Carpal tunnel syndrome is a medical condition cause by nerve compression along the carpal tunnel. The syndrome is characterised by pain, numbness and tingling sensation along the hand. The carpal tunnel is a confined tunnel formed by a row of small bones over the back of the wrist and a stiff ligament along the front of the wrist. One of the major nerves of the hand (median nerve), together with tendons of the hands run through this tunnel. Carpal tunnel syndrome develops when there is compression of the median nerve.
Risk factors for development of carpal tunnel include:
– Work involving repetitive motions and vibrations
– Diabetes mellitus
– Rheumatoid arthritis
Symptoms of carpal tunnel syndrome:
– Pain over the wrist and hand
– Tingling (pins and needles) and numbness over thumb, index finger, middle finger, half of ring finger – Clumsiness
– Night symptoms
Even though the symptoms and diagnosis of carpal tunnel may seem apparent, there are other serious conditions that could present with similar symptoms.
Other conditions that could present similarly:
– Compression of cervical nerves (nerves along the neck)
– Lung cancer (with nerve compression)
– Nerve compression anywhere along the upper limb
Consult an orthopaedic doctor if you show the above symptoms.
XRays and magnetic resonance imaging (MRI) of the wrist may be performed if there is any suspicious of any growth causing compression of the nerve. The most useful tests would be nerve conduction study (NCS) and electromyography (EMG). Nerve conduction study evaluates the condition of the nerve while electromyography checks the muscles of the hand. Information from these two tests would be essential in the diagnosis of carpal tunnel syndrome.
The treatment for carpal tunnel syndrome should be individualised according to
– Severity of symptoms
– Amount of nerve damage
– Severity of muscle weakness
All patients with carpal tunnel syndrome should be given a course of anti-inflammatory medications. Patients should also modify their lifestyle to avoid aggravating activities. They should also wear night splint to rest the wrist. If symptoms persist after non-invasive treatment, the next option would be steroid injection. 80% of the patients would benefit from steroid injection but only 20% of these patients remain symptoms free at one year.
For patients with severe symptoms that are not relieved by the non-surgical treatments, the next treatment option would be surgical release of the carpal tunnel. This surgery involves releasing the tight carpal tunnel by cutting through the carpal ligament along the front of the wrist. This surgical release will open the carpal tunnel and hence reduce the compression on the nerve. Carpal tunnel release can be performed open or using an endoscope (keyhole surgery). Your orthopaedic surgeon will discuss in detail regarding the pro and con for each option. Open carpal tunnel release involves making an incision over the front of the wrist and cutting the carpal ligament. Endoscopic carpal tunnel release involves making two small incisions along the front of the wrist. Special keyhole surgery tools will be utilised to release the carpal tunnel. The surgery will be performed under local or regional anaesthesia. The surgery will take about 30 minutes. You can be discharge on the same day. Your surgeons will review your condition regularly after surgery to make sure your recovery is on track.
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