Carpal Tunnel Syndrome
Management of a Nerve Compression Syndrome in the Hand
Carpal tunnel syndrome, a condition often associated with use of the hands, can be mild or severe, but it can be treated in various ways.
Carpal tunnel syndrome is a common condition that is seen more in women than men. As a nerve compression syndrome, it can disrupt one's quality of life. Individuals who suffer from carpal tunnel syndrome may get it from any manual work they do. Others may have it secondary to a separate medical condition. Either way, there are ways to treat carpal tunnel syndrome and prevent it from worsening.
Symptoms and Signs
The nerve involved in carpal tunnel syndrome is the medial nerve. It originates from the brachial plexus in the vicinity of the shoulder and runs through the upper arm and forearm. It then passes through the wrist by way of the carpal tunnel. The medial nerve travels through this space alongside tendons of several muscles and underneath a fibrous band called the flexor retinaculum. Once the nerve reaches the hand, it branches off and innervates the thumb side of the hand.
The median nerve can be compressed with prolonged or repetitive bending of the wrist, as with certain occupations. It can also be associated with rheumatoid arthritis, hypothyroidism, diabetes mellitus, acromegaly, menopause, pregnancy, and amyloidosis. The symptoms of carpal tunnel syndrome include numbness, tingling, pain, and muscle weakness in the distribution of the median nerve. They are usually worsened with further bending of the wrist.
In fact, a physician may ask the patient to place his or her hands together with their back sides touching and fingers pointed downward, bending both wrists simultaneously. If the patient feels the same symptoms after several seconds (Phalen's sign), it is suggestive of carpal tunnel syndrome. The physician may also attempt to reproduce the symptoms by tapping the wrist over the carpal tunnel (Tinel's sign) or compressing the wrist. If additional testing is needed, electromyography and nerve conduction studies can be done to detect any abnormal neural activity beyond the wrist.
Treatment and Prevention
The first line of treatment for carpal tunnel syndrome includes pain medications, such as Tylenol and ibuprofen, and preventive measures, such as reducing force in hand use, taking frequent breaks, and improving posture. Otherwise, the patient may need to wear a flexible wrist splint. This prevents inadvertent bending of the wrist, especially while sleeping. Steroid injections into the wrist are also helpful. If none of these conservative options help, particularly when it is severely debilitating, the last option is surgery to cut the flexor retinaculum and relieve pressure off the median nerve.
References
- eMedicine - Carpal Tunnel Syndrome
- Mayo Clinic - Carpal Tunnel Syndrome
- Merck Manual - Nerve Compression Syndromes
