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Carpal Tunnel Syndrome

Carpal Tunnel
Syndrome

Everything you need to know about Carpal Tunnel Syndrome

The median nerve is compressed as it passes through the hand, this causes carpal tunnel syndrome. On the palm side of your hand, the median nerve is found (also called the carpal tunnel). The median nerve gives your thumb, index finger, long finger, and part of your ring finger sensibility (the ability to feel). It sends an impulse to the muscle that moves the thumb. Carpal tunnel syndrome can affect either one or both hands.

Carpal tunnel syndrome is caused by swelling inside the wrist, which causes compression. On the side of your hand near the thumb, it might cause numbness, weakness, and tingling.

Symptoms of Carpal Tunnel Syndrome

Because the median nerve is compressed, the symptoms are frequently present along the nerve course. Your hand may regularly “sleep” and drop objects. Other signs and symptoms include:

  • Your thumb and the first three fingers of your hand are numb, tingling, and painful.
  • A searing sensation that runs up your arm
  • Wrist ache that keeps you awake at night
  • A weakening in the hand’s muscles

Diagnosis

To evaluate whether you have carpal tunnel syndrome, your doctor may ask you questions and perform one or more of the following tests:

  • Symptoms in the past. The pattern of your symptoms will be examined by your doctor. Because the little finger isn’t supplied with sensation by the median nerve, complaints in that finger could indicate anything other than carpal tunnel syndrome.  Symptoms of carpal tunnel syndrome frequently appear when you’re holding a phone or a newspaper, or when you’re grasping a steering wheel. They also tend to happen at night, and you may be awakened in the middle of the night or detect numbness when you wake up in the morning.
  • Physical examination. A physical examination will be performed by your healthcare practitioner. He or she will assess the feeling in the fingers as well as the strength of the hand muscles. In many people, bending the wrist, tapping on the nerve, or just pressing on the nerve might cause symptoms.
  • X-ray. Some doctors advise getting an X-ray of the injured wrist to rule out other possibilities like arthritis or a fracture. X-rays, on the other hand, are ineffective in diagnosing carpal tunnel syndrome.
  • Ultrasound. An ultrasound of your wrist may be recommended by your doctor to acquire a clear picture of the bones and nerves. This can assist in determining whether or not the nerve is crushed.
  • Electromyography. The tiny electrical discharges produced in muscles are measured in this test. Your provider will place a thin-needle electrode into certain muscles during this test to assess electrical activity while the muscles contract and relax. This test can detect injury to the muscles controlled by the median nerve while also ruling out other possible causes.
  • Nerve conduction study. Two electrodes are taped to the skin in a version of electromyography. To see if electrical impulses in the carpal tunnel are slowed, a mild shock is administered through the median nerve. This test can be used to determine the cause of the problem and rule out other possibilities.

Causes

Carpal tunnel syndrome is caused by excessive pressure in the wrist and on the median nerve causing pain. Swelling can be caused by inflammation. An underlying medical problem that causes oedema in the wrist and often restricted blood flow is the most typical cause of this inflammation. The following are some of the most common conditions associated with carpal tunnel syndrome:

  • Diabetes
  • Thyroid condition
  • Pregnancy or menopause can cause fluid retention.
  • Blood pressure that is too high
  • Rheumatoid arthritis is an autoimmune disease.
  • Wrist fractures or abrasions

Carpal tunnel syndrome can be aggravated by repeatedly overextending the wrist. Swelling and compression of the median nerve are caused by repeated wrist motion. This could be a result of:

  • When using a keyboard or mouse, be sure your wrists are in the right position.
  • Using hand tools or power equipment for an extended period of time exposes you to vibrations.
  • Any movement that causes your wrist to overextend, such as playing the piano or typing

Carpal Tunnel Syndrome Diagram

Treatment

Carpal tunnel syndrome should be treated as soon as the symptoms appear. Simple things you can do for yourself in the early phases of the problem may be enough to solve it. Consider the following scenario:

  • Take more regular rests to allow your hands to rest.
  • Avoid activities that aggravate your symptoms.
  • To reduce swelling, use cold packs.

Wrist splinting, medicines, and surgery are some of the other treatment possibilities. If you’ve only experienced mild to moderate symptoms that come and go for less than 10 months, splinting and other conservative treatments are more likely to assist. If you feel numbness in your hands, you should seek medical attention.

Nonsurgical therapy

If discovered early, non-surgical treatments for carpal tunnel syndrome may be effective, including:

  • Splinting of the wrist. A splint that keeps your wrist still while you sleep can help reduce tingling and numbness at night. Even if you just use the splint at night, it can help you avoid symptoms throughout the day. If you’re pregnant, nighttime splinting may be a viable alternative because it doesn’t require the use of any medications to be effective.
  • Nonsteroidal anti-inflammatory medicines (NSAIDs). Medications that are used to treat inflammation (NSAIDs). In the short term, NSAIDs like ibuprofen (Advil, Motrin IB, and others) may help reduce pain from carpal tunnel syndrome.However, there is no proof that these medications help with carpal tunnel syndrome.
  • Corticosteroids. To ease pain, your doctor may inject a corticosteroid such as cortisone into the carpal tunnel. An ultrasound may be used to guide these injections in some cases.Corticosteroids reduce strain on the median nerve by reducing inflammation and oedema. For treating carpal tunnel syndrome, oral corticosteroids aren’t as effective as corticosteroid injections.

If rheumatoid arthritis or similar inflammatory arthritis is the cause of carpal tunnel syndrome, treating arthritis may help to alleviate symptoms. This, however, has not been proven.

Surgery

If your symptoms are severe or don’t respond to conventional treatments, surgery may be the best option.

The purpose of carpal tunnel surgery is to relieve pressure on the median nerve by cutting the ligament that is pressing on it.

There are two procedures that can be used to do the surgery:

  • Endoscopic surgery. A type of surgery that involves the use of To see within the carpal tunnel, your surgeon uses an endoscope, which is a piece of telescope-like equipment with a tiny camera attached to it. One or two small incisions in the hand or wrist are used by your surgeon to sever the ligament. Instead of using a telescope, some surgeons may use ultrasonography to guide the tool that cuts the ligament. In the days or weeks following surgery, endoscopic surgery may cause less discomfort than open surgery.
  • Open surgery. In a type of surgery in which the patient has the nerve freed, your surgeon makes an incision in the palm of your hand over the carpal tunnel and cuts through the ligament.

Before surgery, talk to your surgeon about the risks and benefits of each procedure. The following are some of the hazards of surgery:

  • Ligament release that isn’t full
  • Infections of the wound
  • Formation of scars
  • Nerve or blood vessel injuries are common.

The ligament tissues eventually grow back together throughout the healing phase following surgery, leaving more room for the nerve. The internal healing process can take several months, although the skin only takes a few weeks to mend.

After the ligament has healed, your provider will usually advise you to use the hand again, gradually returning to regular use while first avoiding vigorous hand motions or extreme wrist positions.

After surgery, soreness or weakness might last anywhere from a few weeks to a few months. If your symptoms were severe, they may not totally go following surgery.

Risk Factors

Carpal tunnel syndrome affects three times as many women as it does men. Between the ages of 30 and 60, carpal tunnel syndrome is most commonly diagnosed. Diabetes, high blood pressure, and arthritis are among illnesses that enhance your chances of getting it.

Carpal tunnel syndrome has been linked to a number of variables. They may raise the risk of irritation or injury to the median nerve, even if they do not cause carpal tunnel syndrome directly. These are some of them:

  • Anatomical considerations. The space within the carpal tunnel can be altered by a wrist fracture or dislocation, or arthritis that deforms the tiny bones of the wrist, putting pressure on the median nerve. Carpal tunnel syndrome is more common in people with smaller carpal tunnels.
  • Sex. Carpal tunnel syndrome is more common in women than in men. This could be due to the fact that women’s carpal tunnels are smaller than men’s. Carpal tunnel syndrome affects women differently than it affects males. Women with carpal tunnel syndrome may have smaller carpal tunnels than women without the illness.
  • Conditions that cause nerve damage. Nerve injury, especially damage to the median nerve, is more likely in several chronic conditions, such as diabetes.
  • Inflammatory diseases. The lining around the tendons in the wrist can be affected by rheumatoid arthritis and other inflammatory disorders, putting pressure on the median nerve.
  • Medications. Carpal tunnel syndrome has been linked in certain studies to the usage of anastrozole (Arimidex), a medicine used to treat breast cancer.
  • Diabetes. Carpal tunnel syndrome can be caused by diabetes when excessive glucose levels disrupt the blood vessels that supply the median nerve. But it gets even more difficult. Carpal tunnel syndrome patients who do not have diabetes are more likely to develop diabetes later in life, according to research.
  • Obesity. Obesity is linked to a higher incidence of carpal tunnel syndrome.
  • Body fluid changes. Fluid retention can cause irritation to the median nerve by increasing pressure within the carpal tunnel. During pregnancy and menopause, this is a common occurrence. Carpal tunnel syndrome caused by pregnancy usually improves on its own once the baby is born.
  • Other medical problems. Carpal tunnel syndrome can be exacerbated by a number of factors, including menopause, thyroid issues, kidney failure, and lymphedema.
  • Factors at work. Working with vibrating equipment or on an assembly line that needs lengthy or repetitive wrist flexing can put undue strain on the median nerve or exacerbate existing nerve damage, especially if the activity is done in a cold environment.The scientific data is mixed, and these elements haven’t been proven to be direct causes of carpal tunnel syndrome.A number of studies have looked into the possibility of a link between computer use and carpal tunnel syndrome. According to some data, the problem may be with mouse use rather than keyboard use. However, despite the fact that excessive computer use may produce a different type of hand pain, there isn’t enough high-quality, consistent evidence to establish it as a risk factor for carpal tunnel syndrome.

Prevention

Although there are no proven solutions for preventing carpal tunnel syndrome, you can reduce stress on your hands and wrists by using the following techniques:

  • Reduce the amount of force you use and relax your hold. If your job requires you to use a cash register or a keyboard, for example, strike the keys gently. Use a large pen with a larger, comfortable grip adapter and free-flowing ink for long-term handwriting.
  • Take regular, short pauses. Stretch and bend your hands and wrists gently on a regular basis. When possible, switch tasks. This is especially critical if you’re working with equipment that vibrates or demands a lot of force. It only takes a few minutes every hour to make a difference.
  • Keep an eye on your form. Avoid completely bending your wrist up or down. The optimal position is in the middle, relaxed. Keep your keyboard at or slightly below elbow height.
  • Make improvements to your posture. Incorrect posture causes the neck and shoulder muscles to shorten and the nerves in the neck to be compressed. This can cause pain in the wrists, fingers, and hands, as well as in the neck.
  • Change the mouse on your PC. Make sure your computer mouse is comfortable to use and does not cause wrist strain. Gel pad mouse mats are also effective.
  • Warm-up your hands. If you work in a cold workplace, you’re more likely to suffer hand pain and stiffness. Put on fingerless gloves that keep your hands and wrists warm if you can’t manage the temperature at work.

Outlook

Early treatment of carpal tunnel syndrome with physical therapy and a change in lifestyle can result in significant long-term improvement and the elimination of symptoms.

Carpal tunnel syndrome, if left untreated, can result in irreversible nerve damage, disability, and loss of hand function.

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