Carpal Tunnel Syndrome
What is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome is a common disease that is classified under a group of diseases called compression neuropathies. As the name implies, the symptoms (tingling and pain in the hands) are caused by nerve impingement in the carpal tunnel at the base of the wrist. The carpal tunnel is a narrow tunnel which the median nerve (Latin nerve medianus) and finger tendons passes through to the palm. The carpal tunnel is made by the bones of the base of the palm and the carpal ligament.
Carpal Tunnel Syndrome – A nerve print on the wrist that causes pain and tingling in the palm of the hand and fingers (may be present in all but the small finger)
Why does the impingement of the median nerve occur?
During our lifetime, the tendons and carpal ligament in the carpal tunnel gradually thicken (due hypertrophy caused by wear and tear), gradually decreasing the space available within the tunnel, this narrowing can eventually impinge the median nerve. It is the impingement of this nerve that manifests as the typical complaints and symptoms associated with carpal tunnel syndrome. Carpal tunnel syndrome can affect anyone, but most often afflicts people with a background in heavy or tedious labor – conveyer workers, farm and building industry, IT and professions utilizing fine motor skills. Carpal Tunnel Syndrome is 4 times more common in women than in men. It is also more common in people with metabolic and hormonal imbalances, in diabetic patients, in patients with impaired thyroid function, and in rheumatoid arthritis. Pregnant women frequently get carpal tunnel due to hormonal changes, but the condition usually resolves spontaneously after giving birth.
What are the key features of carpal tunnel syndrome?
Carpal Tunnel Syndrome manifests itself as:
- progressive tingling and pain in the hands, especially at night;
- swelling, numbness in the fingers in the morning;
- usually the dominant arm is affected first ((this arm experiences more use and stress on a day to day basis)
- If the disease is ignored and timely treatment is neglected, additional symptoms may appear:
- decreased range of motion and decreased strength in the affected hand;
- inability to grasp and hold small objects.
- If left untreated for extended periods of time, the impingement of the nerve can cause permanent, irreparable damage to the nerve and seriously affect quality of life. In time the sensation in the fingers worsens, muscles of the hand become strained and gradually wear out, eventually muscle and with-it grasping strength decreases to the point where performing even simple, mundane daily tasks becomes almost impossible. In more severe cases, there is a total loss of capacity for work and the condition can lead to disability.
What to do if carpal tunnel syndrome is suspected?
Since there are various causes for tingling in the hands, you should first seek a consultation with a qualified neurosurgeon, the specialist will then initiate the proper investigation plan and provide adequate treatment. In order to choose the most appropriate treatment for relieving pressure off from the nerve the extent and level of the damage done to the nerve have to be found and estimated first.
How Is the Diagnosis of Carpal Tunnel Syndrome made?
Diagnosis is based on:
- characteristic complaints (symptoms);
- signs of disease that your doctor may detect during examination (nerve compression test, wrist muscle wasting, etc.)
- neurography – examination to determine the depth and location of nerve damage;
How is Carpal Tunnel Syndrome treated?
Carpal tunnel syndrome is treated by a neurosurgeon. The main goal of treatment is to reduce / prevent nerve compression. Depending on the degree of nerve damage, there are several options.
Drug therapy. In mild cases, drug therapy with local injections of steroids (blockade) are used. Blockades reduce oedema of the surrounding tissues, therefore providing more space for the nerve and alleviating the symptoms, however, the effect of such blockades is limited (the effect wears out within 6 to 12 months), and symptoms eventually return.
Orthoses – Since the least pressure exerted on the wrist is in its neutral position, applications of orthoses at night prevent the wrist from being bent or moved unintentionally, therefore relieving some of the pressure within the tunnel.
Surgery is the most effective and the ultimate remedy for carpal tunnel syndrome. Because the nature of the disease is an impinged nerve, the purpose of the operation is to relieve the pressure off the nerve, this is achieved by cutting the carpal ligament. The operation is short and easy to tolerate and is performed under local anesthesia – comparable to the one used during a visit to the dentist. The patient can go home shortly after surgery.
A traditional approach for surgery can be used, or a more recent and much less traumatic endoscopic technique can be chosen to decompress the nerve.
Traditional surgical / conventional surgery is performed under local anesthesia. An approx. 2-3 cm incision is made in the skin at the base of the wrist, to open the canal and relieve the impinged nerve. After the operation, a gentle and sparing regimen should be followed.
The endoscopic technique is significantly more patient-friendly. A miniature endoscope (a small medical camera) is inserted through a small incision in the skin, very fine surgical instruments are then used to localize and decompress the trapped nerve.
Compared to the traditional surgical method, the endoscopic method has several advantages – the technique spares and does not extensively damage surrounding tissues, thus offering significantly faster recovery and return of working capacity, it also achieves better aesthetical results. The endoscopic method is especially favourable in patients with underlying conditions that complicate wound closure and healing – such as vascular disease or diabetes.
What is the prognosis for the operation?
Overall, the prognosis for carpal tunnel syndrome treatment is very good:
- 90% of patients are completely cured and / or achieve significant improvement.
- The result of the operation depends on how long the nerve has been compressed. It is therefore important to see your doctor as early as possible in the course of the disease.
- The operation provides long-term results – you will be able to sleep and work the way you used to before the onset of the disease.