Carpal Tunnel Syndrome describes compression of the median nerve in the palmar part of the wrist, causing pain, numbness, and impaired movement in the palm.
Carpal Tunnel Syndrome and Anatomy
Anatomy plays a vital role in the occurrence of this syndrome where our wrist has two sides, one side of the palm and one side of the back of the hand; the bones of the wrist are aligned on the dorsal side, and above them are the muscle tendons that move the fingers of the hand and make them form a fist.
The median nerve passes between these tendons, and all the previous structures from the side of the palm are covered by the transverse carpal ligament, and the bones of the wrist with the transverse carpal ligament form what is called the Carpal Tunnel in which the median nerve and tendons pass.
The pathogenetic mechanism of carpal tunnel syndrome occurs when the median nerve passes through the tunnel and is compressed, which reduces its blood supply and therefore disturbs sensory and motor nerve functions.
Causes of carpal tunnel syndrome
Many factors predispose and form a cause for the occurrence of carpal tunnel syndrome, which often leads to the thickening of the transverse ligament in the tunnel and, thus, pressure on the nerve as it passes through it, including:
- Constant and frequent use of the wrist (as in the many household chores of some housewives or some trades and professions that require more movement of the wrists, such as playing some instruments)
- Some work in which the wrist is kept firmly bent, whether towards the palm or the back of the hand (such as reading books or carrying some objects for long periods and frequently)
- Heredity: Some people have a naturally small carpal tunnel and are more likely to develop carpal tunnel syndrome
- Pregnancy: Pregnancy increases the incidence of carpal tunnel syndrome due to hormonal changes in pregnant women
- Obesity and rapid weight gain are predisposing factors for carpal tunnel syndrome
- Wrist diseases and injuries: such as osteoarthritis, rheumatoid arthritis, a wound, fracture, or inflammation in the wrist
- Some systemic diseases and hormone changes include thyroid disorders, female menopause and diabetes.
Symptoms of carpal tunnel syndrome
The patient with Carpal Tunnel Syndrome (CTS) suffers from a group of symptoms ranging in severity according to the patient's condition and stage of the disease.
- Pain, burning, tingling and numbness In the palm and the fingers (thumb, forefinger, middle finger, and half of the ring finger on the middle finger side), the pinky (the smallest finger), and half of the ring finger on the pinky side are unaffected.
- The sensation of pulsations and electric shocks in the fingers above, or a feeling of swelling of the fingers
- Pain radiating from the hand to the arm and shoulder
- Weakness in the movement of the fingers, especially the thumb, which leads to difficulty grasping objects or forming a solid grip and dropping things held by the hand
- Night pain that awakens the patient at night and interrupts his sleep (because the sleeper bends his wrist during sleep, which leads to increased compression of the median nerve in the carpal tunnel)
Diagnosis of carpal tunnel syndrome
Diagnosis of Carpal Tunnel Syndrome (CTS) is based on the clinical history, the patient's symptoms, the signs that the doctor detects during the examination, and the results of the tests ordered.
Signs include numbness (tingling) when the doctor presses on the median nerve or when holding the wrist and bending it for some time. Also, muscle atrophy at the base of the thumb guides the diagnosis.
Carpal tunnel syndrome diagnostic tests
The results of these tests and radiographs play an essential role in confirming the diagnosis of the syndrome, and they are:
- Electrophysiological test: The electrical activity along the nerve is known through this test. It helps us determine the severity and location of its compression and may indicate pathological conditions associated with carpal tunnel syndrome.
- Echography: We may use an echocardiogram to notice signs of nerve compression.
- X-rays: They are used to rule out other diseases that cause wrist pain, such as fractures in the wrist bones or arthritis.
- Magnetic resonance: It gives a clearer picture of tissues, and we resort to it in case of difficulty in diagnosis or to detect other accompanying diseases.
Carpal tunnel syndrome treatment
Since the symptoms of Carpal Tunnel Syndrome (CTS) are gradual in severity, the treatment of the disease will depend on the progression of the condition, and the treatment is as follows:
Self-treatment of carpal tunnel syndrome
When symptoms first start in the median nerve syndrome (Carpal Tunnel Syndrome), some tips may help reduce its severity and may sometimes heal (it sometimes heals alone if pregnancy is the cause of the syndrome). These tips are:
- Wearing a splint or corset on the wrist to stabilize it and prevent its movement, especially during sleep. This procedure is recommended for a month until results appear.
- Changing habits and actions that require a lot of movement of the hands and it may come to changing the profession
- Rest the hand of carpal tunnel syndrome as much as possible and do not rely on it to carry out work
- Take pain relievers and non-steroidal anti-inflammatory drugs such as Paracetamol and ibuprofen
- Do some exercises that help release the median nerve and relieve the pain caused by its compression
Suppose the above did not help and the symptoms of the syndrome persist. In that case, you should go to your doctor immediately to avoid severe consequences and complications resulting from delaying treatment.
Non-Surgical Treatment in Carpal Tunnel Syndrome
Your doctor will use some of the treatments that may be successful in treating carpal tunnel syndrome without surgery, including:
A local anesthetic or cortisone injection to relieve pain, and this procedure depends on the severity of the median nerve compression and the severity of the patient's symptoms.
But if carpal tunnel syndrome is in its late stages, the injection may not last for more than several days, and the patient at this stage may need immediate surgery.
Surgical Treatment in Carpal Tunnel Syndrome
We resort to surgical treatment in carpal tunnel syndrome if non-surgical treatment is not benefited from and the course of the disease worsens, or surgery may be recommended early so that the condition does not develop because the final stages of the syndrome are not reversible and do not cure with treatment whatsoever.
However, even in the worst stages of the disease and with the complete lack of treatment benefits, it remains of great help. It must be performed, and a surgical operation at this stage of the disease because the lack of treatment leads to worse results.
The surgical treatment of carpal tunnel syndrome is divided into two types of procedures that differ in technique and share the same goal (decompression of the median nerve in the wrist):
Open surgery in carpal tunnel syndrome: Here, we make a small surgical incision in hand to expose the transverse carpal ligament and the median nerve beneath it. We cut this ligament while keeping the two ends of the cut in the ligament close. We close the hand-wound, and the operation ends (it takes about 20 minutes, and there is no need to stay and sleep in a hospital)
The purpose of the cut is to relieve pressure on the nerve, and the goal is to keep the two ends close for this cut to heal, but without putting pressure on the nerve.
Endoscopic treatment of carpal tunnel syndrome: Here, the surgeon makes two small holes in the hand, one for inserting the small camera with light and the second for inserting a small scalpel. Then the surgeon cuts the ligament that causes pressure on the median nerve, thus removing the cause of Carpal Tunnel Syndrome (CTS).
That is, we expect the numbness and pain in hand to improve immediately after the operation (and this will happen in most patients with carpal tunnel syndrome), but if the patient has symptoms of carpal tunnel syndrome for a long time, he will need months to feel the success of the surgery and this period may even reach the year.
This depends on the severity of the disease. Some patients regain their grip strength, and the numbness of the hand goes away immediately after the surgery. Some patients take two or three months, and some a year.
Postoperative recovery in carpal tunnel syndrome
After treatment of Carpal Tunnel Syndrome (CTS), a surgical procedure that releases the median nerve from pressure will cause some pain and swelling, so your surgeon will recommend elevating the hand above the level of the heart to reduce swelling, give you pain relievers, and place a splint or brace to stabilize the wrist.
After a few days, the doctor will encourage you to move your hand to prevent it from stiffening and atrophy. The pain and symptoms that cause you to wake up at night will be gone immediately after the surgery. The carpal tunnel syndrome operation will leave a scar at the site of the wound that will gradually disappear after several months.
Some complications may occur from hand surgery in the treatment of carpal tunnel syndrome, like any other operation, and these complications require a visit to the surgeon immediately, and they are:
- Nerve damage in surgery
- Pain (which is not relieved by the painkillers prescribed by the doctor, so you should review him so that he can prescribe more potent painkillers or see the reason behind this pain)
- Infection (redness, heat, and swelling are seen)
- Poor wound closure and surgical site scar
- Undesirable healing of the transverse ligament and re-compression of the median nerve in the wrist (and here, we will have to repeat the operation for carpal tunnel syndrome)
If you experience symptoms of this syndrome and want medical advice Do not hesitate to contact us.
You know that you have carpal tunnel syndrome by the symptoms that indicate compression of the median nerve in the wrist, which are numbness and pain in hand, tingling in your fingers, and poor ability to form a grip and grasp objects firmly.
If appropriate treatment is received at the onset of the disease, carpal tunnel syndrome can be cured, and sometimes recovery occurs immediately after surgery.
Carpal tunnel syndrome is not considered dangerous or life-threatening, but the pain caused by it and the weakness of the hand due to the compression of the nerve limits the person's ability to carry out his daily tasks and delaying treatment leads to bad results, as the strength of the grip may not return to what it was.