Carpal Tunnel Syndrome

Most people think that Carpal Tunnel Syndrome is a legacy of Computerage. Evidence of existence of carpal tunnel syndrome exists in medical literature dating back to the beginning of the 20th century.

CARPAL-TUNNEL-SYNDROME1The carpal tunnel is a narrow passage was at the wrist for the main nerve of the hand (median nerve) and for the tendons facilitating bending of our fingers. The tunnel is as big as our thumb and is bounded by bones (carpals) and ligaments (flexor retinaculum). Pressure on the median nerve at the wrist produces the numbness, pain and eventually weakness of the hand that characterize the presentation of the condition.

How does it present?

The syndrome typically starts with a vague ache in the wrist and can extend to hands and forearm. There may be tingling and numbness in fingers or hands especially thumb, index, middle and ring finger. The little finger is spared since it is supplied by another nerve (ulnar). Sometimes there may be weakness in hands with a tendency to drop objects.


What are the causes?

The condition is caused by pressure on the median nerve at the wrist. Median nerve has both sensory and motor function. It provides sensation to thumb, index, middle and part of ring finger and also aids in movements of these fingers. Pressure on th enerve ca be anything that reduces the space for the nerve in the carpal tunnel. The commenst cause is swelling or thickening of the lining and lubricating layer of tendons (synovium) surrounding the nerves in the carpal tunnel.

Who are at risk?

People in packing industry are at risk. Contrary to popular belief that computer use is a risk factor, there is no scientific evidence. Women in general are more prone to develop carpal tunnel syndrome.

How can one diagnose?

A good clinical examination will help in diagnosis. Confirmation is done by electrophysiology where muscle damage due to compression on the nerve can be assessed.

What are the treatment options?

Frequent breaks from work will give good relief in milder cases. The other options are wrist splinting and surgical decompression.

Surgical decompression can be open or through endoscope. The procedure is done under local anesthesia. The procedure lasts for about 15 minutes and consists of cutting the flexor retinaculum through a small incision over the palm of the hand at the wrist. It usually results in marked improvement in symptoms. Surveys of population who have undergone carpal tunnel release indicate that about 80% were satisfied with the outcome. The underlying risks like thyroid disease, rheumatoid arthritis, obesity have to be addressed simultaneously.

How can one prevent the problem?

There are no proven strategies. The grip has to be relaxed. One has to take frequent breaks at work. Extremes of wrist bending shoul dbe avoided. Posture should be corrected to avoid shoulder rolling forward. Hands should be kept warm.