Carpal tunnel syndrome

Diagnosis

In order to identify if you have carpal tunnel syndrome, your doctor may ask you questions and perform one or more of the tests listed below:

• History of symptoms. The symptom pattern will be examined by your healthcare provider. For instance, since the little finger does not receive sensation from the median nerve, problems in that finger may point to anything other than carpal tunnel syndrome.

Symptoms of carpal tunnel syndrome frequently appear when holding a phone, a newspaper, or firmly clutching a steering wheel. Additionally, they frequently happen at night, and you can be awakened by them or wake up feeling numb.

• Physical examination. Your doctor will examine you physically. He or she will assess the strength of the hand’s muscles and the sensation in the fingers. Many people can experience symptoms as a result of bending the wrist, tapping on the nerve, or just pressing on the nerve.
• X-ray. To rule out alternative causes of wrist pain, such as arthritis or a fracture, some medical professionals advise taking an X-ray of the affected wrist. However, X-rays are useless for identifying carpal tunnel syndrome.
• Ultrasound. A healthcare provider may suggest an ultrasound of the patient’s wrist to obtain clear images of the bones and nerves. This approach can aid in identifying any compression of the nerve.
• Electromyography. This examination measures the minute electrical discharges that muscles make. In order to measure the electrical activity that occurs when muscles contract and relax, your doctor will implant a thin-needle electrode into a few selected muscles during this test. This test may rule out other disorders while detecting damage to the muscles the median nerve controls.
• Nerve conduction study. Two electrodes are taped to the skin in an electromyography version. To determine whether electrical impulses in the carpal tunnel are delayed, a brief shock is delivered to the median nerve. This examination could be used to identify the ailment and rule out any others.

Treatment

As soon as symptoms of carpal tunnel syndrome appear, start treatment. Simple things you can do for yourself could solve the issue in its early stages. For instance:

• Avoid doing things that aggravate your symptoms.
• Increase the frequency of your hand rests.
• Use cold therapy to lessen swelling.

Surgery, medicine, and wrist splinting are further therapeutic possibilities. If you’ve only experienced mild to moderate symptoms that come and go for less than 10 months, splinting and other conservative treatments are more likely to be effective. You should see a doctor if you get numbness in your hands.

Nonsurgical therapy

In the event that carpal tunnel syndrome is detected early, nonsurgical treatments, such as:

• Wrist splinting. Numbness and tingling during the night can be eased by wearing a wrist splint while you sleep. Even if the splint is only worn at night, it can still help prevent symptoms from occurring during the day. Given that it does not require the use of any pharmaceuticals to be effective, nighttime splinting may be a suitable choice if you’re expecting.
• Nonsteroidal anti-inflammatory drugs (NSAIDs). Carpal tunnel syndrome discomfort may be temporarily reduced by NSAIDs like ibuprofen (Advil, Motrin IB, etc.). However, there is no proof that these medications help in carpal tunnel syndrome.
• Corticosteroids. To ease pain, your doctor may administer an injection of a corticosteroid such cortisone into the carpal tunnel. These injections are occasionally guided by ultrasound, according to the provider.

Inflammation and edema are reduced by corticosteroids, relieving strain on the median nerve. For treating carpal tunnel syndrome, oral corticosteroids are not thought to be as beneficial as corticosteroid injections.

Treating the inflammatory arthritis, such as rheumatoid arthritis, which may be the cause of carpal tunnel syndrome, may lessen its symptoms. But this hasn’t been proven.

Surgery

If symptoms are severe or do not improve with previous therapies, surgery can be necessary. Carpal tunnel surgery aims to relieve pressure on the median nerve by severing the ligament that is obstructing it.

There are two methods for doing the surgery:

• Endoscopic surgery. The endoscope (a device resembling a telescope with a tiny camera attached to it) is used by your surgeon to view the interior of the carpal tunnel. Through one or two small incisions in the hand or wrist, your surgeon slices the ligament. Instead of using a telescope to guide the tool that cuts the ligament, some surgeons may use ultrasound instead.

In the initial days or weeks following surgery, endoscopic surgery might be less painful than open surgery.

• Open surgery. To release the nerve, your surgeon makes a cut through the ligament over the carpal tunnel in the hand’s palm.

Surgery for ligament release is a medical procedure with potential risks and benefits. Before undergoing the operation, it is essential to discuss these factors with your surgeon. Possible risks of this surgery include incomplete release of the ligament, wound infections, scar formation, and nerve or blood vessel injuries.

After the surgery, your healthcare provider will likely encourage you to use your hand, starting with light movements and avoiding forceful or extreme wrist positions. It is important to gradually work back to normal use of the hand while being aware that soreness or weakness may take several weeks to a few months to fully resolve. While surgery can provide relief for carpal tunnel syndrome, it is important to note that symptoms may not completely go away after surgery, especially if they were severe before the procedure.