Brief overview
- Symptoms: Nocturnal falling asleep of the hand, paraesthesia, pain, later functional limitations, paralysis, decreased sense of touch.
- Diagnosis: Query of typical symptoms and possible risk factors, functional and pain tests, measurement of nerve conduction velocity
- Causes and risk factors: long-term overloading of the wrist, predisposition, rheumatism, injuries, water retention, diabetes, overweight, kidney weakness
- Course and prognosis: Complete cure with timely therapy, irreversible paralysis possible if treatment is delayed.
- Prevention: treat pre-existing conditions, reduce overweight, avoid one-sided stress
What is carpal tunnel syndrome?
The carpal tunnel is formed by the carpal bones and a stabilizing connective tissue ligament. Several hand tendons run through its center, as does the median nerve. This runs from the shoulder over the upper and lower arm. Along with two other nerves, it controls muscle movements and enables the hand’s sense of touch.
Carpal tunnel syndrome: What are the symptoms?
At an early stage, sufferers often do not take carpal tunnel syndrome seriously. But the longer the nerve is pinched at the wrist, the more likely it is to be permanently damaged. Therefore, it is important to have the first signs of carpal tunnel syndrome neurologically clarified.
Early symptoms
Sensations of discomfort: Carpal tunnel syndrome usually announces itself by tingling sensations in the palm of the hand. Later, they gradually extend to part of the fingers.
Pain: Initially, pain only occurs after a particular strain on the wrist. This includes gardening, renovating or cleaning, for example. In a later stage, the complaints also occur quite suddenly without any apparent cause, i.e. “spontaneously”.
Symptoms in the later stage
Loss of sensitivity: If the pressure on the nerve persists for a long time, it becomes increasingly damaged. Soon the unpleasant sensations in the fingers disappear. Instead, they become largely numb. Later, paralysis occurs.
Muscle atrophy in the thumb: A muscle of the thumb that is controlled by this nerve then gradually regresses. A visible dent develops on the ball of the thumb (thumb ball atrophy).
At this stage, the nerve is already very severely damaged. If therapy is not started until now, it is often already too late – the damage to the nerve can no longer be reversed. Lifelong numbness in the palm and paralysis of the thumb are possible consequences.
Symptoms on both hands?
In most cases, the symptoms develop successively on both hands. However, there are sometimes months or even years in between.
How can carpal tunnel syndrome be tested?
The first step in diagnosing carpal tunnel syndrome is to obtain a personal medical history. The doctor asks the patient about his or her symptoms and any risk factors, such as physical work, previous illnesses and family history.
The next step is a physical examination. Here, the physician checks the following aspects, among others:
- Thumb function: The function of the thumb is also examined. The doctor asks the patient to hold a bottle, for example. Typical of carpal tunnel syndrome is that the patient is no longer able to spread the thumb well or at all.
- Sensitivity: The doctor tests the patient’s sense of sensation by stroking the palm with a cotton ball. If the patient does not perceive the touch, surface sensitivity is impaired.
Provocation tests
Hoffman-Tinel test: In this carpal tunnel syndrome test, the skin over the carpal tunnel is tapped. If this triggers pain and discomfort in the patient, it is a sign of carpal tunnel syndrome.
Phalen’s sign: For this test, the patient places the backs of their hands together. The wrist is strongly bent. If the pain increases, this also indicates carpal tunnel syndrome.
Neurological carpal tunnel syndrome test
In order to rule out other diseases with similar symptoms, the doctor often also examines the elbow region and the neck and shoulder area. There is also the possibility that the median arm nerve is constricted in these areas.
In some cases, an exact measurement with a surface ENG is not possible. This is the case, for example, if the nerve does not run normally. For a needle ENG, small needles are then inserted directly into the vicinity of the nerve, with the help of which the measurement is taken. This may hurt a little. However, the examination is relatively short. Afterwards, there is usually no further discomfort.
- Ultrasound (sonography): Ultrasound examination can be used to determine how narrow the carpal tunnel is.
- X-ray: The doctor uses an X-ray examination to check whether arthritis-like changes are narrowing the wrist.
- Magnetic resonance imaging (MRI): If the doctor suspects that a tumor is causing the symptoms, this can be clarified in the course of a magnetic resonance imaging.
What causes carpal tunnel syndrome?
- Narrow carpal tunnel: People who already have a rather narrow carpal tunnel by nature are more likely to get the disease. For this reason, women generally get carpal tunnel syndrome more often than men.
- Heredity: Presumably, a congenital anatomical constriction is the reason why carpal tunnel syndrome is particularly common in some families.
- Injuries: Carpal tunnel syndrome easily develops after an injury near the wrist, especially after a broken radius.
- Inflammation: Another possible cause is inflammation and swelling of the tendon sheaths, which are also located in the carpal tunnel and then press on the nerve.
- Chronic kidney weakness (renal insufficiency): People who have to go on dialysis frequently because of kidney weakness easily develop carpal tunnel syndrome in the arm that is connected to the dialysis machine (shunt arm).
How is carpal tunnel syndrome treated?
Mild cases of carpal tunnel syndrome can be alleviated without surgery. For example, by immobilizing the affected hand overnight with a splint. If inflammation is the cause of the narrowing of the carpal tunnel, cortisone can help – in the form of tablets or sometimes as an injection. Some sufferers take painkillers for carpal tunnel syndrome.
In some cases, surgery is necessary for carpal tunnel syndrome.
What is the course of carpal tunnel syndrome?
Basically, everyone is at risk of developing carpal tunnel syndrome. In most cases, both hands are then affected sooner or later. Both symptoms and the course of carpal tunnel syndrome vary greatly from patient to patient.
In general, the symptoms worsen continuously during the course of the disease and increase after heavy exertion as well as during pregnancy and after injuries to the arm.
How long sufferers are ill and unable to work after an acute flare-up of the disease is individual and depends on various factors, such as occupation and therapy.
If surgery is performed successfully and in good time, it is possible for carpal tunnel syndrome to be completely cured. The pain usually disappears the day after the operation. The patient then retrains mobility as well as the sense of touch and sensation.
Be sure to perform the exercises recommended by your doctor and/or physical therapist on a regular basis and have a neurologist monitor the healing process after surgery.
The healing process sometimes takes several months, depending on the severity of the condition.
Complications such as post-operative bleeding and infection are rare with carpal tunnel surgery. However, in some cases, further surgery is necessary.
Occupational disability with severe nerve damage
Therefore, be sure to see a doctor at the first sign of carpal tunnel syndrome. The earlier treatment begins, the better the chances of recovery!
How can carpal tunnel syndrome be prevented?
If possible, avoid one-sided movements and postures, for example, hands permanently resting on the computer or on the tabletop. Varied and relieving movement sequences enable you to work in a way that is gentle on your body, even in high-risk occupations.
