Carpal Tunnel Syndrome
Carpal tunnel syndrome is compression of the median nerve in the wrist. The median nerve gives feeling to the thumb, the index finger, the long finger, and half of the ring finger. The carpal tunnel is covered by a ligament called a transverse retinacular ligament. When there is swelling in this area, it puts pressure onto the retinaculum, leading to carpal tunnel syndrome.
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Dr. Dean Johnston, MD, MHSc, FRCPC, Neurologist, discusses hand numbness and carpal tunnel syndrome.
Understanding carpal tunnel syndrome
Carpal Tunnel Syndrome is a common condition that causes pain, numbness and tingling in the hand. The condition occurs when one of the major nerves to the hand, the median nerve, is squeezed or compressed as it travels through the wrist.
The median nerve travels through a narrow tunnel within the wrist, called the Carpal Tunnel. The Carpal Tunnel is approximately 2 centimetres wide and 4 centimetres long. The Carpal Tunnel is formed by the wrist bones on one side and by the transverse retinacular ligament on the other side.
Within the Carpal Tunnel are 9 flexor tendons to the digits. There are 2 flexor tendons to for every digit, except for the thumb where there is only one. Flexor tendons are structures that cause the fingers to bend. Carpal Tunnel Syndrome occurs when the median nerve, travelling through the Carpal tunnel gets compressed. This compression is usually the result of swelling to the flexor tendons. A local chiropractor may work with your local massage therapist and your local physiotherapist to create the best health or rehabilitation plan for your situation.
Most cases of Carpal Tunnel Syndrome are caused by a combination of factors.The most common and important factor is likely hereditary. The Carpal Tunnel may be smaller in some people and there may be anatomic differences that change the amount of space for the nerve. These traits can run in families. Heavy, repetitive use of the hand can lead to swelling of the flexor tendons. This repetitive activity usually needs to be prolonged.
Light repetitive use of the fingers is not likely a cause of Carpal Tunnel Syndrome. Heavy gripping of objects, especially when vibration is incurred, can lead to swelling in the flexor tendons.
Doing activities that involve extreme flexion or extension for prolonged periods of time, can also increase pressure on the nerve. Systemic hormonal changes, such as those that occur during pregnancy, can also cause swelling and lead to Carpal Tunnel Syndrome.
Health conditions such as diabetes, rheumatoid arthritis, or thyroid gland imbalance, are also conditions that are associated with Carpal Tunnel Syndrome. These health conditions, however, are rare causes of Carpal Tunnel Syndrome.
The most common symptoms are of Carpal Tunnel Syndrome are numbness and tingling, primarily in the thumb, index, long, and ring fingers. The small finger is rarely affected as the nerve carrying feeling to the small finger is not the median nerve. Feeling to the small finger is carried by the ulnar nerve, also known as the “funny bone”. If patients have numbness primarily in the small finger, then one must reconsider the diagnosis of Carpal Tunnel Syndrome.
Patients may also exhibit burning and pain in the median nerve distribution of the hand. That pain, or tingling, may travel up the forearm towards the shoulder. Weakness and clumsiness in the hand may make it difficult to perform fine movements, such as buttoning clothes. Dropping objects, as a result of this loss of sensation is a common symptom.
In most cases, symptoms of Carpal Tunnel Syndrome begin gradually.
There is rarely any specific injury to account for the onset of symptoms, although an acute injury can precipitate the problem. Night time symptoms are very common. The reason for this is that the flexor tendons swell spontaneously at night time, when the digits are not moved.
Resolution of the symptoms usually involves shaking of the hand, or moving of the digits. This causes the localized swelling to decrease and the numbness to resolve. Symptoms often occur when holding something for a prolonged period of time with the wrist bent forwards or backwards, such as when using a phone, driving, or reading a book. This can also occur during sleep when most people are unaware of the bent position of their wrist. Presenter: Dr. Bertrand Perey, Orthopaedic Surgeon, New Westminster, BC
Local Practitioners: Orthopaedic Surgeon
The carpal tunnel syndrome is a very common condition of the hand and is characterized by numbness and tingling at the fingertips but also weakness of the hand, and more on this later. We're going to start by talking about what causes carpal tunnel syndrome, the median nerve is the major nerve that comes from the forearm up through the tight carpal tunnel into the palm and into the digit tips.
This tunnel is only two centimeters wide and it contains the median nerve, but also the nine tendons that go to the fingers are responsible for flexing the fingers and making a grip, any excessive change in position of the wrist or inflammation within the carpal tunnel, puts pressure on the nerve, and results in the typical symptoms. These include numbness and tingling in the thumb and the index finger in the long finger as well as part of the ring finger but not the small finger since that's innervated by a different nerve.
Because of the lack of sensation, the hand is weaker and feels weaker, but the nerve also controls the muscles of the base of the thumb, adding to the weakness of the hand. The condition is rarely painful but there can be pain and issues such as numbness and tingling or they go up into the forum and into the evenings the shoulder.
It is worse with aging it is worse with heavy lifting, it is worse with anything that involves excessive vibration, it's particularly worse at nighttime and patients will awaken and want to shake their hands to try to get the feeling back is also worse with certain medical conditions such as diabetes and thyroid disease as well as rheumatoid arthritis, and worse with pregnancy, patients notice it when holding a steering wheel or in holding a book for prolonged periods of time, because it's a condition of positioning and inflammation and pressure on the nerve, the treatment is directed at this, the three treatments are firstly, using a splint at nighttime. This keeps the wrist in the straight position and helps reduce the excess of pressure and the inflammation in the carpal tunnel.
Secondly, a corticosteroid injection or cortisone injection can be very helpful. This is a strong anti inflammatory as injected into the carpal tunnel, it's very safe, very effective. But like splinting is rarely effective and long term. Surgery is commonly recommended and surgery is done an outpatient basis with local or regional anaesthetic, a small incision is made in the skin and the tight ligament of the roof of the carpal tunnel is incised to create more room within the carpal tunnel stitches are used to close the skin and light dressings applied finger range of motion is encouraged and light lifting can begin soon but heavy lifting might take a month or longer.
The operations tolerated very well. Most patients will notice some relief the first night after the surgery. All operations do have risks for these are very rare. Patients may for example have tenderness around the incision and deep massage and occasionally physiotherapy are helpful for this infection rate and other other complications are very rare.
So to summarise carpal tunnel syndrome is the numbness and tingling in the weakness of the hand, due to pressure on the nerve is treated by splinting a corticosteroid injection, and by surgery, you should talk to your family doctor, or your surgeon to determine what treatment is most effective for you. Often seeing a local family physician or a physiotherapist in conjunction with a registered dietitian and athletic therapist is a great option to take control of this condition. Smart Food Now and exercise is also optominal for overall health.
Presenter: Dr. Herb Von Schroeder, Orthopaedic Surgeon, Toronto, ON
Now Health Network Local Practitioners: Orthopaedic Surgeon