Basically, a hand & arm condition which features tingling, numbness & other symptoms; Carpal Tunnel Syndrome is generally caused by a nerve being pinched within the wrist. There are a number of factors which are contributing to carpal tunnel syndrome, including anatomy of the patient’s wrist, certain underlying health conditions & quite possibly patterns of hand use. Wrists are typically bound by bones & ligaments & carpal tunnel is a narrow passageway which is located on the palm side of the wrist. Carpal tunnel in fact is the main nerve to hand & nine tendons which bend the fingers. Compression of this nerve results in producing tingling, numbness & eventually weakness in hand which characterizes carpal tunnel syndrome. However, it is fortunate that for most people developing carpal tunnel syndrome, proper treatment can help relieve numbness & tingling & effectively restore hand & wrist function.
Signs & Symptoms of Carpal Tunnel Syndrome
Most often, carpal tunnel syndrome starts gradually with tingling or numbness in thumb, index and/or middle fingers which usually come & go. This may sometimes be associated with discomfort in wrist & hand. Most common carpal tunnel syndrome symptoms include the following.
- Numbness or Tingling – Most carpal tunnel syndrome patients experience numbness & tingling in fingers or hand, especially the thumb, index, middle and/or ring fingers but not the little finger. This sensation is usually found to occur while people are holding a newspaper, phone or steering wheel or, commonly, waking the patient from sleep. This sensation, quite often extends from the wrist up to the arm. Many people are also found to ‘shake out’ their hands trying to relieve symptoms. This numb feeling may in some cases become constant with progression of the disorder.
- Weakness in Hand – Patients may also experience weakness in hand & a general tendency to drop objects while holding. This may either be due to numbness in hand or because of weakness in thumb’s pinching muscles, which are generally controlled by the median nerve.
Time to Seek Appointment with Doctors for Carpal Tunnel Syndrome
People having persistent signs & symptoms which are suggestive of carpal tunnel syndrome, especially when these are interfering with sleep patterns & normal activities, it is time to seek professional medical help. In case this condition is left untreated, there are chances that permanent muscle & nerve damage may occur.
Causes of Carpal Tunnel Syndrome
Carpal tunnel syndrome is primarily found to occur as a result of compression exerted upon the median nerve. Median nerve is found to run from the forearm through carpal tunnel or a passageway in wrist to the hand. This is meant to provide sensation to the palm side of fingers & thumb with the sole exception of the little finger. This nerve also provides signals to move muscles (motor function) around the base of thumb. Generally speaking, anything which irritates or crowds or compresses the median nerve inside the carpal tunnel space is bound to cause carpal tunnel syndrome. Like for example, wrist fractures can narrow down the carpal tunnel so as to irritate the median nerve, as also swelling & inflammation can which is resulting from rheumatoid arthritis. However, in many cases, no single cause of carpal tunnel syndrome can be identified. Most often, it can be a combination of risk factors which eventually contribute to development of this condition.
Risk Factors Associated with Carpal Tunnel Syndrome
There are a number of factors which are generally associated with carpal tunnel syndrome. Though, singly by themselves they do not cause carpal tunnel syndrome, but collectively they definitely increase chances of aggravating or developing damage to the median nerve. Some of the most common risk factors associated with carpal tunnel syndrome include the following.
- Sex – Carpal tunnel syndrome is found to be more common among women. This is generally because carpal tunnel area is relatively small in women than in men; this effectively means that there is less room for error. Moreover, women having carpal tunnel syndrome may also be having smaller carpal tunnels than women who do not have this condition.
- Anatomic Factors – Dislocation or wrist fracture can alter space within the carpal tunnel & eventually create extraneous pressure upon the median nerve. Moreover, it may be people with smaller carpal tunnels who most likely suffer from carpal tunnel syndrome.
- Nerve-Damaging Conditions – This includes some chronic illnesses like diabetes which increase risk of nerve damage, including damage to the median nerve.
- Inflammatory Conditions – This includes illnesses which are characterized by inflammation, like rheumatoid arthritis. Rheumatoid arthritis can also affect tendons in wrists & subsequently exert pressure on the median nerve.
- Alterations in Balance of Body Fluids – Fluid retention, which is common during menopause or pregnancy, can also increase pressure within the carpal tunnel so as to irritate the median nerve. Carpal tunnel syndrome which is associated with pregnancy will usually resolve on its own after childbirth.
- Other Medical Conditions – There are certain other conditions like kidney failure, thyroid disorders, obesity & menopause which may increase chances of a person developing carpal tunnel syndrome.
- Workplace Factors – It is also possible that people working with vibrating tools or on assembly lines which require repetitive or prolonged flexing of wrists may generate harmful pressure on median nerve in order to worsen existing nerve damage.
However, scientific evidence which is available is conflicting & these risk factors have not been established as to be the direct causes of developing carpal tunnel syndrome. There are several studies which have tried to evaluate whether there is any association between working on computers & carpal tunnel syndrome. Although computers can cause different types of hand pain, there has not been enough quality & consistent evidence which can support that extensive computer usage is a risk factor for carpal tunnel syndrome.
Tests & Diagnosis for Carpal Tunnel Syndrome
Doctors usually conduct one or more of the following tests in order to determine whether a person is having carpal tunnel syndrome.
- History of Symptoms – Doctors would usually begin by reviewing the patient’s symptoms. This would include the pattern of signs & symptoms which can offer clues to the underlying cause of carpal tunnel syndrome. Like for example, since median nerve does not provide sensation to the little finger, any symptom in this finger would indicate that the problem is other than carpal tunnel syndrome. Another important clue is timing of these symptoms. Most usual time when patients experience carpal tunnel syndrome includes when they are holding a phone or newspaper, or gripping the steering wheel or waking up at night due to symptoms.
- Physical Examination – Doctors will routinely conduct a physical examination for carpal tunnel syndrome. This would include testing the feeling in fingers & strength of muscles in the patient’s hand. Pressure on median nerve at wrist which is produced by bending the wrist, tapping on nerve, or simply pressing upon the nerve will usually bring on symptoms in many patients.
- X-Rays – Quite a few doctors recommend an x-ray test of the affected wrist in order to exclude other causes of wrist pain like a fracture or arthritis.
- Electromyogram – Electromyography is meant to measure tiny electrical discharges which are produced in muscles. Doctors would insert a thin-needle like electrode into specific muscles during this procedure. This test will help evaluate electrical activity of the patient’s muscles when they contract & while they are at rest. Electromyogram can effectively determine if any muscle damage has occurred & can also be used to rule out many other conditions.
- Nerve Conduction Study – This is in fact a variation of electromyography, where two electrodes are taped on to the skin of the patient. A small shock is subsequently passed through the median nerve so as to see if any electrical impulses slow down within the carpal tunnel. This test procedure can be effectively utilized to diagnose the patient’s problem & rule out any other conditions.
Doctors may also recommend that patients see another doctor (neurologist) who is trained in brain & nervous system surgery (neurosurgeon), rheumatoid arthritis, hand surgery or in other areas in case signs & symptoms indicate some other medical disorder or in case any other additional treatment is needed.
Treatment Options & Drugs for Carpal Tunnel Syndrome
Carpal tunnel syndrome cases should be treated as early as possible, soon after the patient has begun to experience symptoms. Quite a few people with mild symptoms of this condition can erase their discomfort by taking frequent breaks to rest their hands & by avoiding activities which worsen symptoms. Cold ice packs can also be applied so as to reduce occasional swelling. When these techniques fail to offer relief within a few weeks, other available treatment options would include wrist splinting, medications & surgery. Wrist splinting & other conservative methods of treatment are more likely to help in case patients have tried only mild to moderate symptoms for less than 10 months of time.
- Nonsurgical Therapies
In case carpal tunnel syndrome is diagnosed early, nonsurgical treatment methods can help improve symptoms. Common nonsurgical methods include the following.
- Wrist Splinting – Splints are designed to hold the wrist while sleeping. This is generally meant to relieve nighttime symptoms of numbness & tingling. Nocturnal wrist splinting can be an ideal option for women who are pregnant & having carpal tunnel syndrome.
- NSAIDs – Nonsteroidal Anti-Inflammatory Drugs – NSAIDs like ibuprofen (Motrin IB, Advil) can effectively help relieve pain caused by carpal tunnel syndrome in the short term. However, there is no sufficient evidence that these drugs can improve carpal tunnel syndrome symptoms.
- Corticosteroids – Quite often doctors inject the patient’s carpal tunnel syndrome with corticosteroids like cortisone in order to relieve pain. Corticosteroids normally decrease swelling & inflammation & which would eventually relieve pressure on the median nerve. However, oral doses of corticosteroids are not considered to be as effective as corticosteroid injections in treatment of carpal tunnel syndrome.
In cases where carpal tunnel syndrome is resulting from inflammatory arthritis like rheumatoid arthritis, then treatment of arthritis can effectively reduce symptoms of carpal tunnel syndrome. However, this possibility has not yet been scientifically proved.
Surgery for Carpal Tunnel Syndrome
When carpal tunnel syndrome symptoms are still persistent & severe even after trying nonsurgical therapies, then surgery may be the most appropriate medical solution. However, goal of carpal tunnel syndrome surgery is to relieve pressure upon the median nerve by cutting off the ligament which is pressing on the nerve. Surgery is most often performed using two different techniques. Patients must however discuss risks & benefits of each technique with surgeons prior to undergoing surgery. Risks of surgery normally include incomplete release of ligament, nerve or vascular injuries, wound infections & scar formation. Nevertheless, final results of both endoscopic & open surgery are quite similar.
- Endoscopic Surgery – Surgeons use a telescopic type of device attached with a tiny camera (endoscope) to view inside the carpal tunnel & cut the ligament through 1 – 2 small incisions in wrist or hand during the endoscopic surgery operation for carpal tunnel syndrome. Typically, endoscopic surgery will result in lesser pain than open surgery does during the first few days or weeks following carpal tunnel surgery.
- Open Surgery – Surgeons will usually make a large incision in the palm of hand over the carpal tunnel & cut the ligament to free the median nerve in open carpal tunnel surgery procedure. This procedure can also be conducted by using a smaller incision & which may also eventually reduce risk of complications.
During the healing process following the carpal tunnel surgery, ligament tissues would gradually grow back together while allowing more room for median nerve than it had existed prior to undergoing surgery. Doctors will generally encourage patients to use their hand after surgery by gradually working back to normally use the hand while avoiding extreme wrist positions or forceful hand motions. Weakness or soreness may however take several weeks to a few months of time to resolve following carpal tunnel surgery. Moreover, in case carpal tunnel syndrome symptoms were very severe prior to undergoing surgery, they may not completely go away following surgery.
Lifestyle Changes & Home Remedies for Carpal Tunnel Syndrome
Following steps may help patients gain at least temporary relief from their carpal tunnel syndrome symptoms.
- Taking quick breaks from repetitive activities involving use of hands.
- Rotate wrists & stretch palms & fingers.
- Take pain relievers like aspirin, naproxen (Aleve) & ibuprofen (Motrin IB, Advil).
- Wearing a wrist splint at night. Wrist-splints are generally available as over-the-counter sales at most pharmacies or drugstores. These splints must be snug-fit but not tight.
- Patients must avoid sleeping on hands so as to help ease numbness or pain in wrists & hands.
In case weakness, numbness or pain recurs or persists, it would be best to see a doctor.
Alternative Medicine for Carpal Tunnel Syndrome
Alternative medicine therapies can be conveniently integrated along with the regular health plan in order to help patients deal with carpal tunnel syndrome signs & symptoms. However, patients may have to experiment so as to find a treatment which works best for them. Still, it would be sensible that patients check with doctors before they try any alternative or complimentary treatment.
- Yoga – Postures in yoga are generally designed for balancing, stretching & strengthening every joint within the upper body including the entire upper body as well. These postures can therefore help reduce pain & improve grip strength of patients suffering from carpal tunnel syndrome.
- Hand Therapy – There is preliminary evidence suggesting that certain occupational & physical hand therapy techniques can effectively help improve symptoms associated with carpal tunnel syndrome.
- Ultrasound Therapy – High-intensity ultrasound therapy can also be used to raise temperature of targeted areas of body tissue in order to reduce pain & promote healing in people. This course of ultrasound therapy lasting over several weeks can help improve signs & symptoms associated with carpal tunnel syndrome.
Preventive Measures for Carpal Tunnel Syndrome
Although there are no proven strategies to prevent occurrence of carpal tunnel syndrome, but patients can minimize the amount of stress they put on their wrists & hands by taking precautions mentioned below.
- Reducing Force to Relax Grip – Normally, most people use more force than what is required to perform several manual tasks. Like, for people whose work involves a cash register, they should hit the keys softly. Carpal tunnel syndrome patients can use a bigger pen with an oversized soft-grip adapter & free-flowing ink for prolonged sessions of writing. This way they will not need to grip the pen tightly or even press as hard on paper.
- Taking Frequent Breaks – It would be ideal for carpal tunnel syndrome patients to give their wrists & hands a break by gently bending & stretching them periodically. They should therefore alternate tasks whenever possible. Using equipment which vibrates or which requires the person to exert great amount of force, taking breaks would not just be a good idea, but even more important.
- Watching Form – Carpal tunnel syndrome patients should avoid bending wrists all the way up or down. It is best to relax in the middle position. For patients using keyboards, it would be best to keep it at elbow height, or even slightly lower.
- Improving Posture – Sometimes, an improper posture can cause shoulders to roll forward. Neck & shoulder muscles are thus shortened & nerves within the neck are compressed when shoulders are in this position. This would eventually affect the person’s fingers, wrists & hand.
- Keeping Hands warm – Carpal tunnel syndrome patients are most likely to develop stiffness & pain in hand when they work in cold environments. In case they cannot control temperature at workplace, they should pur on fingerless gloves, which would keep their wrists & hands warm.
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Affordable Carpal Tunnel Syndrome Treatments with Orthopaedic Surgery India
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