Carpal tunnel syndrome is a very common condition, that can cause debilitating pain if it’s not treated promptly. In his latest online article, renowned consultant trauma and orthopaedic surgeon Mr Angelos Assiotis offers his expert insight into the condition.
What are the symptoms of carpal tunnel syndrome?
Carpal tunnel syndrome is a very common pathology that affects up to 10% of the general population at some point in their lifetime. It presents with several symptoms, which often gradually deteriorate. One of the first symptoms is tingling (known as ‘pins and needles’) in the palmar aspect of the thumb, the index finger, the middle finger and sometimes, the radial half of the ring finger as well. This is not often present all the time, especially in the earlier stages of the pathology and it may present at night when the patient is asleep. In those cases, patients often wake up and have to shake their hands to get it better.
Numbness is another symptom and it is felt in the same area as the tingling that we mentioned earlier. This symptom essentially is felt as a reduction in the degree of sensation the patient has when touching something with the affected fingers. Sometimes, patients mention that they don’t know when they have picked something up, unless they look at their hands. Patients have reported sustaining small burns while cooking in more severe cases, as they can’t feel hot surfaces very well.
Pain is a symptom that is often associated with carpal tunnel syndrome, and is usually felt in the palm, thumb, index, middle and ring fingers. This pain is often described as ‘deep’ or resembling a ‘toothache’ and often wakes up patients at night.
Finally, patients sometimes present with weakness of their grip and in more serious cases, the shape of their palm changes, as the muscles that take innervation from the affected nerve, start shrinking (we call that ‘wasting’). This is a later sign and it signifies the presence of a significant carpal tunnel syndrome.
What causes carpal tunnel syndrome?
The term ‘carpal tunnel syndrome’ is used to describe the most common peripheral neuropathy that can affect patients. It describes a compression of the nerve that exists within the carpal tunnel (which corresponds to the very base of your palm, in the middle of it), which is called the median nerve.
Normally, the nerve exists in that anatomical space, along with nine tendons, in close relation. Carpal tunnel syndrome occurs when the nerve is compressed from the surrounding structures. This compression may occur if the contents of the carpal tunnel increase in diameter (for example, if the tendons and their covering become inflamed and/or swollen). Another possible cause of this compression is the reduction in the diameter of this defined space (for example, from the thickening of the ligament that forms the tunnel’s roof, called the transverse carpal ligament).
Nerves are sensitive structures and any prolonged compressive force, is likely to result in symptoms of pins and needles, pain, numbness and eventually weakness of the muscles that take signals from that nerve.
How is carpal tunnel syndrome diagnosed by a doctor?
Diagnosis of carpal tunnel syndrome is usually done with clinical examination, as opposed to other pathologies, where investigations may be necessary to confirm or exclude a diagnosis. You will be seen in the clinic and the clinical history is often highly indicative of a suspected carpal tunnel syndrome. Clinical examination will confirm it, where certain manoeuvres and pressure in certain areas of the hand will reproduce your symptoms. Rarely, there may be some uncertainty in the diagnosis, if for example there are some atypical symptoms, or if there is also evidence of cervical spine (neck) pathology, that may contribute to the symptoms.
On such occasions, we can then perform a diagnostic test, called a nerve conduction study. This aims to confirm the carpal tunnel syndrome, but also report on the contribution to your symptoms from other pathologies. This may affect treatment and also allow for a more accurate prognosis for your expected recovery after treatment.
What treatment options are available for carpal tunnel syndrome?
Treatment can be divided into non-operative and operative depending on the severity of your symptoms and their characteristics. In mild/moderate cases, the patient may try measures such as rigid splints, worn at night, with or without the addition of an injection of local anaesthetic and steroid in the carpal tunnel. The injection aims to reduce the inflammation and oedema within the carpal tunnel. Hopefully, this removes some pressure from the median nerve, thus allowing symptoms to improve.
In more significant cases (for example where the patient wakes up every night with these symptoms, or where there is established muscle weakness and wasting in the hand), your surgeon may propose operative treatment, in the form of a carpal tunnel decompression.
This is a quick surgical procedure, done under local anaesthetic, where we numb the skin with an injection and then we proceed to cut the skin and the tissues that overly the nerve, releasing it and in doing so, removing the pressure off it. The skin is then sutured and a simple dressing applied. You will be able to use your hand for light tasks, as long as you keep the wound dry for 12-14 days.
In cases where the nerve has been compressed significantly for a long time, it is likely that removing the compression will not result in complete relief from symptoms. It is however important to decompress because the main goal is to prevent further deterioration, which may affect the hand’s function even more. However, even in severe cases, decompression usually results in an improvement of symptoms. This is especially true for pain and the sensation of pins and needles.
Can carpal tunnel syndrome be prevented, and what lifestyle changes can help?
Prevention of carpal tunnel syndrome is not applicable for everyone, because it often presents in patients who do not have manual jobs or use their hands for repetitive movements.
However, in patients who suffer from diabetes, good control of their blood sugar is important, as it is likely to reduce the incidence of carpal tunnel syndrome in that population.
Patients who use their hands at work for repetitive tasks are likely to benefit from alternating their hands as they perform the repetitive movement. Changing their technique, so that the wrists are kept straight when doing the movement may also result in an improvement of symptoms, or perhaps a reduced incidence of carpal tunnel syndrome, although this has not been proven.