Carpal Tunnel Syndrome

A young lady wants to know about carpal tunnel syndrome. What is it? Who gets it? How is it managed?

Carpal tunnel syndrome was first described in 1853. It is a common, painful disorder of the wrist and hand. It is caused by pressure on the median nerve in the wrist. The median nerve travels from the forearm into the hand through a “tunnel” in the wrist.

The cause of the pressure can be multifactorial. Some common causes and associated conditions are:
-repetitive and forceful grasping with the hands
-repetitive bending of the wrist
-broken or dislocated bones in the wrist which produce swelling
-arthritis, especially the rheumatoid type
-thyroid gland imbalance
-sugar diabetes
-hormonal changes associated with menopause
-pregnancy

Although any of the above may be present, most cases have no known cause.

It can occur at any age. The condition occurs most often in people 30 to 60 years old, and it is 5 times more common in women. It affects the dominant hand more frequently. It may affect both hands.

The symptoms start with pins and needles in three and half fingers (thumb, index finger, middle finger and half of ring finger) that are supplied by the sensory branch of the median nerve.

This may be followed by pain in the distribution of the median nerve, from the tip of the fingers to the neck. Symptoms may be worse at night and wake the patient from sleep. Relief is obtained by dangling the arm over the side of the bed.

Eventually, the median nerve supplying the small muscles of the hand may be affected. This produces wasting and weakness of the hand. There may be tendency to drop things.

A good history and physical examination is very important. Sometimes the condition may be confused with other problems affecting the shoulder and the neck. Therefore, nerve conduction study of the median nerve can provide more information.

The nerve conduction study helps localize the site of the entrapment and estimate the severity of damage. In less than 10 percent of the patients the test may be falsely negative. Clinical correlation is required to come to a final diagnosis.

Non-surgical treatment of carpal tunnel syndrome is: avoidance of the use of the wrist, placement of a wrist splint in a neutral position for day and night use, and anti-inflammatory medications.

Splinting can be combined with steroid injections. In one study, 80 percent had immediate relief of symptoms. But after one year only 20 percent were free of symptoms.

Ergonomic redesign of work stations is widely practiced for prevention and for relief of symptoms.

Surgical treatment involves a small incision on the palmar aspect of the wrist and the hand. The incision is deepened to divide the ligament to open the tunnel. Thus the pressure on the nerve is released.

The surgery requires no hospitalization and is done under local or regional anesthetic. No genera anesthetic is required. Studies have shown that surgical treatment relieves symptoms in 82 to 98 percent of the patients.

Relief of symptoms and return to normal level of physical activities may take few days to several months – depending on the damage to the nerve and the type of activity. Physiotherapy may become necessary.

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