Carpal tunnel syndrome – causes, symptoms & therapy

Carpal tunnel syndrome

Carpal tunnel syndrome is one of the most common nerve compression syndromes and is caused by a narrowing of the median nerve in the carpal canal (carpal tunnel). The increase in pressure leads to short-term or chronic damage to the median nerve, which becomes noticeable through sensory and motor deficits (eg numb and tingling fingers).

What is carpal tunnel syndrome?

Carpal tunnel syndrome is damage to the median nerve (wrist) that results from a narrowing of the carpal tunnel. The carpal canal serves as a tunnel between the wrist and forearm through which the median nerve and important tendons of the hand pass.

When there is a discrepancy between the space required by the nerves and tendons passing through the carpal tunnel and the expansion of the carpal tunnel, increased pressure is placed on the median nerve, which can lead to damage known as carpal tunnel syndrome.

causes

In most cases, no immediate causes can be identified for carpal tunnel syndrome (idiopathic carpal tunnel syndrome). In many cases, carpal tunnel syndrome is preceded by stress-related tendonitis .The swelling of the flexor tendon sheaths causes an increase in pressure in the carpal tunnel, as a result of which carpal tunnel syndrome can develop. If causes can nevertheless be determined, they are fundamentally subject to one of the following mechanisms.

On the one hand, an increase in pressure on the median nerve and a corresponding carpal tunnel syndrome can be caused locally by fracture-related malpositions near the wrist, carpal bone dislocations (dislocations), tumors or ganglia .

Permanent mechanical stress on the wrist from the outside can also result in carpal tunnel syndrome. On the other hand, systemic diseases that affect the entire human organism, such as an overactive thyroid gland , rheumatoid arthritis or gout , can promote the development of carpal tunnel syndrome. Pregnancy, which is often accompanied by swelling structures, can also cause carpal tunnel syndrome.

When to the doctor?

Hands falling asleep at night, abnormal sensations and other typical symptoms of carpal tunnel syndrome must be clarified at an early stage. If the signs of the disease occur more frequently and seem to be getting worse, it is best to see your family doctor. Depending on the cause and symptoms, treatment is carried out by an orthopaedist, sports physician or trauma surgeon.

Those affected who already suffer from pinched nerves or arthrosis should inform the doctor responsible about the symptoms. People with rheumatism or metabolic diseases such as gout also belong to the risk groups and must consult a doctor immediately with the symptoms.

If the symptoms occur during pregnancy, it is important to consult the gynecologist. In this case, the condition is due to a harmless metabolic change and disappears on its own after birth. However, the course must be monitored so that the necessary measures can be taken in the event of complications. If carpal tunnel syndrome is treated early, it usually takes a good course. If the median nerve is already damaged, permanent deficits can be the consequence.

symptoms and course

Possible symptoms of carpal tunnel syndrome:

  • electrifying pain sensations in hand
  • Restrictions in the fine motor skills of the hand (e.g. grasping)

At the beginning of carpal tunnel syndrome, sufferers often report that their hands or fingers have gone to sleep. In the further course, sensory disturbances in the thumb, index and middle finger (tingling, numbness ) and pain occur more frequently when the wrist is bent (holding a book, but also nocturnal rest pain due to a bent wrist position when sleeping). These sensory disturbances can develop into motor and sensory deficits.

Sometimes the pain caused by carpal tunnel syndrome can radiate to the upper arm, shoulder and neck. If carpal tunnel syndrome is not treated, a massive reduction in the muscles of the ball of the thumb (thumb ball atrophy) and a reduced gripping ability can be observed in the later course. In the very advanced stage, carpal tunnel syndrome can lead to irreparable numbness in the entire area of ​​the affected fingers and partial paralysis of the ball of the thumb.

Diagnose

In the case of carpal tunnel syndrome, the description of the symptoms by those affected can already indicate the disease. Using various clinical-neurological tests, the hands and the function of the median nerve are checked for carpal tunnel syndrome.Percussion pain and sensory disturbances when the median nerve is tapped (Hoffmann-Tinel sign) as well as pain and sensory disturbances when the wrist is bent to the maximum (Phalen test) indicate carpal tunnel syndrome.

In the advanced course of carpal tunnel syndrome, a bottle can no longer be held by those affected due to the partial paralysis (bottle test).

If a difference is found between the affected and non-affected hand when measuring the nerve conduction velocity (NLG) of the median nerve and the electrical muscle activity (electromyography), this is a definite indication of carpal tunnel syndrome.

complications

Carpal tunnel syndrome can cause complications such as restricted mobility, pain and numbness. These symptoms can worsen as the syndrome progresses, leading to malpositions and nerve damage. The “falling asleep” of the hand is also typical, which lasts longer and longer in an untreated syndrome and ultimately promotes circulatory disorders . Sudden pain or sensory disturbances can lead to accidents and falls. Even with the surgical treatment of carpal tunnel syndrome, complications cannot be ruled out.

Nerve injuries can cause temporary or permanent discomfort and loss of sensation in the thumb, index, middle, or ring finger. Poor movement of the thumb can also occur. Swelling in the area of ​​the incision may occur soon after the procedure. Postoperative bleeding and bruising cannot be ruled out either. In very rare cases, infection can occur, which may necessitate a follow-up operation. Occasionally there is increased sensitivity to touch at the surgical scar. In addition, the prescribed painkillers and antibiotics may cause side effects and interactions.

treatment and therapy

Carpal tunnel syndrome is usually treated conservatively at the beginning. As part of such therapy, the affected hand is immobilized at night with a splint. In addition, a local anesthetic in combination with cortisone can be injected into the narrowed carpal tunnel to reduce pain. In many cases, taking anti-inflammatory drugs ( diclofenac , ibuprofen ) is used as an additional measure, although a positive effect on carpal tunnel syndrome has not yet been proven.

Dorothy Farrar

Hello and welcome to my Health Guide & Encyclopedia! My name is Dorothy Farrar, and I'm the founder and main author of this platform.
My passion for health and wellness started at a young age when I became interested in the connection between the food we eat and the way we feel. This fascination led me to study nutrition and dietetics in college, where I learned about the importance of a balanced diet and the impact of various nutrients on the body.

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