Carpal Tunnel Syndrome – Symptoms and Treatment

If the median nerve that runs through the hand and arm is pinched in the carpal tunnel, symptoms such as aching and numb hands occur. Carpal tunnel syndrome is the most common compression syndrome of a peripheral nerve: About one in ten people will suffer from the typical symptoms in their lifetime. What to do if the hand keeps falling asleep? The most effective therapy is surgery, although it is not suitable for treatment in all cases. Exercise, splints and the use of cortisone can also help alleviate the symptoms. Read more about the background of carpal tunnel syndrome and the treatment options here.

What is carpal tunnel syndrome?

The carpal tunnel – also known as the carpal canal – is located in the palm, approximately at the level of the wrist bones. The median nerve (Nervus medianus) runs through this canal, which is responsible, among other things, for muscle movement and the hand’s sense of touch, especially the index and middle finger. In addition to the median nerve, the nine flexor tendons of the fingers also run through the carpal tunnel.

The carpal canal is, therefore, a constriction in which comparatively little space is available. If this canal narrows due to swelling, more pressure is exerted on the nerve. This compression of the median nerve causes pain, sensory disturbances and discomfort, and in later stages, there is also a breakdown of the thumb muscles. This is called carpal tunnel syndrome (CTS).

What are the causes and risk factors?

In most cases, the cause of carpal tunnel syndrome is unknown (idiopathic). Women are affected about three times as often as men, and children only very rarely get it. As a rule, the syndrome occurs on both hands. It can happen that it only affects one hand at first and later develops on the other.

Some risk factors make carpal tunnel syndrome more likely:

• Overloading and incorrect loading in physical work
• chronic inflammation of the tendon sheaths
• Osteoarthritis in the wrists
• frequent occurrence in the family
• obesity
• Diabetes  mellitus
• underactive thyroid
• pregnancy

What are the symptoms of carpal tunnel syndrome?

The typical symptom of carpal tunnel syndrome is the painful falling of the hands, especially at night. This pain is perceived as pinprick-like and can also be caused by certain hand positions, for example, when using the telephone. Numbness and tingling can also be associated with the “falling asleep” of the hand. In the early stages of the disease, the symptoms improve by shaking out the hand.

If the disease is more advanced, those affected report further symptoms:

• Persistent loss of sensation in the fingers, especially the index and middle fingers
• the pain can now also travel up into the arm, rarely up to the shoulder
• Regression of the lateral thenar muscles (thumb visibly flattened)
• loss of fine motor skills
• loss of strength in the hand

 

Diagnosis: how does carpal tunnel syndrome become noticeable?

The most important clue for diagnosing carpal tunnel syndrome is the nocturnal pain. But which doctor should you go to first? The first point of contact is the doctor’s office. Based on the anamnesis (discussion of the medical history) and the typical symptoms, the suspected diagnosis of carpal tunnel syndrome can be made.

To further confirm the suspicion, some tests are performed. For example, by applying targeted pressure to the carpal tunnel, you can provoke lightning-fast, electric shooting pain. If tapping the flexor region below the wrist leads to electrifying pain and discomfort, the so-called Hoffmann-Tinel sign is positive.

Another possibility if carpal tunnel syndrome is suspected is a self-test, which is also called the Phalen sign in professional circles. To do this, the patients are asked to press their hands firmly together for one minute. Point your fingertips down and press your palms together for the first minute. In the second minute, it’s the other way around: now the palms of the hands are pressed together, and the fingertips point upwards. The second position resembles a prayer posture.

On the palm, the median nerve is responsible for transmitting stimuli to sensitive parts of the thumb, the entire index and middle finger and parts of the ring finger. If, after a minute of the Phalen sign, you experience abnormal sensations, i.e. pain or numbness, in these fingers, the Phalen sign is positive.

Who diagnoses carpal tunnel syndrome?

If there is a suspected diagnosis of carpal tunnel syndrome, you should first be referred to a neurologist. The nerve conduction velocity can be measured there. Only by measuring the electrical conduction of the nerve and determining the limit values ​​can one reliably determine the nerve damage’s location and severity.

It is also essential to rule out other diseases. The most common differential diagnosis is disc damage in the cervical spine. The same symptoms can also occur here. However, since the damage to the nerve is at a different location, this differential diagnosis can be ruled out using the nerve conduction velocity.

What are the therapies for carpal tunnel syndrome?

Not every diagnosis of carpal tunnel syndrome requires treatment. Some sufferers have only occasional or minor symptoms. If the neurological readings are also standard, you can wait and see.

If the symptoms increase, there are various therapies to choose from. First of all, a distinction is made between conservative and surgical treatments.

Carpal tunnel syndrome can be treated conservatively in the following ways:

• Wearing a splint to immobilize the wrist at night: The special arm splint for carpal tunnel syndrome relieves the median nerve and can be prescribed by a doctor.
• Injection of a cortisone preparation into the wrist
• Administration of cortisone as tablets for 14 days
• short-term administration of pain medications such as ibuprofen

Low-level laser therapy can be considered according to the current guidelines. To support the treatment of minor complaints, physiotherapists sometimes use special kinesio tape as an alternative to splints to immobilize the wrist with tape. Home remedies or over-the-counter ointments for pain relief often do not affect carpal tunnel syndrome. The effectiveness of extracorporeal shock wave therapy (ESWT) is controversial.

 

What can I do myself if I have carpal tunnel syndrome?

In the early stages, you can relieve some pain with stretching exercises . There are some guides on the internet for this. These exercises can be tried in addition to standard therapy.

However, there is currently no data to prove that stretching exercises or foam rollers help effectively. Nevertheless, those affected can try these measures and test whether this approach helps them.

When is carpal tunnel syndrome operated on?

If conservative treatment is unsuccessful or the carpal tunnel syndrome is at an advanced stage, surgery is advisable. Specialists in the field of hand surgery specialize in this.

There are two surgical techniques: open surgery and endoscopic surgery, which use the so-called keyhole procedure. Both types of surgery are usually performed with local anaesthesia or under a short sedation. A minor knife cuts through the ligament (flexor retinaculum, carpal ligament) that forms the “roof” of the carpal tunnel. This creates more space and relieves the pressure on your nerves.

How long does recovery take after surgery?

With this procedure, those affected can usually clench their fists the next day, and after two to three weeks, the hand can be used again for most activities.

You cannot work for three to four weeks, depending on your occupation. It can sometimes take longer in physically demanding jobs, such as assembly line work because you shouldn’t strain your hand too early.

The pain does not usually disappear suddenly but subsides within days to weeks. It is essential to have the wound checked by a doctor after the operation and not to apply constricting bandages.

The healing time depends on factors such as age and general health status. Since this is a small operation, you can count on two to three weeks. The chances of success with the operation are excellent: If the operation was carried out correctly, the probability of carpal tunnel syndrome recurring is very low.