What is carpal tunnel syndrome?

Carpal tunnel syndrome is a median nerve that is pinched and inflamed. It manifests itself in a violation of the sensitivity of the hands and a gradual loss of motor activity. The cause of the disease is compression of the median nerve in the anatomical canal.

Vessels, nerves, synovial membranes, tendons pass through the carpal canal. Here is the median nerve, the main nerve of the hand, which runs from the brachial plexus to the fingertips. Responsible for coordinating movement, fine motor skills of the hands, constriction, and expansion of blood vessels from external stimuli, regulates the work of sweat glands. The width of the canal is limited on three sides by the bones and the transverse ligament.

The carpal tunnel itself is quite narrow, which contributes to the formation of various pathologies. Any additional narrowing entails squeezing the nerve fibers and blood vessels; blood supply is disrupted. Pathological processes proceed slowly, begin with a loss of physiological sensitivity, and lead to motor and trophic disorders. The clinical picture of the disease has clear symptoms, which makes it easy to make a diagnosis even at the initial stage.

Tunnel syndrome symptoms

1. Decreased brush sensitivity. At first, patients begin to notice numbness in the fingers immediately after waking up. Over time, the periods of paresthesia increase, and feelings of burning, pain, cold, or heat are added to it. Carpal tunnel syndrome is characterized by a simultaneous, radically opposite change insensitivity. In one area, it rises, but the other part of the palm does not feel anything.
2. Burning pain in palms, with shooting in fingers. Initially, pain is felt in the zone of the pinched nerve; then, it gradually begins to affect the entire arm from the shoulder to the fingertips. This is accompanied by swelling of the wrist. As a rule, the dominant hand hurts the right hand in the right-hander, the left in the left-hander, but there are also bilateral symptoms.
3. Muscle weakness and impaired motor activity. As a result of prolonged pinching and inflammation of the nerve fibers, the hand loses muscle strength, restricting movement. It becomes difficult to handle small objects, as when buttoning up. The function of grasping and then holding objects weakens. A gradual decrease in the working capacity of the hand leads to muscle atrophy and deformity of the hand.
4. Lesions of the autonomic nervous system. This is expressed in a pale and sometimes cyanotic color of the hand, dry skin, brittle nails, cold hands.

Naturally, carpal tunnel syndrome affects the general physical and mental state of the patient. He loses his ability to work, the quality of life decreases. Regular pain and constant discomfort increase at night, which interferes with normal sleep, causing insomnia.

A characteristic feature of this disease is that the patient can relieve discomfort on his own without resorting to medications. It is enough to put your hands down, move your fingers, shake your hands, stretch them, do massage, gymnastics. These manipulations help restore blood supply, but, unfortunately, not for long since they do not eliminate the causes.

Carpal tunnel syndrome diagnostics

It is easy to diagnose this disease; it is enough to interview the patient and conduct several tests since carpal tunnel syndrome has vivid distinctive features. Among them are the symptoms described above and the preservation of the functions of the little finger, which is not affected when the nerve and blood vessels in the carpal canal are pinched.

The doctor also conducts palpation and the following tests:

• Hoffman Tinel test. Tapping the median nerve area. With carpal tunnel pathology, the patient feels numbness, tingling, burning with his palm.
• Phalen’s test. By maximally bending the hand at the wrist joint, the patient feels pain and numbness in the palm.
• It is difficult to hold the arms raised above the head for more than 1 minute; pain syndrome and numbness of the extremities begin.
• It is impossible to connect (touch) the thumb with the little finger.

To determine the degree of damage and associated complications, additional examinations are prescribed to confirm the correctness of the diagnosis:

• Electroneuromyography to assess the conduction of nerve impulses is the gold standard for diagnosing tunnel syndrome.
• Ultrasonography helps detect damage and inflammation.

A neurologist, physiotherapist, and hand surgeon can diagnose and treat.

Treatment for carpal tunnel syndrome

All measures aimed to eliminate the cause of the disease, complete or partially eliminate the median nerve’s compression. The method of therapy depends on the severity of the tunnel syndrome: it may be conservative and surgical treatment. Also, the doctor’s tasks include identifying the cause of the disease’s onset to limit movements that worsen the symptoms.

Conservative treatment 

Patients are prescribed wearing an orthosis, which keeps the wrist joint in a safe position for blood vessels and nerves. It is recommended to wear it constantly, during the day and at night. According to statistics, orthotics are effective in the early and middle stages of the disease. It is recommended to switch to a salt-free diet and limit fluid intake to reduce swelling.

Medications are also prescribed:

1. Non-steroidal anti-inflammatory agents to reduce pain and inflammation.
2. Oral or injectable corticosteroids to relieve pain and restore joint mobility.
3. Vascular drugs to improve tissue blood supply.
4. Diuretics to relieve swelling.
5. Vitamin B6 relieves symptoms and increases the effectiveness of treatment.

Physiotherapy, electrophoresis, UHF, magnetotherapy, and other methods help speed up tunnel syndrome therapy to achieve a positive result faster. Physical therapy and massage are often prescribed. The complex combination of these therapy methods and the use of medications leads to remission in 59% of patients. The rest are forced, on average, after 1-2 years to turn to a wrist surgeon for an operation.

Surgery treatment

If conservative treatment is ineffective and if the disease is neglected, a surgical operation is prescribed. They are dealt with only by hand surgeons, narrow-profile specialists who conduct surgical aids on the hand. The purpose of the operation is to release the median nerve, relieve pressure. There are two ways to open the carpal tunnel:

1. Open surgery, in which an incision is made in the wrist. Having gained access, the surgeon dissects the ligament, increasing the volume of the carpal tunnel.
2. Endoscopy has a shorter incision length but is performed in two places. They are necessary for the introduction of a micro camera, using which the ligament can be dissected.

Both types of surgery are performed under local anesthesia. Sometimes excision of tissue around the nerve and tendons is required, with cicatricial changes, ovaries, and strands. On average, the procedure is carried out within 20 minutes.

At first, the patient may feel pain in ​​the scars and physical weakness in the wrist. It will take several months to recover fully; the period is individual in each case. Rehabilitation consists of gymnastics, massage, physiotherapy. During the recovery period, many have to give up their activity if it affects recovery.

According to statistics, up to 90% of patients who underwent surgical treatment completely restore the physical activity of the hands and get rid of the symptoms of carpal tunnel syndrome. Relapses occur in 8-12% of cases.

Alternative treatments 

You can relieve the symptoms of tunnel syndrome without medication and surgery. This requires:

1. Reduce the stress on the hands and wrists, exclude activities that worsen the condition.
2. Fix the arm with a splint, orthosis, or an elastic bandage to restrict movement.
3. Remove swelling with ice, limit fluid and salt intake.
4. Perform arm gymnastics aimed at stretching the joints. We recommend exercising under the supervision of a physiotherapist.

If there is no improvement, then you should not delay seeking medical attention.

Carpal tunnel syndrome is not life-threatening; it is a slowly ongoing pathological process. The disease has a favorable prognosis for recovery, but some people are in no hurry to visit a doctor due to the neglect of their health. Over time, this leads to decreased motor activity, muscle strength, and fine motor impairment. If left untreated, irreversible processes will begin, the median nerve will atrophy. This will lead to the loss of the functionality of the brush, which will no longer be possible to return.