It is a disabling problem in the hand which is unfortunately not visible from outside. It happens due to compression of a nerve in wrist. The function of nerve is to provide sensation at the fingertip and to perform motor activity as it gives innervation to hand muscles. Prolong compression of nerve can result in temporary or permanent loss of function in the part which is taken care of by nerve. Timely intervention can almost cure the problem if associated medical conditions are also well controlled.
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What is carpal tunnel syndrome?
At wrist level, there is one-inch diameter tunnel through which one major nerve & nine cables (flexor tendons) are passed. If the size of tunnel is reduced or the tissue wrapping the cables (synovial tissue) gets inflammation or hypertrophy, then the nerve gets compressed in the tunnel. Sometimes, there could be small lump in the carpal tunnel can also cause this syndrome. This has been observed in people who have or had wrist fractures as bone fragment compresses the nerve directly leading to severe numbness in hand.
Following are the most common symptoms:
- Tingling & numbness of the thumb, index, middle & outer half of ring fingers
- Sleep disturbance as hand gets numb due to lack of movement during sleep
- Decrease sensation at the finger tip
- Decrease grip strength of hand causing dropping is the objects or such feeling
- Pain in thumb or fingers
It is more common in people who have diabetes, hypertension, thyroid disorder, high cholesterol or any kind of arthritis like rheumatoid arthritis. Now a day, due to continuous use of electronic gadgets like laptops, mobile phones etc., is also seen in younger generation. Many times, during and after pregnancy this is very commonly presented.
Many times, some people have tingling or numbness from neck or shoulder to finger on one or both sides along with neck pain. This could be due to pathology in neck.
Is there any test to prove it?
Nerve conduction study (NC study) gives us idea about the severity of the problem and urgency of the treatment. There are two components of nerve named sensory (responsible for sensation) & motor (responsible for thumb movements). This test along with Electromyography (EMG) can guide functioning of the nerve.
Ultrasonography of the palm and wrist can tell us about the size of the tunnel and size of the nerve & cables (flexor tendons) as well as extent of nerve damage.
Those who have symptoms not only in hand but also in neck and arms may need to consider X-ray of cervical spine (neck) or MRI scan to rule out compression in spine.
What is the treatment?
After detail examination of patient and tests, various treatment options are considered. If symptoms are not bothering daily activities, then splintage & exercises for hand with medical treatment can be considered but may not cure the problem. Steroid injection in the palm in some selected patients can give relief without much side effects. In some patients, it may relieve symptoms may show recurrence. Splint age and steroid injection therapy may work in carpal tunnel syndrome seen in pregnant females or post pregnancy.
If nerve compression is severe then ultimately surgery to release the roof of the tunnel and to consider excision of the hypertrophied synovial tissues around flexor tendons to relieve pressure on the nerve is the best option.
Surgery is done as day care procedure. It has excellent success rate if done in time. Person can use operated hand immediately after the surgery. As it is mostly done under local anesthesia, surgery is very safe.
In late presentation, those who have wasting of thumb muscles, additional surgical procedures like tendon transfer (opponenceplasty) to improve thumb function may have to be considered.