Carpal tunnel syndrome: doctor’s explanation

Carpal tunnel syndrome (CTS) can limit hand function and affect daily life. It causes pain, numbness and weakness in the hand muscles. In this article you will learn why this happens, how to deal with it and what to do to get relief.

I am a surgeon and help patients who are struggling with CTS. The most important thing is to react in time to emerging ailments. It is helpful to know what carpal tunnel syndrome is and how it can be treated.

It is a disorder of the median nerve in the wrist that occurs in about 3-6% of the general population. It accounts for about 90% of all periphery nerve compression syndromes (in addition to the carpal tunnel, they also affect the ulnar nerve canal or Guyon’s canal).

Carpal tunnel syndrome is an unpleasant condition that occurs when the median nerve is compressed in the carpal tunnel.

The carpal tunnel is a narrow corridor located in the wrist, about 2.5 cm in diameter. The bottom and walls of this passage are made up of small carpal bones. Above the median nerve is a band of connective tissue – the transverse carpal ligament.

The amount of space inside the canal is therefore limited, so it is important to look out for any swelling or irritation that may reduce the space in this area and compress the median nerve, reducing its blood supply and impairing its function.

Proper blood supply to the median nerve is crucial. It allows us to feel by touch and allows us to bend our fingers (all except the little one, which is controlled by the ulnar nerve).

Symptoms usually start slowly, without a clear source of injury. Most patients notice that their discomfort initially comes in waves. However, as the condition of the median nerve deteriorates, the discomfort may last longer or occur more frequently.

Symptoms include:

– pain, numbness and tingling in the fingers (thumb, index, middle and heart), which often awaken from sleep;
– Pain radiating along the forearm;
– Weakening of the muscles of the knuckle of the thumb and hand, leading to difficulties in grasping and – holding objects;
– loss of feeling in the hand.

The discomfort may be due to anatomical factors, such as congenital narrow carpal tunnel or trauma.

According to numerous studies, women face CTS twice as often as men. This is due to biological and anatomical differences in the structure of our bodies.

One key factor is that the carpal tunnel in women is inherently narrower than in men. This gives less room for the median nerve to maneuver through the canal, increasing the risk of compression and causing pain and other symptoms such as tingling or loss of strength in the hand.

In addition, hormonal changes experienced by women can also increase the risk of carpal tunnel syndrome. Pregnancy, menopause and menstruation are associated with changes in hormone levels, which can aggravate swelling, further increasing pressure.

Swelling is also associated with trauma, inflammation and disease, such as diabetes, thyroid disease and rheumatoid arthritis. When the tissues surrounding the nerve are swollen, they automatically press against it leading to CTS.

Excessive strain on the wrist is also significant. For example, prolonged repetitive motions with a narrow area of the hand, such as typing, crafting or operating machinery, can lead to mechanical stress and pressure on the median nerve.

Similarly, athletes, especially those who regularly engage their wrists in intense movements, are at greater risk of developing carpal tunnel syndrome.

Repeated sleeping on a bent wrist also contributes to the condition .

First and foremost, it is important to take regular breaks when performing activities that require intense hand movement.

In office work, for example, it’s a good idea to take your hands off the keyboard every hour and do a series of simple exercises, such as bending and straightening your fingers, twisting your wrists or stretching your entire body. These simple movements will help relax muscles and improve blood circulation.

Another important element is the proper organization of the workplace. The table and chair should be at the right height to give your wrists a natural position.

Tests designed to diagnose CTS include:

1.Measurement of hand sensation and muscle strength.
2.Tinel test.
3.Phalen test.
4.Electromyographic (EMG) study.
5.Nerve conduction study (NCV).
6.Computed tomography of the wrist (optional).
7.MRI of the wrist (optional).
8.Ultrasound (optional).

During the examination, the doctor will assess the condition of the median nerve. It will check whether it is associated with other diseases and rule out conditions that may cause similar symptoms to carpal tunnel syndrome.

The specialist will check the tenderness, swelling and strength in the wrist.

In the Tinel test, the doctor “taps” the median nerve in the wrist. If a patient suffers from CTS, he or she will feel a characteristic tingling in the fingers.

Tests designed to diagnose CTS include:

1.Measurement of hand sensation and muscle strength.
2.Tinel test.
3.Phalen test.
4.Electromyographic (EMG) study.
5.Nerve conduction study (NCV).
6.Computed tomography of the wrist (optional).
7.MRI of the wrist (optional).
8.Ultrasound (optional).

During the examination, the doctor will assess the condition of the median nerve. It will check whether it is associated with other diseases and rule out conditions that may cause similar symptoms to carpal tunnel syndrome.

The specialist will check the tenderness, swelling and strength in the wrist.

In the Tinel test, the doctor “taps” the median nerve in the wrist. If a patient suffers from CTS, he or she will feel a characteristic tingling in the fingers.

In patients with carpal tunnel syndrome, this position causes a characteristic tingling, numbness or pain in the fingers after just a minute or so. The reason is simple – wrists bent in this way cause pressure on the median nerve located in the carpal tunnel.

EMG and NCV are the most commonly used diagnostic methods to assess the extent of possible nerve damage. If the diagnosis is still in doubt a CT scan or MRI to show the anatomy of the wrist may be necessary.

It is always best to start treatment as soon as possible with the advice of a doctor. If any underlying health problems, such as diabetes or arthritis, are causing symptoms, they should be addressed first.

If CTS is detected early enough, it can usually be remedied without surgery. If these bothersome symptoms are not yet too severe, your doctor will probably suggest some non-surgical treatments first as a conservative measure.

There are several ways to alleviate early symptoms:

– Sleeping with an orthosis on the wrist to keep it upright;
– Cool compresses in case of swelling;
– exercises to strengthen muscles and increase range of motion;
– Rest, massages and avoiding repetitive movements that aggravate symptoms;
– Painkillers and anti-inflammatory drugs, such as ibuprofen, corticosteroid injection applied directly to the carpal tunnel.

In mild cases, injections can provide long-lasting relief, while in moderate and severe conditions they usually provide only short-term effects. Always seek medical consultation for medications.

If non-invasive treatment methods do not provide the desired relief or produce only short-term results, the doctor may recommend surgical intervention.

The carpal tunnel release procedure is known as nerve decompression. The operation reduces pressure on the median nerve by releasing the transverse carpal ligament.

This increases the space in the carpal tunnel and reduces pressure on the nerve, so blood flow can be improved and hand function can be restored.

After healing, the ligament is elongated, which nullifies the CTS problem permanently. Cases of carpal tunnel syndrome returning after surgery are rare. Many patients report a cessation of pain immediately after surgery. The rest of the symptoms usually subside within a few weeks.

Patients often ask whether carpal tunnel syndrome can regress on its own. Sometimes a change in lifestyle or nature of work is enough to make symptoms disappear. If carpal tunnel syndrome occurs during pregnancy, it also usually resolves after termination without the need for surgical intervention.

It is best to see a primary care physician, physiotherapist or surgeon. The specialist will direct the diagnosis and, based on it, select the appropriate treatment method. If in doubt, always seek a second opinion. Your health is the most important thing.

If carpal tunnel syndrome goes untreated for an extended period of time, the muscles near the base of the thumb can become weak, contract, and the nerve can become permanently damaged.

Sometimes people with severe CTS are unable to tell whether what they are holding in their hand is hot or cold.

Adequate, rapid response protects against such consequences, eliminates pain and restores hand function.