Do you often feel a nagging wrist pain accompanied by tingling numbness and radiating pain, particularly in the areas of the thumb, index, and middle fingers? This kind of pain is generally seen if you have Carpal tunnel syndrome (CTS), also called median nerve compression neuropathy. CTS is one of the most common causes of wrist and forearm pain and it occurs due to the squeezing or compression of the median nerve (one of the primary nerves of the hand) as it travels through the wrist. In this health article, we bring forward to you more insights on CTS, including its causes, symptoms, treatment, and prevention.

Before proceeding with the causes, let us briefly understand the anatomy of the wrist, and what carpal tunnel is. The carpal tunnel is a small and narrow tunnel-like space in the wrist. This tunnel contains:

  • Median nerve - one of the main nerves of the hand that enters the wrist through the tunnel and splits into several smaller nerve branches and facilitates sensation in the thumb, index, middle finger, and half of the ring finger
  • Transverse carpal ligament and flexor tendons that cause movement and bending of the thumb
  • Carpal bones- forming the floor, roof, and walls of the tendon

Since the carpal bones make up the rigid boundaries, the carpal tunnel has a limited capacity to stretch. Any undue pressure on the wrist results in the narrowing of the tunnel, swelling of the surrounding flexor tendons, and compression of the median nerve eventually leading to CTS.

Causes

  1. Work-related - CTS is very common with works that require repetitive hand use, vibration, or use of force. Examples - Writing, typing work, electric work, construction work, hammering, or works with hand-held instruments that use sonic and vibrations
  2. Wrist anomalies - fracture, wrist dislocation, or pathological/congenital wrist deformity
  3. Postural - Activities that require extreme extension or flexion of the wrist and fingers for prolonged periods
  4. Physiologic factors such as pregnancy, progressing age
  5. Medical conditions - Gout, rheumatoid arthritis, thyroid, diabetes, etc.

Symptoms

The symptoms are transient (symptoms come and go) or mild to begin with and often get better upon moving and shaking the hand or using a wrist strap. But gradually the symptoms worsen. The symptoms include:

  • Tingling, numbness, pain, and burning sensation particularly in the thumb index, middle, and ring fingers
  • Increased discomfort at night 
  • Occasional shock-like sensations 
  • Pain or tingling radiating up the forearm toward the shoulder
  • Hand weakness and painful movements (particularly fine movements)Loss of grip
  • Altered sensations

Diagnosis

Your doctor will perform a thorough physical examination, imaging tests (x-ray, ultrasound, MRI), and electrophysiological tests (nerve conduction tests and electromyogram) to assess your nerve condition, sensitivity, muscle strength, and other factors to arrive at a diagnosis of CTS.

Treatment

The mild cases of CTS are treated by non-surgical measures which include:

  • Wrist braces or splints
  • Pain killers
  • Physiotherapy (Nerve gliding exercises)
  • Intralesional steroid injections

Severe cases of CTS are treated by carpal tunnel release surgery either by open carpal tunnel release or endoscopic carpal tunnel release.

Prevention

The risk of CTS can be minimized by:

  • Stretching and bending the wrists while working with handheld equipment that works with sonic or vibrations
  • If your work demands the application of heavy force, take frequent breaks to reduce the force
  • If working with a keypad relax the grip and hit the keys gently
  • Practice proper postures neck and shoulder positions, and avoid overstretching of the wrist and hands
  • Keep your hands warm

Take Home Message - CTS is multifactorial and may be caused by several physiological, pathological conditions, and work-related causes. The work-related causes can be minimized by taking certain precautions as discussed above. The condition worsens over time if left untreated and may lead to permanent loss of sensation in the fingers and dysfunction of the hand, and hence it is very crucial to diagnose and treat carpal tunnel syndrome promptly.

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