Although not so uncommon, it has only recently started to gain recognition, this interestingly named disease with insidious symptoms. Carpal tunnel syndrome can be characterized by numbness in the fingers and intense pain in the hand or possibly in the arm. This pain can escalate to unbearable level and in extreme cases, lead to irreversible atrophy of the muscles in the palm.
The disease
Although the symptoms manifest as numbness and/or pain in the hand and fingers, the disease got its name in connection with the Latin term for the wrist (carpus), as the triggering factor can be localized in this area. The role of the wrist is to provide a connection between the forearm and the hand, allowing for the multidirectional movement of the hand. The proximal part of the hand, the carpus, is composed of eight small, irregularly shaped bones, called the carpal bones. These carpal bones have hollow formations on their palmar side because it is in these recesses (figuratively described as tunnels or canals) in which the hand flexor tendons and the median nerve run. The median nerve originates from the cervical part of the spine and runs through the shoulder and elbow to the wrist, being responsible for the innervation of the muscles in these areas.
The second part of the term carpal tunnel syndrome is an illustrative reference to the essence of the disorder: if this “tunnel,” through which the median nerve passes, narrows for some reason, it will compress the nerve, leading to the symptoms associated with the disease.
Causes of Carpal Tunnel Syndrome
The narrowing of the carpal tunnel is most often caused by the swelling of tendons surrounding the nerve, but it can also be associated with factors such as fractures, inflammation, hematoma, bone growths or joint disorders.
Swelling of tendons can be triggered by:
- hormonal changes (e.g., pregnancy, menopause),
- certain autoimmune diseases,
- diabetes,
- rheumatic diseases,
- occupational hazards: extended and intense physical stress on the hand (e.g., in potters).
Symptoms of carpal tunnel syndrome
The compressed nerve under pressure causes disturbances in the areas it serves: in the palm and the first three fingers, but the symptoms can also radiate to the wrist and arm, even up to the shoulder.
Typical symptoms include:
- numbness in the thumb, index, and middle fingers, as well as the palm.
- reduced sensitivity in the fingertips.
- pain in the fingers.
- later on, a localized, crampy, sharp pain in the palm, which can radiate to the forearm and upper arm.
Initially, the symptoms are milder and occur periodically, primarily during the day. However, in advanced stages, they become more persistent and predominantly afflict the patient at night, often escalating to an unbearable level.
As a secondary consequence of long-standing, untreated carpal tunnel syndrome, muscle atrophy in the palm may eventually occur, leading to an irreversible process and causes the softness of the palm pads and a weakening of gripping strength. The softening of the palm pads and numbness in the fingertips may also become permanent.
Treatment of carpal tunnel syndrome
It is important to diagnose the disease as early as possible not only because of the constant intense physical pain but also to prevent irreversible changes. Unfortunately, in many cases, the disease is misdiagnosed due to numbness and pain symptoms, leading to the prescription of inappropriate medication or physical therapy. If our symptoms do not improve despite these treatments, it is reasonable to suspect to have carpal tunnel syndrome, as it cannot be cured with the aforementioned therapies, resulting at best in a slight and temporary relief.
Relief and immobilization
In the early stages of the disease, providing relief to the wrist and hand can be beneficial. Using a splint at night can be attempted, while for daytime activities, it is strongly recommended to wear a specialized wrist stabilizer. A wrist stabilizer such as one with a padded palm area that allows free movement of the fingers is suitable for computer work from 30 to 180 minutes, reducing the pain associated with strain. However, continuous wear is not recommended (except on specific medical advice), as it may lead to muscle weakening.
Inflammation reduction
In more severe cases, anti-inflammatory medications may be prescribed, or in some cases targeted local steroid injection treatment may be considered – the latter only with careful consideration.
Surgical Solution
The definitive solution for carpal tunnel syndrome is a surgery. In this process, the narrowed canal is simply released by the hand surgeon, who cuts the ligaments covering the canal between the two elevations in the palm. This very simple and quick surgical intervention can be performed within the framework of outpatient (one-day) surgery. The surgery provides almost immediate relief: the pain ceases immediately, and the numbness typically subsides within a few days. Unfortunately, if muscle atrophy which has already begun, will persist, but it can be improved through physiotherapy. As a residual symptom, there may be a permanent limitation of sensation and/or numbness in the fingertips if the surgery has been carried out too late.
