What is carpal tunnel syndrome? Doctor explains causes, symptoms, and when to seek help

Just as the wearer knows where the shoe bites, only the sufferer knows how the carpal tunnel syndrome hurts. Carpal tunnel syndrome is a compressive neuropathy condition, where the median nerve in the wrist and hand is compressed for reasons unknown, leading to numbness in the fingers, pain in the hand at night, waking the patient from sleep. Software professionals, homemakers, and people working with vibratory machinery are prone to this condition. The incidence is also higher in those with hypothyroidism, obesity, and diabetes mellitus. It also could be a part of repetitive stress injury or overuse syndrome, and is common in pregnant women as well.

Anything that causes swelling or a change in position of the tissue within the carpal tunnel can squeeze and irritate the median nerve. Among the most common causes are these repeated hand movements, especially those that require frequent back-and-forth motion of the wrist, like typing, mouse use or working on an assembly line. Broken wrists and sprained wrists may also be a factor. Medical conditions and pregnancy-related fluid retention can increase carpal tunnel risk. Genetics may also be at play — some people just have a tighter carpal tunnel. Long-term use of vibrating instruments is also another identified risk factor.

Symptoms usually start to appear gradually, but can become worse, especially at night or after repetitive hand use:

• Pins and needles in the thumb, index, middle, and a portion of the ring finger
• Weakness or clumsiness of a hand problems grasping objects or using the hand for fine movements
• Aching, sometimes radiating up the arm or down into the forearm or fingers
• “Shocking” sensations or paresthesia that come and go in your fingers

Treatment in the initial stages is by splinting, physiotherapy, and medications, which help to resolve the symptoms. Regular strengthening hand exercises can help prevent recurrence. In the event of recurrence of symptoms, we investigate with median nerve conduction studies and an ultrasound scan of the hand, which can reveal a conduction block in the median nerve and nerve compression in the carpal tunnel, respectively.

If the symptoms persist beyond 8-10 weeks, a daycare surgery is advised to release the nerve compression at the wrist. Surgery can be done with either a mini-open technique or an endoscopic technique under regional anesthesia. They get significant relief from symptoms after surgery, just as one of my patients, who is an artist, handed me a handcrafted greeting the day after surgery. She had significant pain and numbness for a long time before surgery, affecting her profession of artistry.

If the symptoms of carpal tunnel go untreated, it can lead to weakness of the hand and thumb grip, leading to dropping of objects from the hand, and may require an extra surgery for strengthening the thumb grip called opponensplasty.
All in all, carpal tunnel syndrome is a simple, treatable condition. “Carpal Tunnel syndrome may symbolize feeling restricted or overburdened”. Approach your doctor if you have symptoms of pain, numbness, and weakness in your hands affecting activities of daily living.

Dr. Bharath Kadadi, Consultant - Hand, Wrist and Microvascular Surgery, Orthopaedics, Manipal Hospital Malleshwaram