Carpal Tunnel Syndrome – A Common Ailment
Carpal tunnel syndrome is one of the most common ailments related to the compression of the median nerve within the carpal tunnel. This compression leads to pain in the wrist and hand, numbness, weakness in the fingers, and more. This condition significantly affects a patient's health, not only due to discomfort but also due to a loss of productivity. Weak, painful wrists, numb fingers, and hands often prevent people from performing not only work-related tasks but also daily activities.
Symptoms of Carpal Tunnel Syndrome
Carpal tunnel syndrome most commonly affects people aged 45-65, particularly older women. Causes of carpal tunnel syndrome are varied and not always purely physical, such as constant, strenuous manual work. Other health conditions like diabetes, thyroid disorders, hormone changes related to menopause, and rheumatoid arthritis can also contribute to its onset.
People with this syndrome often experience sensory disturbances, such as reduced or, conversely, heightened skin sensitivity. Numbness, tingling, itching, burning, or a feeling of coldness are common. Many describe it as a sensation similar to ants crawling on the skin. During the night, intense numbness and burning pain in the wrist and hand can radiate up towards the elbow or shoulder, often causing insomnia, irritability, fatigue, and heightened sensitivity to pain.
Carpal tunnel syndrome can also affect fine motor skills, making it difficult to grasp small objects, such as buttoning buttons or holding a zipper or needle. Morning stiffness and hand swelling are also common.
How is Carpal Tunnel Syndrome Diagnosed?
Early and accurate diagnosis of carpal tunnel syndrome can prevent nerve and muscle damage and lead to effective treatment outcomes.
A neurologist or neurosurgeon first evaluates the patient, assessing their clinical history and ordering relevant tests.
To assess nerve health, an electromyography test is conducted to detect nerve conductivity and vitality issues in specific nerve segments. An ultrasound may also be performed to assess the nerve’s condition and any nearby pathological structures, such as tendon changes. In some cases, a magnetic resonance imaging (MRI) scanis recommended to show the nerve and surrounding structures more clearly, helping to differentiate it from spinal pathologies that may cause similar symptoms. Blood tests may also be conducted if other conditions are suspected.
Conservative Treatment of Carpal Tunnel Syndrome
The doctor may recommend conservative treatments or peripheral nerve decompression surgery, depending on the duration and severity of nerve damage. If the condition is not long-standing and has lasted only a few weeks or months, inflammation of the tendons may be treated through injections of anti-inflammatory drugs by a pain specialist or through physical therapy.
A physical therapist can help determine which wrist positions cause the most pain and suggest the most comfortable wrist positions during work or leisure to minimize repetitive strain.
If the syndrome is not advanced, taking frequent breaks during work may reduce mild pain and discomfort. Wrist splints, especially worn at night, can also be quite effective. However, if there is no significant improvement after 4-6 weeks of splint use, continued use may not be beneficial.
Conservative treatment options may include limiting physical activity, exercises to improve circulation and reduce pain, massage, and B vitamins. Non-surgical treatments are generally more effective if the nerve damage is not severe or long-term.
Peripheral Nerve Release Surgery
If numbness, loss of sensation, or pain persists, a neurosurgeon may recommend peripheral nerve decompression surgery to relieve nerve compression.
The neurosurgeon makes a small incision in the palm and cuts the ligament covering the carpal tunnel, creating more space in the tunnel and reducing pressure. The surgery is performed under local or general anesthesia, with the choice being made in consultation with the surgeon. The procedure takes about 30-40 minutes, and the patient can go home with an escort after 3-4 hours.
Some patients experience relief immediately after surgery, while others may continue to feel numbness, pain, stiffness, or weakness for a while due to prolonged nerve compression. Light work can typically be resumed 3-4 weeks post-surgery. If the work involves repetitive movements or is physically demanding, it should be avoided for at least six weeks after surgery.
To restore wrist functionality, physical therapy may also be recommended after surgery. The therapist will suggest exercises to relieve pain and reduce sensitivity.
It is essential to seek medical help at the first signs of symptoms. Delaying treatment can prolong the process and may lead to less satisfactory results.