By Dr. Amod Manocha, Pain Management
Carpal tunnel syndrome, also known as ‘median nerve compression’ is a painful condition that develops when there is excess pressure on the median nerve as it travels into the wrist. The median nerve runs down your forearm and passes through a narrow passageway on the palm side of your wrist (carpal tunnel). This nerve provides sensation to your thumb, index finger, middle finger and a part of the ring finger. Carpal tunnel syndrome may affect one or both hands.
Those, who are involved in jobs that require repetitive movement of the wrist, are more likely to be diagnosed with CTS such as construction workers, manufacturers, etc. Women are three times more likely to have CTS and the prevalence, severity increases with age.
What triggers Carpal Tunnel Syndrome?
One or more of the following factors can trigger carpal tunnel syndrome:
• Repetitive movement, such as typing or moving your wrist over and over again
• Conditions such as rheumatoid arthritis, diabetes, hypothyroidism
• Hereditary factors
Carpal tunnel syndrome is characterised by the following symptoms-
• Numbness, burning, tingling sensation, pain in the ring, middle, index fingers and the thumb
• Occasional shock-like sensations, radiating to the thumb and the fingers
• Clumsiness and weakness of hand
• Difficulty performing simple tasks like buttoning clothes, opening jars
• Losing grip over things, difficulty to hold objects firmly in hand due to weakness
Diagnosis of Carpal Tunnel Syndrome:
Your doctor will conduct a physical examination to diagnose Carpal tunnel syndrome. This may include putting pressure on median nerve along the wrist to see if it causes a tingling sensation in the hands. The doctor may also hold, bend your wrist in a flexed position to check if this increases or brings on your symptoms as this position further narrows the space for the nerve temporarily producing the clinical symptoms. Other diagnosis tools used are Ultrasound, and electrodiagnostic studies include nerve conduction studies and electromyography. Plain X-ray may be useful if bone or joint disease/ structural abnormalities are suspected.
Treatment of CTS:
Management of CTS depends on the severity of your symptoms. If they are not too severe, your doctor will recommend the conservative approach. This includes a combination of modalities such as:
• Splinting or bracing - Wearing a splint or brace will keep you from moving or bending the wrist while you rest. One study has shown that using a neutral wrist splint is twice as likely to give symptom relief compared to a splint in extension position. This modality, in combination with other treatment modalities, can be especially useful in pregnancy.
• Ultrasound-guided local injections - This involves injecting local anaesthetics and a small dose of steroids close to the problem site under ultrasound guidance. Using ultrasound helps to ensure accuracy and minimises the risk of complications. Studies have demonstrated that local injection is effective for more than one month in patients with mild to moderate carpal tunnel syndrome and delays the need for surgery at one year. This can help to manage the symptoms effectively avoiding the need for surgery. Certain cases may require a repeat injection for more effective symptom control.
• Physical therapy - There is some evidence that physical therapy techniques are effective CTS treatments. This option requires multiple sessions from specialist physiotherapists and modalities include carpal bone mobilization, therapeutic ultrasound and nerve glide exercises.
• Oral medications - Oral steroids have shown to improve symptoms for limited time but are less effective than local injections with more side effects. NSAIDS, diuretics have questionable benefits.
• Surgical decompression - This is an effective option for patients with severe symptoms and can provide a lasting relief in majority of cases. Most patients note significant improvement in one week and are able to return to normal activities soon after.