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The Facts Behind Carpal Tunnel Syndrome

Symptoms and diagnosis

By Neurosurgery Singapore

What is a carpal tunnel syndrome? 

Carpal Tunnel Syndrome is a painful, progressive condition caused by compression of the median nerve at the carpal tunnel. The carpal tunnel is a narrow space bound by carpal or wrist bones and ligaments. The median nerve and the flexor tendons pass through this tunnel from the forearm to the hand. When the nerve is squeezed it can cause tingling, numbness, pain or aching in the affected hand.

What are some symptoms of a carpal tunnel syndrome?

You may feel a burning, tingling, or itching numbness in the palm of your hand and thumb, or index and middle fingers.

You might first notice that your fingers “fall asleep” and become numb at night. That usually happens in the evening because of the relaxed position of your hand and while sleeping.

In the morning, you may wake up with numbness and tingling in your hands that may run all the way to your shoulder.

As carpal tunnel syndrome becomes more severe, you may have less grip strength because the muscles in your hand shrink. Pain and muscle cramping will also become worse.

The median nerve begins to lose function because of the irritation or pressure around it. This leads to:

  • Slower nerve impulses
  • Loss of feeling in the fingers
  • A loss of strength and coordination, especially the ability to use your thumb to pinch

You could end up with permanent muscle damage and lose function in your hand.

“The risk of developing carpal tunnel syndrome is not confined to people in a single industry or job, but is especially common in those performing assembly line work – manufacturing, sewing, finishing, cleaning, and meat, poultry, or fish packing. In fact, carpal tunnel syndrome is three times more common among assemblers than among data-entry personnel. “

What types of diagnosis?

Your doctor may ask and conduct one or more of the following tests to determine whether you have carpal tunnel syndrome:

    • History of symptoms. Your doctor will review the pattern of your symptoms. Carpal tunnel syndrome symptoms usually occur include while holding a phone or a newspaper, gripping a steering wheel, or waking up during the night.

    • Physical examination. Your doctor will conduct a physical examination. He or she will test the feeling in your fingers and the strength of the muscles in your hand.

      Bending the wrist, tapping on the nerve or simply pressing on the nerve can trigger symptoms in many people.

    • X-ray. Some doctors recommend an X-ray of the affected wrist to exclude other causes of wrist pain, such as arthritis or a fracture.
    • Electromyogram. This test measures the tiny electrical discharges produced in muscles. During this test, your doctor inserts a thin-needle electrode into specific muscles to evaluate the electrical activity when muscles contract and rest. This test can identify muscle damage and also may rule out other conditions.
    • Nerve conduction study. In a variation of electromyography, two electrodes are taped to your skin. A small shock is passed through the median nerve to see if electrical impulses are slowed in the carpal tunnel. This test may be used to diagnose your condition and rule out other conditions.

Possible treatment methods?

Symptoms may often be relieved without surgery.  Some treatment options are:

  • Changing patterns of hand use (helps reduce pressure on the nerve)
  • Keeping the wrist splinted in a straight position (helps reduce pressure on the nerve)
  • Wearing wrist splints at night (helps relieve symptoms that may prevent sleep)
  • Injections into the carpal tunnel (helps reduce swelling around the nerve)

When symptoms are severe or do not improve, surgery may be needed to make more room for the nerve.  Pressure on the nerve is decreased by cutting the ligament that forms the top of the tunnel on the palm side of the hand.  Following surgery, soreness around the cut area may last for several weeks or months.  The numbness and tingling may disappear quickly or slowly.  Recovery may take several months.  Carpal tunnel symptoms may not completely go away after surgery, especially in severe cases.

 

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