Carpal Tunnel Syndrome

Carpal tunnel syndrome is a condition where a nerve called the median nerve gets compressed within the carpal tunnel at the wrist. Clinical findings are dependent on the duration and severity of nerve compression.

The carpal tunnel is an opening in the wrist which is surrounded by bones on 3 sides and by the transverse carpal ligament which forms the roof. It contains many tendons and the median nerve. The median nerve provides sensation of the thumb, index finger, long finger, and half of the ring finger. It also helps us move the thumb by providing motor power to the thenar muscles.

Causes

CTS can be caused by any condition which either reduces the space inside the carpal tunnel or makes the size of the containing structures bigger.

Most of the times, the cause is unknown, but it can happen in rheumatoid arthritis, hypothyroidism, pregnancy, previous wrist fractures, tumours or cysts within the wrist, infection or burns. It can also occur in diabeticswhich may be due to problems with the nerve as a part of peripheral neuropathy rather than compression of the nerve.

Symptoms

  • Tingling and numbness in the area of median nerve supply which is usually the palmar surface of the thumb, index finger, long finger, and half of the ring finger.
  • Vague pains particularly at night when the patient may wake up and try shaking the numbness off which usually does not help.
  • Clumsiness of fumbling when trying to pick things up
  • Frequent dropping of objects due to weakness
  • Difficulty in performing certain finer activities like picking things out of a purse or fastening buttons or zippers

Diagnosis

Clinical examination can show altered sensation in the region of the median nerve. There may also be muscle wasting in this region. Tapping on the wrist crease near the median nerve may cause shooting type of pins and needles into the fingers.

The diagnosis is confirmed by performing a nerve conduction velocity test which shows how fast the nerve impulses move across a nerve.

Treatment

Treatment is usually conservative to start with by providing wrist braces and analgesics, and such a Bone cancer treatment, in Bangalore, could be cumbersome too.

The Cortisone injections into the carpal tunnel have also been shown to be helpful in some studies. This can also act as a test to confirm that your symptoms are due to carpal tunnel syndrome.

If the clinical findings indicate severe compression of the nerve or if conservative treatment is unsuccessful, You may be recommended to undergo surgery in the form of carpal tunnel decompression which can be performed as a day case. Here a small incision is made over the proximal aspect of the palm and the transverse carpal ligament is divided throughout its length to ensure that the median nerve is free. The skin is then sutured and a bulky dressing will be applied which is temporary. Sutures are usually removed after 7-10 days depending on surgeon preference.

Recovery usually takes several months and depends on the severity of nerve compression. If there has been nerve damage, there may be residual symptoms. Generally the area of the scar is quite tender for several months. Results are satisfactory in patients when the diagnosis is convincing.