Carpal Tunnel Syndrome
The bones that make up the hand and the wrist provide the body with support and flexibility in order to manipulate objects in many different ways. With the support of the ulna and radius of the forearm that support many of the hand’s muscles, the 27 bones in the hand have an incredibly precise range of motion. The hand can be considered in four segments:
- Fingers – digits that extend from the palm of the hand, making it possible to grab the smallest of objects
- Palm – the “high-five” side of the hand
- Dorsum – the back side of the hand where a web of veins is often visible
- Wrist – the point of connection between the hand and the forearm which facilitates proper motion of the hand
These four segments, along with a network of muscles, tendons, and tissues work cohesively to enable the hand to perform the most complicated activities. Unfortunately, like the rest of the body, hands and wrists are susceptible to number of different injuries and conditions.
The carpal tunnel is a narrow, tunnel-like structure in the wrist, with the carpal (wrist) bones forming the bottom and sides and the transverse carpal ligament, a strong band of connective tissue, forming the top of the tunnel. The median nerve, which controls sensation in the palm side of the thumb, index finger, and long fingers as well as the muscles around the base of the thumb, extends from the forearm to the hand through the carpal tunnel. Carpal tunnel syndrome is a hand an arm condition that occurs when synovium (tissues) surrounding the flexor tendons in the wrist is inflamed and as a result, puts pressure on the median nerve. The swelling of the synovium narrows the already-limited space within the carpal tunnel and crowds the median nerve. Women are more liked to develop carpal tunnel syndrome than men and there are a number of different ailments and conditions contribute to the development of the condition, including heredity, age, medical conditions such as diabetes or thyroid gland imbalance, as well as hormonal changes caused by pregnancy.
Individuals who have developed carpal tunnel syndrome commonly have the following symptoms:
- Pain, numbness, or tingling in the affected hand
- Overall weakness in the hand signaled by a greater tendency to drop things
- Unusual or strange sensation and pain going up the arm towards the shoulder
- Shock-like sensation in the fingers – primarily thumb, index, and long fingers
Early diagnosis and treatment of carpal tunnel syndrome can greatly help in reducing symptoms and avoiding more permanent damage to the nerves and muscles. Therefore, it is strongly advised to visit a physician if and individual experiences any of the aforementioned symptoms or suspect carpal tunnel syndrome.
Diagnosis of carpal tunnel syndrome is generally made upon a physical examination and imaging studies. After taking a full history of the symptoms and any prior injuries, the physician will examine the hand for feeling in the fingers and the strength of the muscles in the hand. The physician might put pressure on the median nerve by bending the wrist or simply pressing or tapping on the nerve to see if symptoms worsen. If the individual has limited motion in the wrist, the physician may order x-rays to rule out other conditions. To confirm the diagnosis and identify the best treatment option, the physician may also conduct an electrical testing of the median nerve.
Early diagnosis of carpal tunnel syndrome will typically respond quite well to non-operative treatment, and for most people, the condition will only worsen if left untreated. The main objective of treatment is controlling inflammation and reducing symptoms. Operative treatment is typically a last resort after non-operative approaches have been exhausted.
Activity Modification – Pain is often aggravated when making certain movements with the wrist, therefore changing the patterns of hand usage to avoid activities that worsen the symptoms may be helpful.
Medication – Pain relief medication such as acetaminophen as well as non-steroidal anti-inflammatory medicines (NSAIDs) can significantly reduce pain and swelling.
Brace or Splint – The physician might recommend the use of a supportive brace or splint worn over night or throughout the day to limit the movement of the wrist and keep it in a neutral place.
Steroid Injections – Injecting the wrist with cortisone, a powerful anti-inflammatory medicine, might aide in decreasing pain, however, the pain is likely to return.
Surgery –Surgery may be an option when more-conservative treatments don’t relieve pain or numbness caused by severe carpal tunnel syndrome. The goal of surgery will be to reduce or eliminate the pressure on the medial nerve by trimming the ligament that is contributing the pressure. Options must be discussed extensively with the physician to identify the appropriate surgical procedure.
Recovery, especially after a surgery, can take several weeks if not months. Each patient is unique and their recovery will depend on the treatment method prescribed by the physician. Full recovery from surgery can take several months at which point the individual may return to their prior level of activity.
CALL 911 IMMEDIATELY IF YOU ARE HAVING A MEDICAL EMERGENCY!
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