Carpal Tunnel Syndrome

Carpal

Carpal tunnel syndrome is a painful disorder of the wrist that occurs when the median nerve travelling through the narrow passageway called the carpal tunnel, comes under pressure. Nerve entrapment occurs when the tunnel, a passageway made up of bones and ligament, becomes narrowed and inflamed, thereby compressing the median nerve.

The median nerve is responsible for providing feelings to the thumb, index, middle and ring fingers; when the carpal tunnel gets swollen or narrowed, the nerve gets pressed, resulting in excruciating pain, tingling and numbness in the wrist and hand. Other symptoms include weakness of the hand resulting in difficulties in gripping or manipulating objects and inability to make a fist.

The compression of the median nerve can be due to a variety of factors including repetitive and prolonged use of hand, genetics, physical injury or trauma and the presence of other underlying medical conditions. People who use vibrating machines like drillers and dentists or those bending their hands for long periods of time on computers or musical instruments can also end up with compressed nerves. Other medical conditions like arthritis, thyroid dysfunction, diabetes and the presence of tumors within the carpal tunnel can all result in compression of the medial nerve.

The pain is felt more at bedtime and may give sleepless nights; in severe cases, the pain may radiate to the forearm, elbow, arm and the shoulder. The incidence is higher in women, especially those who are obese, or it may run in families.

Diagnosis of carpal tunnel syndrome requires a comprehensive examination and history check by a neurologist; he may ask you to perform specific tasks to confirm the diagnosis. Electroneurography and electromyography are some of the best tests for confirmation of carpal tunnel syndrome; alternatively, ultrasound or MRI scans can be used when above tests provide ambiguous results.

The treatment regime is largely dependent on the severity of the condition with daily use of non-steroidal anti-inflammatory drugs to provide relief from the pain as well as reduce swelling. Steroid injections are also known to be helpful in pain relief as well as reducing inflammation. Physiotherapy to loosen the muscles in the hands and wrists is helpful too and some even recommend the use of acupuncture as it has been known to provide pain relief. Wearing a brace to keep the wrist immobilized and supported helps to a certain degree, but whenever possible, the hand should be rested. One should remember also that this condition can take up to six months to normalize, so miracles shouldn’t be expected overnight!

If all these conservative treatments do not work or if there is severe nerve compression which is unlikely to respond to medications, your doctor may recommend surgery to relieve the compression. The procedure involves widening the tunnel to relieve pressure and is called carpal tunnel release, which is a short day-care procedure

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