Symptoms
Possible symptoms include burning pain and sensory disturbances of the fingers, such as numbness, tingling, and falling asleep. Patients’ hands “go to sleep” and they respond by shaking and massaging them. The complaints often occur at night and affect the inside of the thumb, the index finger, the middle finger and half of the ring finger. In contrast, no disturbances occur in the little finger. Concomitant symptoms in the forearms or palms are possible. While the symptoms occur only intermittently at the beginning, they may persist permanently later and cause tissue changes, muscle weakness and degeneration with loss of strength. Another complication is sleep disturbances. Women are more commonly affected than men.
Causes
The cause of the condition is increased pressure in the carpal tunnel of the wrist, which leads to compression and decreased blood flow to the median nerve of the hand, resulting in impaired signal conduction. The carpal tunnel is located at the base of the palm and is bounded by the carpal ligament and bone. Sensory disturbances radiate into the area supplied by the nerve. There are some known factors that increase the risk of developing carpal tunnel syndrome. These include overuse, pregnancy, diseases such as arthritis, gout, hypothyroidism and diabetes mellitus, tumors, injuries, and medications such as somatropin. However, a deeper cause usually cannot be determined.
Diagnosis
Diagnosis is made under medical treatment on the basis of the clinical picture, physical examination, and with electrodiagnostic tests (nerve current examination, nerve conduction velocity). It should be noted that other diseases, such as multiple sclerosis, can cause similar symptoms. Therefore, the clarification belongs in professional hands.
Nonpharmacologic treatment
Wearing a wrist splint may be recommended as a first-line treatment at the beginning. It is usually applied at night, but can also be used during the day. Activities or hand positions that aggravate the symptoms should be avoided. Especially unfavorable are bending of the wrist and too much strain. In a severe or therapy-resistant course, hand surgery is possible, in which the tunnel is widened and more space is created for the nerve. Preference is now given to open over minimally invasive (endoscopic) surgery.
Drug treatment
An attempt at treatment with analgesics such as nonsteroidal anti-inflammatory drugs (e.g., ibuprofen or naproxen) or acetaminophen is possible. NSAIDs should not be given long-term because of the health risks. Topically applied agents such as a diclofenac gel, arnica ointment, or comfrey ointment can also be tried. Glucocorticoids such as methylprednisolone are injected into the carpal tunnel as a second-line agent. Treatment should not be given too often to avoid complications. Oral cortisone treatment is controversial because of systemic adverse effects. Vitamin B6 (pyridoxine) and diuretics are not recommended due to lack of evidence. Complementary methods such as acupuncture may be tried. Antiepileptic drugs, tricyclic antidepressants, and opioids are also commonly used for neuropathies. However, the literature does not mention these medications for the treatment of carpal tunnel syndrome. Underlying conditions such as diabetes mellitus or hypothyroidism should be treated with medication. Carpal tunnel symptom during pregnancy usually disappears with the birth of the child and does not require surgery.