The carpal tunnel is a passage for nerves and tendons on the flexing side of the wrist. Carpal tunnel syndrome refers to a narrowing (compression) of the median nerve in the carpal tunnel.
Causes
Around the carpus, the median nerve runs along the flexor side of the wrist and through the carpal tunnel, together with tendons. Various causes can result in the carpal tunnel narrowing and thus putting pressure on the median nerve.
Inflammation of the flexor tendons due to increased strain or an underlying rheumatic disease are often responsible for the development of carpal tunnel syndrome.
Swelling after injuries or wrist fractures are other possible causes. Often, however, there is no specific reason for the illness. Overall, it tends to affect women more than men, with hormonal differences assumed to be responsible.
Symptoms
Pressure on this nerve causes losses of sensation in the thumb and the index, middle and ring fingers. These losses of sensation manifest themselves as tingling, formication, numbness and the fingers ‘falling asleep’. They are also sometimes accompanied by burning pain, which can radiate into the arm. Symptoms are usually worse at night or if the hand is held in a bent position for longer periods of time, such as when driving a car or reading.
Diagnosis
Carpal tunnel syndrome is diagnosed based on the characteristic symptoms and through special examinations. These include measurements of the hand’s nerve function (electroneurography) and muscle function (electromyography) by stimulating the nerves and muscles with electrodes. An ultrasound examination can show the narrowing of the carpal tunnel and any inflammation of the flexor tendons if present.
Conservative treatment
Conservative and surgical measures may be considered for treatment, depending on the progression. Carpal tunnel syndrome is usually treated conservatively at first. This involves the wrist being held in a stretched position with a splint or a bandage, primarily at night. In parallel, flexor tendon inflammation is often treated using anti-inflammatory medications or local cortisone injections. The earlier conservative treatment is started, the better the chances of success. That is why it is important to have any symptoms clarified quickly.
Surgical treatment
If symptoms persist despite conservative treatment or measurements are showing severe narrowing, surgery is usually unavoidable. It is usually done on an outpatient basis. During the surgery, the carpal tunnel is opened, relieving the strain on the nerve.
