Carpal Tunnel Syndrome (CTS) is caused by the nerves at the wrist being squeezed. The median nerve in the wrist can become swollen or irritated after repeated motions. Some of these motions include typing, holding a phone, texting, playing an instrument, etc. It can affect many people with jobs that require repetitive motions.
Bones, tendons, and ligaments around the median nerve make up the carpal tunnel. Carpal Tunnel Syndrome can lead to numbness, pain, or weakness is the thumb, index, ring, and middle finger. These are the locations that the median nerve brings sensations to.
SYMPTOMS
- Pain at the hand and wrist
- Burning sensations in middle and index fingers
- Thumb and finger numbness
- Electric shock feeling that goes through the wrist and the hands
These symptoms can become worse when the wrist is bent in a particular way, typically forward. The symptoms may also be worse at night. Pain may be felt when doing daily activities.
COMMON CAUSES
Pregnancy, diabetes, injured wrist bones, thyroid problems, menopause, or obesity can put one at a higher risk of developing CTS. Repetitive movements of the wrist will also increase risk of developing this condition. These repetitive motions that irritate the membranes around the tendons in the carpal tunnel can increase the pressure on the median nerve. This can cause issues in sensation from the hand up to the arm and to the CNS.
DIAGNOSIS
Seeking medical assistance is important when symptoms of CTS appear. A physician can evaluate a patient's condition and find a good course of treatment. The patient will need to have an examination where strength, sensation, and reflexes are testing.
X-rays and an Electromyogram and Nerve Conduction Study test may be helpful to diagnose CTS.
If nonsurgical treatment does not help, surgery could possibly be an option.
NONSURGICAL TREATMENTS
The goal of treatment is to stop the injury towards the median nerve. This can be treated in multiple ways. Immobilizing the wrist with a splint can help decrease the pressure put on the medial nerve. Anti-inflammatory medications, icing, or injections are other treatment options. Physical therapy may be helpful as well as rest to the wrist. It is important to look for ways to change to stop aggravating the wrist. Some symptoms may improve if the patient maintains a healthy weight and manages other medical disorders. Nonsurgical treatment could be done for one to two months.
SURGICAL TREATMENTS
Few CTS patients will need surgery. A patient may get surgery if nonsurgical treatments options do not work and if neurological symptoms are ongoing. To relieve pressure on the medial nerve can be done through a carpal tunnel release. This surgery can be done with an open incision or endoscopic techniques.
The open incision operation starts with the surgeon opening up the wrist and cutting the ligament at the bottom of the wrist. This will relieve pressure on the medial nerve. The endoscopic operation has a smaller incision and uses a camera to help view the carpal tunnel. The endoscopic surgery has a quicker recovery period but also may lead to an increased risk of damaging a nerve.
SURGERY RECOVERY
After the surgery, a dressing will be put on the patient's hand. The patient might need help to perform daily activities while the hand heals from surgery. Avoid getting the hand wet for a proper recovery. The stitches from surgery will be removed around two weeks later. Try not to have repetitive use of the injured hand and do not hyperextend the wrist for one month post surgery. The pain and numbness should improve shortly after the surgery is done. The area at the site of incision may be numb for multiple months after surgery. Most patients have a complete recovery.
After surgery, the symptoms of Carpal Tunnel Syndrome are not likely to appear again. The symptoms only appear in 5% of patients again. Lifestyle changes should be made to avoid aggravating the wrist again.
