Carpal Tunnel Syndrome Causes Symptoms and Treatment

Carpal tunnel syndrome is compression of the median nerve of the wrist causing pain, paresthesia, numbness, and other symptoms in the distribution of the median nerve. It is the compression of the median nerve traveling through the carpal tunnel. The median nerve of the wrist supplies with feeling and movement of the palm, thumb, index finger, middle finger, and thumb side of the ring finger of the hand. The carpal tunnel is an anatomical compartment located at the base of the wrist. It is a tight and narrow space between the fibrous band of the wrist and the wrist bone. Nine flexor tendons and the median nerve pass through the carpal tunnel that is surrounded on three sides by the carpal bones that form an arch. Any condition that causes swelling or change in position of the tissue within the carpal tunnel can squeeze and irritate the median nerve. The squeezing or irritation of the median nerve causes the symptoms of carpal tunnel syndrome such as pain, numbness, tingling or weakness.

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Causes

Repetitive stress to the wrist joints that causes carpal tunnel syndrome are

Typing

Computer keyboard use

Sewing

Driving

Writing

Vibratory hand tools

Sports such as racquetball or handball

Playing musical instruments

Some medical conditions that predisposes to carpal tunnel syndrome are

Obesity

Fracture and trauma

Hypothyroidism

Arthritis

Diabetes

Kidney failure and dialysis

Infections

Oral contraceptives

Premenstrual syndrome and pregnancy

Rheumatoid arthritis

Systemic lupus erythematosus

Scleroderma

Some rare diseases can cause deposition of abnormal substances around the carpal tunnel leading to nerve irritation are

Amylodosis

Sarcoidosis

Multiple myeloma

Leukemia

Other causes are

Intrinsic factors that exert pressure within the tunnel and extrinsic factors that exert pressure from outside the tunnel.

Benign tumors such as lipomas, ganglion, and vascular malformation are some of the pressure exerting factors that result in this condition.

Signs and Symptoms

Patients with carpal tunnel syndrome experience numbness, tingling, or burning sensation in the thumb and fingers, in particular the index, middle fingers and radial half of the ring fingers, which are innervated by the median nerve. Other symptoms include pain in the wrists or hands and loss of grip strength. Decreased grip strength can lead to frequent dropping of objects from the hand. As the disease progresses, patients can develop a burning sensation, cramping, and weakness of the hand. Occasional sharp shooting pains can be felt in the forearm. Chronic carpal tunnel syndrome can also lead to wasting of the hand muscles, particularly those near the base of the thumb in the palm of the hand.

Management and Treatment

The choice of treatment for carpal tunnel syndrome depends on the severity of the symptoms and any underlying disease that might be causing the symptoms. Treatment consists of splinting or bracing, steroid injection, activity modification, physiotherapy, regular massage therapy treatments, chiropractic, medications, and surgical release of the transverse carpal ligament.

Initial treatment includes

1. Rest

2. Massage

3. Ice application

4. Immobilization of the wrist in a splint or brace

Those occupations which are causing repetitive stress injury that aggravates the symptoms should modify their activities. Computer keyboards and chair height may need to be adjusted to optimize comfort. Periodic resting, range of motion, and stretching exercise of the wrists can prevent the symptoms of carpal tunnel syndrome that are caused by repetitive overuse.

Underlying conditions or diseases are treated individually

1. Fractures can require orthopedic management.

2. Obese individuals are advised regarding weight reduction.

3. Rheumatoid arthritis is treated with measures for the underlying arthritis.

4. Wrist swelling associated with pregnancy resolves after delivery of the baby.

5. Benign tumors are treated through excision, radiotherapy etc. for relieving the pressure.

Medications

Several types of medications have been used in the treatment of carpal tunnel syndrome. Vitamin B6 (pyridoxine) has been reported to relieve some symptoms of carpal tunnel syndrome.

Nonsteroidal anti-inflammatory drugs help in decreasing inflammation and reducing the pain.

Corticosteroids can be given by mouth or injected directly into the involved wrist joint. They can bring rapid relief of the persistent symptoms of carpal tunnel syndrome.

Surgery

Chronic pressure on the median nerve will result in persistent numbness and weakness. To avoid serious and permanent nerve and muscle damage of carpal tunnel syndrome, surgical treatment is considered. Surgery which is called "carpal tunnel release" is done which involves severing a band of tissue around the wrist to reduce pressure on the median nerve. In carpal tunnel release surgery, the goal is to divide the transverse carpal ligament into two. The patient may undergo exercise rehabilitation after the surgery.