Carpal tunnel syndrome is a common condition that causes numbness, pain and tingling in the arm and hand. This condition occurs when one of the primary nerves in the hand is compressed or squeezed as it moves through the wrist. Carpal tunnel syndrome worsens with time in the majority of patients, therefore early diagnosis and management are critical.
We encourage you to contact our physical therapist at the Suarez Physical Therapy if you are experiencing symptoms mentioned above or further in this article for a diagnosis. We are delighted to service the Las Vegas region, and are dedicated to delivering the best medical services to every patient.
Overview of Carpal Tunnel Syndrome
The carpal tunnel is a small, at least one-inch-wide tunnel in the wrist. Its floor and sides are made of small wrist bones called carpal bones. The roof of the tunnel is formed by a transverse carpal ligament, which is a strong band of connective tissue. These structural boundaries are so rigid that the carpal tunnel has minimal capacity to "expand" or enlarge in size.
A nerve, known as the median nerve, is among the major nerves in the arm. It usually starts as a collection of nerve roots in the neck. In the arm, the roots combine to form a single nerve. The median nerve runs down the forearm and arm, and through the carpal tunnel in the wrist, and into the hand. This nerve gives sensory abilities to the thumbs, middle, index finger, and ring fingers. The muscles at the bottom of the thumb are in the same way controlled by the nerve.
The carpal tunnel also houses the nine flexor tendons that allow bending in the fingers. When the tunnel narrows or the tissues neighboring the flexor tendons enlarge, pressure is placed on the median nerve, causing carpal tunnel syndrome.
These surrounding tissues are known as synovium. The synovium usually helps to lubricate the tendons, enabling simpler finger movement. When the synovium expands, it takes up more space in the carpal tunnel, crowding the nerve over time. Pain, numbness, tingling, and general weakness in the hand might occur from this increased stress on the nerve.
Symptoms of Carpal Tunnel Syndrome
Carpal tunnel syndrome can cause the following symptoms:
- Numbness, burning, tingling, and pain in the thumb, index finger, middle finger, and ring fingers are the most common symptoms
- Shock-like sensations in the thumb, middle, index, and ring fingers
- Tingling or pain that travels up the forearm to the shoulder
- Weakness and clumsiness in the hand—this can make fine activities like buttoning your garments difficult
- Dropping objects as a result of weakness, numbness, or a loss of proprioception
These symptoms usually appear gradually and with no particular injury. Often, individuals develop symptoms that recur at first. As the illness progresses, however, symptoms may appear more regularly or for extended durations.
Causes of Carpal Tunnel Syndrome
Instead of an issue with the nerve itself, carpal tunnel syndrome is almost always the result of multiple elements that raise pressure on the median nerve and tendons in the carpal tunnel.
Carpal tunnel syndrome has been linked to a variety of activities, including:
- Monotonous hand movements
- Uncomfortable hand positions
- Using a lot of force when gripping stuff
- When the palm is subjected to mechanical stress.
CTS symptoms are typically reported by workers who work in fields that deal with cleaning, manufacturing, and packaging. Cashiers, knitters, hairdressers, and sewers are just a few examples of people whose jobs require repetitive wrist movements, which can lead to carpal tunnel syndrome.
Other cases are bakers who bend or stretch their wrists when kneading bread, and persons who flex their fingers and wrists while performing chores such as spray painting, milking cows, and hand-weeding. Carpal tunnel syndrome could also be linked to excessive usage of vibrating hand equipment.
Other non-occupational variables that can cause carpal tunnel syndrome include:
- Heredity. This is most certainly a significant element. The carpal tunnel may be narrower in some individuals, or anatomic abnormalities may affect the amount of available space for the nerve, and these features can run in the family.
- Pregnancy. Swelling can be due to hormonal changes that happen during pregnancy.
- Health issues. Carpal tunnel syndrome is linked to conditions such as rheumatoid arthritis, diabetes, and thyroid gland imbalance.
- Using oral contraceptives
- Wrist cysts
- Infiltration of the kidneys, spleen, or liver with a starch-like material
All of these conditions and disorders cause the contents inside the carpal tunnel to expand, compressing the median nerve. Individual characteristics like wrist shape and size, as well as the structure of the median nerve, could also have a role in developing carpal tunnel syndrome.
Females are 3 times more probable than males to get carpal tunnel syndrome, which could be since a woman's carpal tunnel is narrower than a man's.
How is Carpal Tunnel Syndrome Diagnosed?
At your examination, your doctor will inquire about your symptoms and ask about your overall medical and health background. He or she will perform a thorough examination of your wrist and hand, as well as a series of physical examinations. Your doctor will also do the following during these examinations:
- Check for tingling and numbness or in your fingers by pressing down or tapping along the median nerve on your wrist. This is referred to as the Tinel sign
- Check for tingling or numbness in your hands by bending and holding your wrists in a relaxed position
- With your eyes closed, lightly stroke your hands and fingertips with a special device to assess the sensitivity
- Examine the muscles surrounding the root of your thumb for signs of weakness
- Check for degeneration in the muscles surrounding your thumb's root. The muscles could be noticeably smaller in severe situations
These tests will allow your therapist to assess if your median nerve is functioning correctly and identify whether it is under too much stress. The tests will mostly enable your doctor to figure out if you have additional nerve problems, like neuropathy, or if there are any additional areas of nerve compression that are causing your discomfort.
The following electrophysiological tests may be performed:
Nerve Conduction Test
These tests monitor the signals that go through your arm and hand's nerves and could discover if a nerve is not efficiently conveying its signal. Nerve conduction testing can assist your doctor in determining the severity of your condition and guiding treatments.
The electrical impulses of muscles are measured by an EMG. The findings of an EMG can indicate whether or not you have any muscle or nerve damage.
Ultrasound utilizes high-frequency radio waves to make images of tissues and bones. An examination of your wrist using ultrasound may be recommended by your doctor to check for evidence of compression of the median nerve.
X-rays are used to visualize thick structures like bone. If you have reduced wrist mobility or discomfort, your doctor may suggest x-rays to rule out other possibilities like ligament injury, arthritis, or a fracture.
Scans Using Magnetic Resonance Imaging (MRI)
These researches give us a better picture of the soft tissues of the body. An MRI may be ordered by your doctor to rule out other possible causes or to check for unusual tissues that might be affecting the median nerve. The MRI could also be used to see whether there are any issues with the nerve, like a tumor scarring from trauma.
Carpal tunnel syndrome will progress with time for a lot of people if it is not treated. As a result, it's critical to have your doctor examine and diagnose you as soon as possible. It is feasible to delay or prevent the disease’s progression in its initial phases.
Carpal tunnel syndrome symptoms can typically be cured without surgery if identified and treated early. If your doctor is unsure about your diagnosis or your signs and symptoms are minor, he or she will first suggest nonsurgical treatment.
Nonsurgical Treatments include:
Splinting or bracing
Using a night splint or brace will prevent you from folding your wrist while sleeping. The carpal tunnel nerve is relieved by maintaining your wrist in a neutral or straight position. Wearing a splint throughout the day while undertaking tasks that intensify your symptoms may also assist in treating CTS.
Nonsteroidal Anti-inflammatory Drugs
NSAIDs are medications that are used to treat inflammation. Ibuprofen and naproxen are examples of medications that can aid with the pain and swelling you might be experiencing.
Changes in Activity
Symptoms can develop if your wrist and hand are in the same posture for a lengthy period, especially when your wrist is bent or stretched.
Switching or adjusting your profession or leisure activities (if they worsen your symptoms) could help reduce or prevent the progression of the condition. Adjustments to your work location or workstation could be required in some scenarios.
Gliding Exercises for the Nerves
Exercises that let the median nerve function more easily within the boundaries of the carpal tunnel could help in some cases. Your doctor or therapist may suggest certain exercises depending on your situation.
Corticosteroid, sometimes known as cortisone, is a potent anti-inflammatory that can be injected into the carpal tunnel. Even though these injections can assist to ease unpleasant symptoms or reduce a flare-up of the symptoms, their benefits are not always permanent. Your physician could also use a cortisone injection to assist in identifying carpal tunnel syndrome.
When non-surgical therapy fails to relieve carpal tunnel syndrome or the condition has worsened, your doctor will recommend surgical treatments. The purpose of surgery is to expand the tunnel's diameter in an attempt to ease the pressure on the median nerve and the tendons that run through it. During the surgery, the ligament which surrounds the carpal tunnel at the root of the wrist is cut (released) to relieve the pressure. This tissue is referred to as the transverse carpal ligament.
The Surgical Procedure
Carpal tunnel surgery is usually performed as an outpatient procedure. The procedure can be performed under general anesthesia, which will put you to sleep, or sometimes under local anesthetic, which will only cause numbness to your arm and hand. An intravenous (IV) line put into a vein in the arm may be used to administer a gentle sedative
Open carpal tunnel release
Your doctor makes a small cut on your palm and examines the inside of your wrist and hand through it during open surgery. He or she will split the transverse carpal ligament during the treatment (the carpal tunnel's roof). This expands the tunnel and relieves the pressure or stress on the median nerve.
The ligament could slowly heal after surgery, however, the carpal tunnel will have greater room and the strain on the median nerve will be eased.
Endoscopic carpal tunnel release
In this surgery, your doctor can make either one or two minor skin cuts termed portals and examine your wrist and hand with a tiny camera referred to as an endoscope. Just like the open carpal tunnel release surgery, a special knife is utilized to split the transverse carpal ligament. Open and endoscopic surgery produce similar results. Both strategies have their own set of advantages and drawbacks. Your doctor will discuss the best surgical procedure for you.
Risks of carpal tunnel surgery
Carpal tunnel release, like most surgery treatments, comes with concerns. Other risks associated with carpal tunnel surgery include:
- Damage to the median nerve or the nerves that sprout off from it
- Damage to surrounding blood vessels
- Sensitive scars
- Complications arising from the general or local anesthesia used
Carpal tunnel surgery requires time to heal – anything between a few weeks to several months. If the nerve had been constricted for a long period, healing could be difficult. There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your doctor before the procedure.
For 1 to 2 weeks, your wrist will most likely be wrapped in a thick bandage or splint. The split or bandage is normally removed at a later appointment by the doctor. You could be urged to move your fingers throughout this period to assist minimize stiffness.
After surgery, you'll most likely have some pain in your wrist and hand. Pain is commonly managed with over-the-counter pain relievers. To help reduce inflammation, the surgeon could advise you on keeping your affected hand raised while sleeping.
Following the removal of the splint, you will most probably start a physical therapy routine. The physical therapist will show you mobility exercises to help you strengthen your hand and wrist movements. These exercises can help you heal faster and gain more strength back to the area.
In the meanwhile, you might need to change your work activities or perhaps even take some time off to recover. Your doctor will discuss the activity limits you must follow following the surgery.
After the surgery, you could experience the following:
- Swelling, redness, hemorrhage, or other discharge from where the incision was made
- Increased discomfort in the area of the incision
These issues may have to be addressed. Consult with your doctor on what to anticipate and what symptoms indicate that you should seek medical help immediately.
Preventing Carpal Tunnel Syndrome
Although there is no one-size-fits-all solution to prevent CTS, there are techniques to lessen stress on your wrists and hands. Because various factors might encourage the development of CTS, a single remedy may not be sufficient.
The following are some helpful hints for reducing stress in your wrists and hands:
Make Improvements to Your Posture
Ascertain that your posture is acceptable for the task at hand. Too much pressure and poor wrist and hand positions can be avoided by aligning your neck, neck, and shoulders properly.
Take Regular Breaks
Start giving your hands rest by practicing stretching exercises now and then when you're doing repetitive activities. When performing some activities, try to switch your hands as much as possible. To avoid being in a grasping stance all of the time, let your fingers spread apart.
Reduce the Amount of Force Used
When operating with their hands, many individuals use more pressure than is necessary. Reduce the amount of energy you use when typing. To prevent fatigue and strain in your muscles, loosen your grip.
When writing for lengthy periods by hand, choose a pen with a bigger handle or a soft gel grip.
Keep Wrists in a Relaxed Position
For extended periods, avoid bending your wrists. When undertaking long jobs, keep your wrists in a neutral or straight position. This indicates you should avoid bending your wrist.
Adjustments to Your Work Environment
Assess your work environment with the help of a physical therapist to ensure that it is suitable for your stature, stance, and tasks. Ensure your wrist isn't resting on the desk's edge. Simple modifications might help you avoid putting yourself under undue pressure.
Warm-up Your Hands
If you operate in a cold workplace, you're more prone to suffer from hand pain and stiffness. Put on gloves to make your wrists and hands warm if you can't manage the temperature.
Maintain a Healthy Lifestyle
Preventing CTS means paying attentive care to your overall health. Maintaining a healthy weight and being physically active can help manage diseases and disorders that can contribute to CTS.
Find a Las Vegas Physical Therapist
If you've been diagnosed with CTS, your recovery journey starts at Suarez Physical Therapy. Don't wait until your symptoms are unbearable to get help. Delaying treatment may cause your nerves' condition to deteriorate further, resulting in irreversible harm. If you are in the Las Vegas region, our individualized physical therapy services will help you regain physical strength, mobility, and independence. Call 702-368-6778 today to schedule an appointment with our physical therapist.