Carpal tunnel syndrome is a condition that occurs in the hands and wrist. It affects the median nerve which runs through the wrist by compressing it and causing pain, impassiveness, and stinging sensation in the hand and arm. In the preliminary phase, it is highly curable through non-surgical treatment. However, if repetitive strain inducing prolonged activities are continued then injury gets worse leading to permanent nerve damage.
- Numbness, tingling, burning and pain in the fingers which may travel up the forearm toward the shoulder
- Hand stiffness and weakening grip
- Nighttime symptoms are common and can wake up people from sleep
- Difficult to perform fine movements like handling small objects, grasping a steering wheel to drive, writing, and using a computer keyboard
- Hand-intensive actions that involve continued and highly repetitious flexion (bending) or extension (straightening) of the wrist
- Extended usage of vibrating tools or power tools. Usually, manufacturing/ industrial workers are at higher risk of developing CTS
- CTS can occur with pregnancy, diabetes, thyroid problems, rheumatoid arthritis, but most victims have none of these
- For many people, computer use without proper wrist support is a common culprit of carpal tunnel issues as well
Diagnosis and Treatment
Early diagnosis and treatment are needed to avert permanent nerve damage. Fortunately, there are several non-surgical treatments available for CTS which provide a complete cure. Surgery is only recommended when there is critical damage to the median nerve or to prevent permanent sensory or functional loss.
Initial non-operative treatment plan includes the following:
- Complete rest is usually recommended for 2-3 weeks
- People with mild and moderate CTS are recommended to wear splint/brace at night to keep it properly aligned
- Regular usage of ice and cold-packs for maximum 20 mins will help in reduction of pain and swelling
- Avoid extra stress on the wrists, hands, and fingers. Don’t do a heavy physical activity where your hands may suffer
- Take frequent breaks to rest the hands
- Opt for yoga, stretching, acupuncture, chiropractic therapy, ultra sound therapy only after consulting your doctor
- Your doctor may suggest oral corticosteroid medication, steroid injections for decreasing inflammation and pain, which will help to lessen pressure on the median nerve
There are mainly two types of surgeries – open release surgery and endoscopic surgery. The traditional method is the open release, in which the surgeon cuts open for the surgery. While endoscopic is more cutting-edge, where arthroscopic technique is used with a camera which guides the doctor to perform the operation with thin tools, which are inserted into the wrist through small incisions. The outcomes of the two techniques are similar and it is up to the surgeon to decide upon the appropriate method.
Post-operative recovery and activity guidelines must be followed. Some surgeons recommend the use of a splint or brace for few weeks to restrict movement. Gentle hand exercises or physiotherapy are suggested along with required medication like vitamin B6 and anti-inflammatory pills. Re-occurrence of CTS is very rare and up to 95% of patients get completely healed after the operation and post-operative therapies.
By, Dr. Anupam Golash, Department of Plastic, Reconstructive & Hand Surgery, CK Birla Hospitals CMRI