CARPAL TUNNEL SYNDROME

Carpal tunnel syndrome is caused by chronic compression of the median nerve in the narrow tunnel (the carpal tunnel) that contains the median nerve as it crosses from the forearm into the wrist.

Physical examination of the hand will lead to a clinical diagnosis in most cases. Bending the wrist, tapping on the nerve (Tinel’s sign) or simply pressing on the nerve can trigger symptoms in many people.

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RISK FACTORS

A combination of risk factors contributes to the development of the condition.  

1. Risk factors include gender (women are more likely to get carpal tunnel syndrome), swelling and inflammation resulting from rheumatoid arthritis, hypothyroidism, obesity, diabetes, menopause, pregnancy and renal disease.

2. Workplace risk factors include - working with vibrating tools or work that requires repetitive flexing of the wrist. There is no conclusive evidence that prolonged use of computers leads to carpal tunnel syndrome.

3. A wrist fracture can narrow the carpal tunnel and compress the median nerve.

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SYMPTOMS

Carpal tunnel syndrome is a cause of numbness and/or tingling of the fingers, hand and, at times, radiates up the forearm. Typically the pain wakes up the patient at night. In chronic cases weakness of the hand muscles may develop.

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INVESTIGATIONS

1. X-ray: X-rays are only recommended if arthritis or fracture is recommended.

2. Electromyography (EMG) / Nerve conduction test (NCV) is an electro-physiological test of the limbs that is done in certain cases where the diagnosis is in doubt, to rule out conditions like neuropathy that may be from diabetes, hypothyroidism or certain vitamin deficiencies. EMG can also give an indication if a nerve root may be compressed in the cervical spine causing carpal tunnel-like symptoms in the arm.

3. Nerve Conduction test (NCV) is diagnostic in most cases of carpal tunnel syndrome.  

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TREATMENT OPTIONS

1. Nonsurgical therapy includes

   • Wrist splinting in an extended wrist is useful but is practical only for night use.

   • Nonsteroidal anti-inflammatory drugs

   • Corticosteroids: injected locally in the carpal tunnel may reduce the inflammation and pain , at least in the short term.

   • Treatment of the primary risk factor, such as diabetes, rheumatoid arthritis, obesity etc., has to continue simultaneously.

2. Surgical Management -The goal of carpal tunnel surgery is to relieve pressure by cutting the ligament compressing the median nerve.

   • Endoscopic carpal tunnel release is a minimally invasive technique done through small incisions in order to divide the ligament compressing the median nerve.

   • Open surgery achieves the same through a bigger incision across the palm.