Carpal tunnel syndrome is pressure damage to nerves in the wrist caused by a space narrowing in the carpal canal. The condition must be treated or it will lead to secondary damage that can significantly limit the function of the affected hand.
What is carpal tunnel syndrome?
Graphic representation of the anatomy of the hand, carpal tunnel, median nerve, and carpal ligament. Carpal tunnel syndrome (CTS or KTS) is a condition of the wrist in which pressure causes damage to the nerves. Carpal tunnel is the name given to a structure located at the junction of the forearm and the palm of the hand. There, a ligament (retinaculum flexorum) stretches from the ball of the thumb to the ball of the little finger. This band of connective tissue forms a kind of roof over a hollow whose base is the carpal bones. Tendons and nerves that lead to the muscles of the fingers run in the resulting canal. In carpal tunnel syndrome, this channel is too narrow, so that the nerves are squeezed and a nerve conduction disorder develops. Particularly affected is the median nerve, which runs there and is one of the most important nerves in the hand, innervating the thumb, index and middle fingers. Carpal tunnel syndrome is one of the most common nerve compression disorders. It affects women more often than men, usually occurs in midlife (between 40 and 60 years of age), and can be bilateral or unilateral.
Causes
The reason for carpal tunnel syndrome is always a narrowing of the space in the carpal tunnel. Various triggers for this constriction of space are known, but often there is also no exact indication for the development of carpal tunnel syndrome. A distinction is made between systemic and mechanical causes. Systemic causes are diseases of the whole body that trigger carpal tunnel syndrome. These include kidney and metabolic diseases that lead to deposits in the carpal canal and narrow it. It is also known that carpal tunnel syndrome occurs in rheumatoid arthritis and in osteoarthritis, as well as during pregnancy. Mechanical causes are processes at the wrist that cause the space narrowing, such as tumors, bone fractures or swelling during tendonitis. A particular strain on the wrist due to occupational activities are also considered triggers. In most cases of carpal tunnel syndrome, however, no exact causes are detectable.
Symptoms, complaints, and signs
The core symptom of carpal tunnel syndrome is sensory disturbances in the hand, especially in the first three fingers as well as in the palm, the palm of the hand. Typical sensory disturbances are tingling, an electric sensation, pain and numbness. The symptoms often occur on both sides. In the early stages, the pain occurs mainly during the night or intensifies during the night. A very characteristic symptom in carpal tunnel syndrome is sudden awakening from night sleep – brachialgia paraesthetica nocturna. Upon awakening, patients then notice a vague swelling sensation and notice tingling and stiffness in their fingers. They may also have the sensation of “asleep” hands. Shaking the hands, often reflexively, can relieve this discomfort; massaging also provides temporary relief. In addition to the nocturnal complaints, in an advanced stage of the disease, stiffness of the fingers and swelling also occur in the morning. Pain also occurs during the day at this stage and can radiate throughout the arm. A general lack of strength or loss of sensation can lead to slight motor deficits and restricted movement of the hands over time. If necessary, regression of the muscles of the ball of the thumb, called abductor-opponens atrophy, occurs in a late stage of the disease.
Diagnosis and course
Carpal tunnel syndrome often begins with sensory disturbances in the thumb, index, and middle fingers, as these are supplied by the median nerve. The fingers feel numb, tingle as if they have “fallen asleep,” and ache. Mostly these complaints occur under stress and during the night. They are particularly noticeable when the hand is in an angled position, such as when holding the telephone receiver or the steering wheel in the car. This also explains the nocturnal complaints, because many people unconsciously angle their hand slightly while sleeping.As carpal tunnel syndrome progresses, the insensations intensify, become permanent, and the pain may radiate into the arm. In the advanced stage, the fingers become completely numb and the muscles of the thumb ball atrophy (atrophy). The doctor diagnoses carpal tunnel syndrome with the help of various tests, as well as with the measurement of nerve conduction velocity and electromyography (measurement of muscle activity). Another diagnostic test is an x-ray of the wrist, as this clearly shows the constriction of space during carpal tunnel syndrome.
Complications
Carpal tunnel syndrome causes severe limitations and discomfort in the hands. Usually, this syndrome must also be treated directly by a doctor. If treatment is not received, irreversible consequential damage may occur. As a result, the affected person usually suffers from severe limitations in hand movement, which also considerably restricts the patient’s everyday life and reduces the quality of life. Paralysis and sensory disturbances of the hands occur. The typical tingling sensation occurs. Patients also suffer from hand pain, which can also occur in the form of pain at rest. The pain at rest often leads to sleep disturbances and can thus cause general irritability in the patient. Likewise, there is a reduced strength in the fingers and a reduced resilience of the patient. The wrist is not infrequently reddened in the process. As a rule, carpal tunnel syndrome can be treated relatively well with the help of surgical intervention. There are no particular complications or complaints. After the operation, the affected person can use the hand again as usual. Life expectancy is not reduced by carpal tunnel syndrome.
When should you see a doctor?
If sensory disturbances in the hand persist, a visit to the doctor is advised. If numbness, sensory disturbances, or hypersensitivity to incoming stimuli occur, a physician should be consulted. In the case of paralysis symptoms, a visit to the doctor is required as soon as possible so that the cause of the symptoms can be determined. Since the symptoms of carpal tunnel syndrome are often underestimated, special attention should be paid to the first signs. Otherwise, the affected person is threatened with a lifelong impairment with corresponding effects on everyday life and professional life. A tingling sensation in the fingers and hands, pain or restrictions in mobility are the first warning signs. A visit to the doctor is necessary so that medical care can be provided. If the discomfort spreads between the individual fingers or in the palm of the hand, a visit to the doctor must be made. If objects can no longer be held as usual, the strength level drops and the affected person can no longer perform familiar hand movements, he or she needs a doctor. Impaired musculature as well as existing pain during night sleep should be presented to a doctor for closer examination. Complaints during a resting position are considered unusual and indicate an existing disease. If the fingers repeatedly fall asleep during the day or if pain is increasing when the hand is bent, a visit to the physician is required.
Treatment and therapy
Treatment of carpal tunnel syndrome depends on the severity and symptoms. For mild symptoms, anti-inflammatory medications (cortisone) are administered, either in tablet form or by injection into the carpal tunnel. It is also advisable to immobilize the wrist at night with the aid of a splint. During the day, weight-bearing movements should be avoided. The use of ultrasound waves also has a soothing effect on carpal tunnel syndrome. However, if the symptoms are already more severe, surgical intervention is usually necessary. Two different techniques are possible, open and endoscopic surgery. Both are usually performed under local anesthesia, the open one also under general anesthesia. In open surgery, the skin and structures over the carpal tunnel are opened and the ligament that forms the roof is cut under vision from above. In endoscopic surgery, only a much smaller incision is made at the end of the forearm and a special device is inserted into the carpal tunnel. With this, the surgeon cuts the ligament from below.After the wound has healed, the hand should be exercised with physiotherapeutic exercises to regain its full functionality. However, the success of surgery also depends on how far the damage from carpal tunnel syndrome had progressed.
Outlook and prognosis
The prognosis of carpal tunnel syndrome is made depending on the existing cause. If there is an inflammatory process, swelling, or fractures, the outlook for complete recovery is usually favorable. Medical treatment is initiated, leading to freedom from symptoms within a few weeks or months. In the case of a tumor disease or a chronic disease, the prognosis is often worse. The further course of the disease depends on the type of tumor, the size of the tumor, its growth and the prospect of a cure. If osteoarthritis is present, the prognosis is unfavorable. The medical treatment options focus on halting the progression of the disease. According to current scientific and medical possibilities, there is no cure for this chronic underlying disease. A good cooperation of the patient and an avoidance of overloads, a relief of existing complaints can take place. Nevertheless, the course of the disease cannot be completely stopped in the case of arthrosis or other chronic diseases. According to new studies, the stability of the psyche also has an effect on the prognosis. The more stress and dissatisfaction are present, the more frequently a persistent course of the disease is observed. Without medical treatment, the patient is at risk of secondary disease. Irreversible damage may occur, significantly worsening the prognosis and contributing to a reduction in quality of life.
Prevention
Carpal tunnel syndrome cannot be prevented, because the causes are often unknown on the one hand and lie in existing underlying diseases on the other. However, in the case of typical complaints that indicate carpal tunnel syndrome, a physician should be consulted immediately to avoid complications or subsequent damage.
Follow-up care
Carpal tunnel syndrome most often ends with the need for surgical treatment. Surgery eliminates the syndrome along with the pain. As part of the follow-up care, the corresponding hand is splinted and the surgical site is covered and dressed using sterile wound dressings. To avoid blood congestion in the fingers and hand, the hand should be elevated for the first few days after surgery. In the further course, follow-up examinations are carried out by the attending physician. This includes appropriate wound care with dressing changes. After about three weeks, the splint and bandage can be removed. Patients with carpal tunnel syndrome are then symptom-free after the operation. It is recommended that wound treatment be continued for about four weeks. This can be done very well by using a wound and scar ointment. The hand can then be fully used for heavier work after about six weeks. Until then, it should be intensified during the recovery process with the help of physiotherapeutic treatments. In this way, the patient can relatively quickly return to personal and professional everyday life without restrictions. In individual cases, a severely affected carpal tunnel syndrome has developed numbness in the area of the fingers of the affected hand, which can persist permanently or only subside much later. This damage to the metacarpal nerve is not medically treatable.
Here’s what you can do yourself
In the presence of carpal tunnel syndrome, it is initially recommended to immobilize the wrist at night using a night splint. During the day, stress should be avoided as much as possible. Ideally, a support bandage is worn. Anyone who sits at a PC a lot or regularly uses their smartphone should reduce these activities for a few days and always incorporate relaxation phases into their daily routine. Alternative therapeutic measures can also help. For example, cold therapy, which can be supported at home with cold packs and cool compresses, has proven effective. Wraps with anti-inflammatory medicinal plants such as ginger or cypress are particularly effective. With regard to diet, the following applies: consume as few foods as possible that contain acid. Gentle foods such as rice, green leafy vegetables and chicken breast are more suitable.Various fruit juices also promote healing and provide the body with valuable minerals, vitamins and antioxidants. If the symptoms do not subside, an appointment for surgery must be made with the doctor. After the procedure, rest and gentle treatment are also recommended. In addition, care should be taken to maintain adequate hygiene in the area of the procedure, otherwise infections and further complications may occur. Regular check-ups ensure a positive healing process.