Carpal tunnel syndrome

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at March 10, 2016
StartDiseasesCarpal tunnel syndrome

Carpal tunnel syndrome is characterized by numbness, tingling, and other issues in the hand. The carpal tunnel is a space in the wrist where several tendons run along with the median nerve. This nerve controls the thumb and first three fingers, but not the last finger. The symptoms associated with carpal tunnel syndrome are a result of pressure on that nerve.

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Definition & Facts

The carpal tunnel can be found on the palm side of the wrist, and it protects the ligaments responsible for bending the fingers, as well as the median nerve. This nerve communicates feeling and movement, making it vital for dexterity. Carpal tunnel syndrome results from physical compression of the median nerve, and it generally leads to tingling, weakness, joint pain, and other uncomfortable symptoms.

Many things might contribute to the development of the condition, like repetitive motion, wrist anatomy, and even pre-existing health issues. Thankfully, carpal tunnel syndrome can be treated, and full hand function can easily be restored with proper care.

Symptoms & Complaints

Since the effects of carpal tunnel syndrome are limited to the area of the hand above the wrist, and only to the thumb and first three fingers, it is generally easy to categorize the condition by discomfort in that area. It may start with a tingling sensation that builds to persistent numbness. Several of the most common symptoms for carpal tunnel syndrome include:

  • Tingling
  • Numbness
  • Joint pain
  • Weakness
  • Lack of dexterity
  • Muscle atrophy

Many people who suffer from carpal tunnel syndrome find that they can't perform the same simple tasks that they once could, like typing, writing, or anything that requires fine control of the digits. This condition is one of the most common reasons for employees to be absent from work, especially when that work involves tedious repetitive motion.

Causes

Anything that creates extraneous pressure on the wrist, and therefore the median nerve, can lead to carpal tunnel syndrome. Anything that causes general swelling in the body can lead to this condition, including diabetes, arthritis, and pregnancy. Women tend to experience the condition more often than men, but there is no certain reason why. It has been posited that the smaller carpal tunnel in a woman's wrist provides less margin of error.

Small, repetitive motions also lead to the development of carpal tunnel syndrome, especially those that have the wrist bend downward. Typing is one of the most commonly associated causes, but studies have shown there is no direct link between long-term typing and the development of the condition.

However, other forms of hand pain can develop as a result of excessive typing, and those pains are commonly misdiagnosed as carpal tunnel syndrome. Nearly any work that involves fine movement of the hands in a repeating pattern can cause carpal tunnel syndrome.

Extreme vibrations are thought to exacerbate the symptoms of carpal tunnel syndrome as well, like those one might experience working with power tools or heavy machinery. Assembly line work that doesn't necessarily require fine control, but is still overly repetitive, can also lead to the condition.

Diagnosis & Tests

One of the first things a doctor looks for in a diagnosis of carpal tunnel syndrome is symptom history. How the symptoms present, and where, can lead toward the possible conclusion that the condition is present. There are more certain tests that might be performed to confirm the presence of the condition, and they include:

  • Physical examination - A doctor can test for feeling and strength in the hand, and by touching or pressing on the area where the median nerve passes through the carpal tunnel, the doctor can usually trigger a symptom of pain or discomfort if the condition is present.
  • Electromyography - This simple test works by measuring the electrical activity in certain muscle groups within the hand. By looking for inconsistencies with the standard values, doctors can pinpoint the source of the problem.
  • X-ray - Other potential causes can be excluded by use of an X-ray, which rules out structural damage or arthritis. The test won't actually prove the existence of carpal tunnel syndrome, but it is a simple way to narrow down the possibilities.
  • Nerve conduction study - Similar to the electromyogram, this test uses electrical impulses sent through the median nerve to search for delays or other problems with the signaling.

Treatment & Therapy

Several treatment options are available depending on the severity of the condition. Most mild instances of the condition can be repaired with simple physical therapy and a change of the activities that may have lead to the development of symptoms. Wearing a wrist splint is helpful for some, and other therapies include range-of-motion stretches, ultrasound therapies, and general non-repetitive exercise.

Certain medications are recommended to help abate the symptoms, like nonsteroidal anti-inflammatory drugs (also known as NSAIDs). The most common NSAIDs are ibuprofen and naproxen, both of which can be purchased over the counter. More severe occurrences of the condition might require corticosteroid treatment, either through oral administration or direct injection.

In rare cases, surgery is recommended for those who haven't responded to the other, less invasive treatments. Surgery usually can't be avoided if there is existing nerve damage caused by the most severe cases of carpal tunnel syndrome.

Prevention & Prophylaxis

There are many ways to fight the development of this condition. A more relaxed standard grip can help create less overall pressure on the wrist, and taking frequent breaks stops the accumulation of pressure.

Posture is another often overlooked factor, since bad posture can lead to poor form when using the hands. It is recommended that those who work in a repetitive manner should keep their hands warm at all times, because warm hands are much less likely to become stiff or painful.