CARPAL TUNNEL SYNDROME

 

If you ever experienced numbness in your hands and fingers as you fell asleep it might be an early sign of carpal tunnel syndrome (CTS). And if utensils keep falling off your hand in the kitchen, you might have ignored it a bit too long. Carpal Tunnel Syndrome is a condition in which the median nerve, which runs from the forearm into the palm of the hand, becomes compressed at the wrist. The compression may cause pain, numbness, and weakness in the fingers, hands, and wrists, and sometimes the arms. It is fairly common involving approximately 3% of the general population.

 

Symptoms

• Numbness, tingling, burning, and pain
• Especially in the thumb and the index, middle, and ring fingers
• Shock like sensations that radiate to the thumb and index, middle, and ring fingers
• Pain and tingling that extends to the whole hand or up to the wrist and forearm toward the shoulder
• Hand weakness and clumsiness
• This may cause difficulty with fine movements such as buttoning clothes
• Dropping things
• This may be due to weakness, numbness, or a loss of awareness of where the hand is in space (proprioception)

I have also encountered patients who complain of

• Stiff fingers
• Inability to make a fist
• Fingers feel swollen even though little or no swelling is apparent
• Itchy palms
• Changes in hand temperature (colder or warmer)
• Changes in skin color of the affected hand
• Untreated, the muscles at the base of the thumb may waste away
• Inability to determine between hot and cold by touch (in severe cases)

 

Why does it occur?

A bunch of structures – tendons, in their synovial sheathes, nerves and blood vessels are entering the palm from the forearm. These tendons help us to close the fingers and thumb and form a fist. These tendons are attached to their muscles in the forearm which contract to form a fist. In order to prevent these tendons from bow-stringing across the wrist while they contract they and the Median nerve are held close to the bones by a tight fibrous band, the transverse carpal ligament, and this ligament and the underlying carpal bones form the carpal tunnel. In health the tunnel allows its contents to glide effortlessly but if the contents increase in size the Median nerve gets compressed and causes the above mentioned symptoms. 

 

People who use vibratory tools in their profession often encounter this problem. So do people who use high force repeatedly like hammering, do long hours of manual work with extreme wrist motions. People who suffer from a thyroid disease called hypothyroidism, where the gland makes lees amount of thyroxine hormone than what the body requires are also prone to CTS as are people who have rheumatoid disease. Patients on haemodialysis, patients with a history of wrist fracture and dislocation in the past and the elderly often end up with CTS. Carpal tunnel syndrome is more common among women than men and is more likely to affect middle-aged people.

 

Preventive Measures

At the very outset the opinion of a Plastic Surgeon or a Hand Surgeon should be obtained and some investigations should be done before you start these preventive measures. This is vital because you may already be too late in presenting and well beyond the stage of these preventive measures. Here are six effective ways to treat numbness in hands, which we recommend you give a try as soon as you experience the early signs of carpal tunnel syndrome, after you have ascertained that you can afford to delay the definitive treatment:

 

1. Take frequent breaks: Carpal tunnel symptoms are especially evident among people whose jobs require a lot of repetitive motion in their hands and wrists. Your hands need regular breaks between working sessions, so be sure to set a reminder every two to three hours and do a little exercise.
2. Keep wrists straight while working: There is a positive association between wrist posture and carpal tunnel syndrome, studies show. Adjust your chair so that your forearms are level with your keyboard and try to keep your wrists in a neutral position without bending them.
3. Consider wearing a wrist splint: Wearing a splint will hold your wrist in a neutral position. It is especially important to wear one if you do a lot of typing or while sleeping at night, so wearing a wrist splint can make a significant difference.
4. Do wrist exercises: Focus on exercises that will stretch the muscles surrounding the wrists to help ensure that the tendons that pass through the carpal tunnel stay in good shape. Include a variety of stretches, bending, and flexing your wrists when doing these exercises. carpal tunnel syndrome
5. Use correct posture: Using correct posture while working is important for more than just your back. If you succumb to poor posture on a regular basis, your shoulder nerves tend to be compressed at the thoracic outlet, which ultimately affects your wrists and hands. Make sure that you sit with your back straight and your feet flat on the floor.
6. Ice fomentation of your wrists: Ice will help relieve the pain in your wrists and hands. So ice your wrist or soak it in an ice bath for 5 to 10 minutes. While it won't prevent carpal tunnel syndrome, it will alleviate the pain that it causes.
7. Cortisone injections: Cortisone can reduce inflammation and swelling but can also weaken your immune status, worsen diabetes, cause fluid retention and weight gain and cause osteoporosis, tendon rupture and high blood pressure. It can take up to 7 days for a cortisone injection to begin working in the body. The effects of the injection usually last up to 2 months, but sometimes longer.

  

How do we diagnose it?

·        Tinnel Sign: In this test, the physician taps over the median nerve at the wrist to see if it produces a tingling sensation in the fingers.

·        Wrist flexion test (or Phalen test): In this test, the patient rests his or her elbows on a table and allows the wrist to fall forward freely. Individuals with carpal tunnel syndrome will experience numbness and tingling in the fingers within 60 seconds. The more quickly symptoms appear, the more severe the carpal tunnel syndrome.

·        Nerve Conduction studies: This is the surest way of documenting the status of the Median Nerve and remains the most proven indicator of surgery. After the surgery, once the compression on the Median nerve is relieved, repeating this study after 6 months may also document a recovery of the nerve.

 

Treatment

Surgery is recommended when carpal tunnel syndrome does not respond to non-surgical treatments or has already become severe. The goal of surgery is to increase the size of the tunnel in order to decrease the pressure on the nerves and tendons that pass through the space. This is done by cutting (releasing) the transverse carpal ligament that covers the carpal tunnel at the base of the palm. This can be done in regional anaesthesia and under tourniquet control and so there is virtually no blood loss. It can be done both by open approach as well as by an endoscope and both techniques are equally effective, though the open approach is less risky. Sutures are removed after 10 days. However you will immediately feel the difference in your hand after surgery, once the local anaesthesia effect wanes off. That pain and tingling sensation will be gone!

Unlike the Cortisone treatment surgery is definitive and you will never have the same symptoms again in your operated hand. Recovery times can vary depending on your age, general health, severity of carpal tunnel syndrome and how long you had symptoms. You will continue to gain strength and sensation in the following year after surgery.

 

So don't suffer with a Carpal Tunnel Syndrome. Contact a Plastic Surgeon or a Hand Surgeon and get quick and lasting relief.