with conventional electrical stimulation devices, Sham Comparator.
Local effects of acupuncture and nerve conduction studies are ongoing which measure the local effects of manual acupuncture, low-frequency electroacupuncture, and high-frequency electroacupuncture on the median and ulnar nerves in patients with carpal tunnel syndrome, using nerve conduction investigations and quantitative sensory testing.
People who have carpal tunnel syndrome or have a suspicion of having carpal tunnel syndrome should consult doctors. Doctors can help them get proper and working treatment. If they are interested in participating in clinical trials, the doctors might also find one for them.
References:
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Carpal tunnel syndrome. American Academy of Orthopaedic Surgeons.
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Carpal tunnel syndrome fact sheet. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Carpal-Tunnel-Syndrome-Fact-Sheet.
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American Academy of Orthopaedic Surgeons. Management of Carpal Tunnel Syndrome Evidence-Based Clinical Practice Guideline. https/
www.aaos.org/ctsguideline.
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Carpal Tunnel Syndrome: American Association of Neurological Surgeons
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Carpal Tunnel Syndrome: Diagnosis and Management. American Family Physician
