Carpal tunnel syndrome
Carpal tunnel syndrome or CTS is a painful and debilitating condition of the hand and arm caused due to pinched or pressed nerves in wrist (median nerve). Carpal is derived from the word, carpus (meaning wrist), and taken from the Greek word, karpos. In medical jargon, the carpus refers to an assembly of eight small bones that lie side-by-side in the wrist – in two rows – which join the forearm to the hand. The tunnel is a narrow passageway for nine (some anatomists say, ten) tendons and one nerve (the median nerve – so called, since it lies in the middle of the forearm and the wrist), to pass from the forearm to the hand. This passageway lies on the carpal bones and is roofed by a strong ligament, the flexor retinaculum. In the case of CTS, a group of symptoms occur together and it is therefore called a syndrome.
What causes nerve compression is more often than not impossible to determine. In such cases, CTS is said to be idiopathic in origin. This syndrome is often a consequence of injury to the wrist and conditions that put pressure on the median nerve at the wrist like rheumatoid arthritis, diabetes, osteoporosis, hypothyroidism, obesity, and even pregnancy.
CTS has also been seen in patients who have used medicines like phenytoin (for epilepsy) and oral contraceptive pills for a long period of time. And finally, lipomas and ganglions (seen as lumps on the wrist), can also put pressure on the nerve from the outside leading to CTS.
Strangely, the symptoms of CTS are usually seen in the middle of the night, with symptoms on both the wrists or bilaterally.
Nowadays, this condition has become synonymous with the use of computers, and is the commonest form of computer related injury (CRI). This is an injury that is caused due to over-use of the wrist, which occurs most commonly in people who work with their hands all day long, such as cradling a phone or typing on a keyboard. This over-use results in tendonitis (strain in the tendons) in the wrist, thumbs or shoulder. Such an injury is called a Repetitive Strain Injury (RSI). (Read: 10 natural remedies to prevent osteoporosis)
Someone suffering from CTS will experience pain, numbness and paraesthesia (a pins-and-needles sensation) in the affected hand and in the areas supplied by the median nerve. The median nerve supplies structures on the outer half of the hand — this includes the thumb, index, middle finger and the outer half of the ring finger. Later, as the disease progresses, a patient might notice a weakened grip in the affected hand and fingers along with a loss of muscle mass on the outer side of the hand. Sometimes the pain may extend to the forearm and beyond the wrist.
The symptoms of CTS are very characteristic, so diagnosis is not very difficult. The doctor will ascertain the patient’s history and examine the patient for signs of median nerve neuropathy by performing the Durkan Test and checking for the presence of the Tinel’s sign (a pins-and-needles sensation that is a positive sign of CTS). He/she may also advice the patient to get a nerve conduction velocity test (NCV) to further confirm the diagnosis.
When a patient is diagnosed, the treatment options are many. Combined with lifestyle changes the condition can be treated appropriately. Some of the options a patient has are:
Splints: Braces and splints are advised, especially at night, to support the wrist.
Physiotherapy and exercises: Once diagnosed the patient will be taught to do exercises to tone the muscles of the upper limb, along with specific exercises to treat CTS that can reduce the severity of the symptoms, especially in the early stage. Exercises aim to stretch the carpal tunnel, and hopefully create some space for the affected nerve.
Steroid injections: These injections help temporarily, by reducing the inflammation, and therefore the symptoms. That being said, they cannot be considered appropriate as a permanent or long-term therapy.
Surgical release of the carpal tunnel: In this surgery, the retinaculum is divided to create more space for the nerve. This surgery is essentially for those patients for whom other conservative therapy has not worked. So far it is the only permanent solution to the problem.
The outcome of an operation is usually good, and recurrence of symptoms rare. One serious (and late) complication of the operation is the development of a ‘trigger thumb’(where the tendon associated with the finger catches, snaps or locks due to the malfunction of the tendon itself). But whether the treatment given was conservative or operative, a small amount of residual nerve damage will remain, and this is probably because of the structure and physiology of the tunnel and the nerve itself.
If left untreated, the patient will have irreversible nerve damage leading to intractable pain, numbness and muscle weakness in the areas supplied by the median nerve.
In such cases it is essential that the patient adjust their lifestyle to accommodate and treat the symptoms. Since this is essentially due to the overuse of a the wrist, the patient should take frequent breaks, give rest the painful part the moment you notice some discomfort and consult their doctor if the symptoms persist.
The most important part of relieving the symptoms and pain related to CTS is to rest the part when at home, and exercise when the pain is less.
Finally, CTS can be treated but when done in a timely manner, ignoring symptoms only leads to irreversible damage.
Read about the 6 tips to relieve pain in carpal tunnel syndrome.