Carpal tunnel syndrome – causes, symptoms, treatment and prevention. When is surgery necessary?

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The cup falls out of your hand and crashes to the floor with a crash. You have a hard time holding a pen, the letters change shape strangely, you feel a tingling sensation around your thumb and wrist. It may be carpal tunnel syndrome, a disease that was very rare 50 years ago, and today it is the cause of up to 8% in some countries. all sick leave of office workers. Because carpal tunnel syndrome is often associated with a specific position of the hand on the mouse and computer keyboard. Although it is not only about IT specialists, secretaries and journalists!

Carpal tunnel syndrome – basic information

Carpal tunnel syndrome can hardly be called a disease because it is rather a collection of symptoms associated with compression of the median nerve in the carpal tunnel. Carpal tunnel syndrome belongs to the group of compression neuropathies. This means that the unfavorable changes in the nerve are caused by excessive mechanical pressure.

What exactly is a carpal tunnel? It is the transition from the forearm to the hand that is limited by the wrist bones and connective tissue. Nerves, vessels and tendons pass through the carpal tunnel. It is the pressure on the nerves that pass through the isthmus that causes a very severe pain called carpal tunnel syndrome.

Carpal tunnel syndrome is a condition that affects an increasing percentage of the population. It is currently estimated that approximately 15% of people worldwide are struggling with symptoms that could indicate carpal tunnel syndrome. Much lower statistics concern the performance of tests helpful in the correct diagnosis of this disease. Carpal tunnel syndrome most often affects women over 55 years of age. In nearly 60% of patients, the symptoms of carpal tunnel syndrome affect both hands.

If you want to learn more about the skeletal system, check out: Skeletal system – structure and functions

Carpal tunnel syndrome causes

There are two types of carpal tunnel syndrome: chronic and acute. The main difference between the two types is the causes of the onset of the disease. Chronic carpal tunnel syndrome is usually caused by inflammation of the tendons, haemophilia, lipoma, untreated fracture or dislocation of the navicular bone, vascular abnormalities, and traumatic scarring.

In the case of acute carpal tunnel syndrome, the causes of the symptoms include dislocation of the hand, purulent inflammation, contusions, hemorrhage, blood clot, and swelling of the wrist.

The actual cause of carpal tunnel syndrome is actually diagnosed in only 50% of the reported cases. One of the possible and common causes of this disease is excessive, prolonged and unilateral strain on the small muscles of the hand and forearm. Such a state is brought about by long-term typing, operating a computer mouse, working with tools, and also playing musical instruments.

Additionally, carpal tunnel syndrome can be a symptom complex that accompanies other diseases, including:

1. occupational diseases – carpal tunnel syndrome may be classified as an occupational disease. This is especially true for people who significantly overload the upper limb in their work. Carpal tunnel syndrome is common among butchers, hairdressers, writers, copywriters, programmers, and musicians;
2. rheumatic diseases – carpal tunnel syndrome may occur in the course of rheumatoid arthritis, systemic scleroderma, gout or degenerative joint disease;
3. endocrine and metabolic diseases– especially in the case of diabetes, hypothyroidism or acromegaly; 
4. infectious diseases – mainly affects people suffering from tuberculosis;
5. other disease states – carpal tunnel hematomas, osteomas, lipomas, bone fractures, osteomyelitis;

Carpal tunnel syndrome symptoms – monkey hand

When working on a computer, especially if we haven’t taken typing courses (or have taken them a long time ago, learning to write on a traditional typewriter, not the keyboard), we often keep our hands in the air, without any support for the wrists. Even trying to hold our hands according to the principles of ergonomics, we cannot avoid bending them for many hours and repeating the same movements over and over again, even several thousand times a day. And the median nerve in the carpal tunnel does not particularly like it.

Carpal tunnel syndrome begins innocently. The fingers (usually the thumb, index and middle finger) suffer, there is pain in the elbow and shoulder joint. At night, we are awakened by a pain in the hand. We downplay that by saying that she just stiffens. We probably slept badly, we pinned her down, tipping from side to side. We lower our hand, shake it off, and the ailments pass.

Then, however, the pain appears more and more often, the hand ‘runs through electricity’, it is difficult to clench it into a fist, draw a precise circle or an intricate pattern, evenly cut the paper with scissors. And the hand goes numb even when we are not sitting at the computer, not sleeping, or staying motionless for a long time.

During the development of the carpal tunnel syndrome, the feeling in the fingertips may gradually deteriorate, objects begin to fall out of the hands, and in the advanced stage, the muscles of the withers of the thumb disappear, which means that it ceases to be the opposite finger and becomes flush with the other fingers. Doctors call it the ‘monkey hand effect’.

A quick diagnosis of carpal tunnel syndrome is often difficult. Especially if one of the symptoms is numbness in the arm and hand in the elbow. For the doctor, this may be a signal that the patient suffers from changes in the cervical spine, and that he focuses on its treatment and rehabilitation. Meanwhile, the problem is still in the wrist. And only electromyography (EMG), i.e. a test showing muscle activity and conductivity in peripheral nerves, can finally show that we are dealing with carpal tunnel syndrome (Latin syndrome isthmi canalis carpi).

To reduce the discomfort associated with carpal tunnel syndrome, order the OS1st WS6 wrist compression bandage in black or flesh-colored. Various sizes of the wristband are available on Medonet Market.

What diseases are manifested by wrist pain? Check it out: Wrist pain – what can it be caused by?

People who work physically (for example, clutching a shovel all day long or screwing a screw with the same movement for years) also get sick. Carpal tunnel syndrome often occurs after fractures and other injuries to the hand.

Women who have not complained about wrist ailments or had barely noticeable symptoms often complain of them during pregnancy or in the first months after giving birth. There are several reasons for this, mainly hormonal changes and water retention in the body, also increasing the swelling in the wrist canal. With a small child, the wrists are additionally overloaded by constantly lifting and putting the baby down, rocking it on the hands, holding it against the breast without moving, in a position unnatural for the wrists, etc. So it is worth talking to a physiotherapist or even a midwife, who will tell you how to take care of the baby without wrist strain.

Carpal tunnel syndrome also occurs very often in diseases such as rheumatoid arthritis, diabetes, kidney failure, as well as in alcoholics, obese people and people who walk on crutches. It is almost an occupational disease of cyclists gripping the handlebars for many hours a day.

How to take care of your health after 40? Read: The health record of a 40-year-old

After the initial diagnosis, the primary care physician will refer the patient to an appropriate specialist. For carpal tunnel syndrome, the appropriate physician may be a rheumatologist, orthopedist, neurologist, or hand surgeon. In special cases, when carpal tunnel syndrome is caused by another comorbid disease, the general practitioner may send the patient to an endocrinologist, diabetologist or occupational medicine physician.

If you want to learn more about visits to a specialist doctor, check: How to make an appointment with a specialist doctor? Referrals and deadlines

Carpal tunnel syndrome – an essential diagnosis

In many cases, carpal tunnel syndrome is only diagnosed based on a medical history and physical examination. However, it also happens that a specialist doctor diagnoses a patient with carpal tunnel syndrome will recommend some diagnostic tests.

Tests that may be helpful in the diagnosis of carpal tunnel syndrome include:

1. X-ray image – this test is not used to diagnose carpal tunnel syndrome, but it is helpful in excluding wrist fractures, degenerative changes, and tumors;
2. ultrasound imaging – this test is performed to assess the size of the median nerve;
3. magnetic resonance imaging – it is used to assess possible swelling of the median nerve and the size of the carpal tunnel;
4. assessment of nerve conduction and electromyogram, i.e. EMG – this test is performed to assess the possible loss of conductivity in the median nerve. EMG testing is performed when the clinical picture is unclear or prior to surgery for carpal tunnel syndrome.

What diagnostics is necessary in the case of rheumatic diseases? Check: Rheumatic profile, i.e. what tests will help detect rheumatic diseases

Physical therapy in carpal tunnel syndrome

If your doctor determines you have carpal tunnel syndrome, you will start with physical therapy, wearing an elastic band around your wrist, and taking high doses of vitamin B6 for at least 8 weeks. If that doesn’t work, your doctor will likely advise you not to use your affected arm, even for 3 months, or to wear a plaster for 3 weeks. Such complete stillness is the most effective way to regenerate the nerve, and is 90% effective in people with mild disease.

– Few people are able to decide on it, because it is about completely relieving the diseased limb, not even lifting a cup of tea in it, not holding a pen in it, not driving a car – explains Maria Łaszewska, a physiotherapist and physiotherapist, who herself suffers from Carpal tunnel syndrome. – If we do not want to put our hand in the plaster, which shortens the whole process of ‘rest’, we should keep the arm in a sling to refrain from instinctively reaching for a sandwich, fork or apartment keys.

As long as the symptoms of the carpal tunnel syndrome are not very severe, it seems to us that ‘it will be somehow’ and it is difficult for us to decide not to use the sick hand for several weeks. Later, as the disease gets worse, this method may no longer be effective. Then the doctor recommends a series of hydrocortisone injections.

In most cases, they do not improve the situation permanently and sooner or later a decision about surgery has to be made.

The doctor adjusts the method of carpal tunnel syndrome treatment to the patient, i.e. the duration and severity of the disease. Treatment of this condition usually begins with drug therapy. The purpose of using medications for carpal tunnel syndrome is:

1. treatment of comorbidities or comorbidities;
2. controlling and eliminating pain ailments;
3. reducing inflammation;
4. relieving symptoms.

In the treatment of carpal tunnel syndrome, glucocorticosteroids, non-steroidal anti-inflammatory drugs and vitamin B6 are used.

What is worth knowing about physical therapy? Check: Physical therapy – types of physical therapy and when should it be used?

Carpal tunnel syndrome – surgery

Often the treatment of carpal tunnel syndrome ends with surgery. This applies to cases where the efficacy of pharmacotherapy has not been established. The indication for surgery is also the risk of occurrence or damage to the median nerve.

The course of the operation consists in cutting the ligament that covers the carpal tunnel. Such action increases the free space inside the carpal tunnel and reduces the pressure inside it.

The operation is performed in three ways:

1. incision of the palm surface of the hand and wrist – it is associated with a longer wound healing time and regaining full efficiency;
2. endoscopic surgery – the incision is very small, which results in a shorter wound healing and recovery time. The downside is the risk of having to repeat the procedure;
3. combination of incision and endoscopic method – is the newest method of surgical treatment of the carpal tunnel syndrome. 

What is the endoscopic method? Read: Endoscopy

Home remedies for carpal tunnel syndrome symptoms

You can also deal with bothersome symptoms of carpal tunnel syndrome with home remedies. However, it should be remembered that home remedies are not a method to cure the disease, but can only prevent the development of permanent changes in the median nerve and reduce unpleasant symptoms.

To minimize the unpleasant symptoms associated with carpal tunnel syndrome:

1. spend more time resting your fingers, hands and wrists;
2. give up or limit activities that cause ailments;
3. use non-steroidal anti-inflammatory ointments for swelling in the wrists;
4. apply cold compresses on the wrist (e.g. using Visiomed KINECARE VM-GB8 compresses on the ankle, wrist, elbows);
5. wear wrist braces available at pharmacies at night;
6. perform exercises that will improve strength and mobility in the hands and wrists;
7. try acupuncture or acupressure treatments.

As an aid, in carpal tunnel syndrome, wear a Gel wrist guard with magnets. You can buy it at a favorable price on Medonet Market. It stabilizes the wrist joint and regulates blood circulation.

What might pain in the wrist indicate? Check: Wrist – why does it hurt?

Carpal tunnel syndrome – median nerve decompression

The procedure called median nerve decompression is most often performed under local or regional anesthesia and leaves the hospital on the same or the next day. During the operation, the doctor cuts the flexor cord lengthwise and does not staple it. Thanks to this, the edges of the drawstring slide apart and a scar is formed above them, which becomes a new, wider drawstring. The nerve that runs through the carpal tunnel is no longer pinched and the symptoms disappear.

– This is the only effective method in the case of advanced carpal tunnel syndrome – confirms Maria Łaszewska. – Yes, there are complications of the isthmus, many people complain of numbness in the hand also after surgery, but even they admit that it is not as severe as pain in the carpal tunnel syndrome. I have already had one-hand surgery and can use it freely again. Next year, I will have surgery on the other wrist. 24 hours in the hospital, then a cast for two weeks, a sling, rehabilitation, a small seam visible for the rest of my life … Nevertheless, I have no doubt that it is worth it. Finally, my hand does not get numb at night and I can help my patients again and knit in my free time.

Carpal canal and median nerve

The tiny knuckles of the wrist form a tunnel called the carpal tunnel. It runs the median nerve and tendons, and is covered with a transverse ligament, called the wrist flexor cord. The problem arises when this cord overgrows and begins to compress the median nerve. Very quickly, at the point of pressure, there is swelling of the inflammatory nerve or the surrounding tissues. Due to the pressure, the nerve fibers are not nourished properly, and then the discomfort and swelling intensify. Which, of course, causes further disturbances in the nutrition of nerve fibers and even more severe ailments.

You can learn more about the structure of the wrist in this article: Hand bones – anatomy, injuries

Regardless of the result of home diagnosis, see an internist or orthopedist if wrist pain or numbness recurs regularly!

1. Test Phalena: Raise your hand in front of you and bend your elbow to a right angle. Then bend your wrist as far as possible, as if you want to touch the inside of your wrist with your fingers. Keep your fingers and hand relaxed. Hold this position for a minute. Carpal tunnel syndrome usually develops numbness, tingling, or a ‘running current’ sensation along the nerve.
2. Inverted Phalen test: Bring your palms together, as if in prayer, with your fingers extended, and pull your elbows to the sides so that your wrists are bent as much as possible and your fingers are pressing against each other. If you suffer from carpal tunnel syndrome, pain will appear within 10-15 seconds.
3. Test Tinela: Ask someone in your household to gently tap (e.g. with a flat tip of a pen) around the wrist, on the inside, especially in the middle, and then move 2-3 cm towards the palm of your hand. Knocking on sick people causes pain and tingling.
4. Tourniquet test: Put the armband on your arm and inflate it above your normal systolic pressure. If your hand starts tingling and going numb in your wrist, you may suspect you are suffering from carpal tunnel syndrome.

What ailments should you go to the orthopedist? Check: Orthopedist – what diseases does he treat?

Prevention of carpal tunnel syndrome is based on:

1. healthy lifestyle – maintaining a correct weight, physical activity, no addictions;
2. care for muscle strength – frequent stretching of the muscles of the arms, forearms and hands;
3. observing your activities and giving up those that cause pain, tingling or numbness in the hands;
4. taking care of the correct positioning of the hands during exercises or working in front of the computer;
5. making sure to evenly distribute the load on both hands;
6. maintaining the correct body posture;
7. wearing a brace on your wrists or wearing it overnight.