Darrick Robles Carpal tunnel syndrome is caused by a relative narrowing of the carpal tunnel, the bony connective tissue canal on the inside of the wrist. The median nerve runs through this canal. The increased pressure in the carpal tunnel damages the median nerve, which leads to the typical “sleeping hand” picture. Carpal tunnel syndrome commonly occurs in both hands. The mean age at onset is between 40 and 70 years of age, but young people and old people can also get it. Women are affected more often than men.
What is the carpal tunnel?
The carpal tunnel is a canal on the inside of the wrist. One side of the canal is bounded by the carpal bones, while the other side is closed by a band of connective tissue, the flexor retinaculum. The median nerve and the tendons of the long flexors of the fingers pass through this canal.
The size of the carpal tunnel is different in every person. However, there are some anatomical variants that can promote the development of a carpal tunnel due to their particular narrowness.
Symptoms of Carpal Tunnel Syndrome
The symptoms of carpal tunnel syndrome depend on the stage of nerve damage to the median nerve.
At the onset of carpal tunnel syndrome, there is little pressure on the median nerve. The compression leads to the typical symptoms: “The hands go to sleep” at night . In addition, the hands can start to tingle painfully . The middle and ring fingers are mainly affected, but later the discomfort can also spread to the thumb and index finger and radiate into the arm towards the elbow. During the day, the symptoms can be triggered by activities that put a strain on the wrist:
- cycling and motorcycling
- reading the newspaper
- Make a phone call
- Stricken etc.
Symptoms typically improve if you shake and rub your hands, pump your fingers, change the position of your arm or hand, or run your hands under cold water.
If the median nerve is further damaged, the tingling in the hands can turn into electric shocks . These are often triggered by gripping movements. The discomfort can then also last permanently and not only occur under stress. Fingers can become numb and you may have trouble performing delicate crafts.
In the late stages of carpal tunnel syndrome, the muscles of the medial thenar eminence atrophy. This can make it difficult to spread your thumb wide. In rare cases, skin and nail changes also occur.
Carpal tunnel syndrome can vary greatly from person to person. Some people have only minor symptoms with longer intervals without symptoms for years. Other people suffer greatly from ever-increasing symptoms. The symptoms often increase when the hands are overstrained (e.g. due to heavy gardening or renovation work), during pregnancy or after injuries to the hand.
Causes of Carpal Tunnel Syndrome
Carpal tunnel syndrome is the most common nerve entrapment syndrome in the extremities. It arises from a mismatch between the size of the carpal tunnel and the volume of the structures it contains . Carpal tunnel syndrome is often based on an anatomically rather small carpal tunnel. An increase in the volume of the tunnel contents puts pressure on the median nerve, which causes the symptoms. This increase in volume can be caused by:
- Swelling of the tendon tissue due to illnesses (e.g. gout), pregnancy or overuse
- Wrist injuries (e.g. fractures or bleeding)
- wrist inflammation
- masses
At night, the symptoms increase in many patients. It is assumed that bending the hand during sleep at night leads to increased pressure on the median nerve. The extent of nerve damage caused by carpal tunnel syndrome depends on the duration and intensity of pressure on the median nerve.
The symptoms of carpal tunnel syndrome can also arise as part of a herniated disc in the cervical spine or other neurological diseases. These should therefore be clarified in order to be able to initiate correct therapy.
Risk factors for developing carpal tunnel syndrome
The development and severity of carpal tunnel syndrome is influenced by many different factors. Risk factors for developing carpal tunnel syndrome include:
- Diabetes mellitus type 1 or 2 (sugar diabetes)
- hypothyroidism
- long-term cortisone treatment
- hormone therapy after menopause
- menopause
- pregnancy
- overweight
- Smoking
How is carpal tunnel syndrome diagnosed?
In order to make the diagnosis “carpal tunnel syndrome”, a detailed discussion about the course of the disease and the symptoms and a clinical examination are usually sufficient. By examining mobility and skin sensitivity, your doctor can assess the existing nerve damage in order to be able to offer you the best possible therapy. In addition, the nerve conduction velocity of the median nerve can be measured, which allows the nerve damage to be objectified.
When should I go to the doctor?
If you suspect you have carpal tunnel syndrome, you should definitely see a doctor. The sooner therapy is initiated, the faster damage to the median nerve can be prevented. But which doctor deals with carpal tunnel syndrome? The first point of contact for carpal tunnel syndrome is the general practitioner. He can rule out various diseases through a careful examination and, if necessary, issue a referral to a specialist for a nerve conduction measurement.
What can you do yourself against carpal tunnel syndrome?
Unfortunately, there is nothing you can do about carpal tunnel syndrome. As a rule, a reduced load on the hand or a change in the hand position is not possible. Even if you could take these measures, they would not permanently solve the problem, but only bring about a temporary improvement. Unfortunately, you cannot prevent the symptoms from occurring on the other hand either. However, stretching exercises can slow it down.
The Therapy of Carpal Tunnel Syndrome
The treatment of carpal tunnel syndrome is based on the clinical symptoms . If you have frequent or persistent symptoms, immediate therapy is necessary. However, if a reduced nerve conduction speed was found in your case without you having any symptoms, therapy is not necessary.
In the early stages , nocturnal wrist splinting is sufficient in most cases. The splint prevents your hand from bending off while you sleep and thus pinching the median nerve. The splints are usually provided with a Velcro fastener so that you can easily remove them during the day. Cortisone therapy can also be considered. In most cases, the cortisone is injected directly into the carpal tunnel area.
If there are signs of failure in the hand muscles or the skin innervation, an operation on the carpal tunnel can be considered. Surgery may also be indicated during pregnancy or if carpal tunnel syndrome develops as part of complications from diabetes mellitus (diabetes). The goal of carpal tunnel syndrome surgery is to create more space in the carpal tunnel to relieve the pressure on the median nerve. Such an operation is usually performed on an outpatient basis, so in most cases you do not have to spend the night in the hospital.
Here’s how Med-Healths can help
Med-Healths gives you the opportunity to talk to a doctor about your symptoms. Through a careful discussion, he can narrow down the possible triggers of your symptoms in order to be able to initiate the best possible therapy. If you have carpal tunnel syndrome, they can refer you to specialist doctors. If you are severely restricted by your symptoms, you can also get sick leave via Med-Healths.
