There are many nerves and their branches running through our arms and legs. The function of these nerves is to activate the relevant muscle groups and transmit sensation from their regions to the brain. Each nerve can be compressed at one or more points, causing a condition. The most common, studied, and recognized of these is the compression of the median nerve at the wrist. This condition is called carpal tunnel syndrome.
When pressure increases within the carpal tunnel canal for any reason, the nerve becomes compressed, resulting in nerve compression. It can disrupt a person's daily life, work, and sports activities, and in more advanced cases, cause sleep disturbances and difficulty using the hand due to nighttime awakenings. It is a very common condition in orthopedic practice and is commonly known as nerve compression.
What are the causes?
There are many predisposing factors for carpal tunnel syndrome.
Any problem that increases the pressure within the canal, whether internal or external, can cause nerve compression. This condition most commonly occurs in people who perform certain occupations and housework that require the use of the hand and wrist joint in a bent position. In these individuals, the tendons and tendon sheaths adjacent to the median nerve thicken and edema due to overuse. This condition is also very noticeable in rheumatic diseases such as rheumatoid arthritis.
It can sometimes be a symptom of diabetes, thyroid, and growth hormone disorders, and is quite common in diabetics.
Pregnancy is also a common condition. During the last trimester of pregnancy, water retention (edema) increases, affecting the carpal tunnel and causing edema. After birth, as the edema resolves, the problem usually subsides and improves.
How does it manifest?
The initial symptoms are pain, numbness, and tingling. The pain and numbness are burning, typically starting in the second and third fingers and extending to the palm and forearm. Sometimes, it radiates to the shoulder and neck area and can be confused with shoulder problems. A person may feel the need to rest their hand due to rapid fatigue, numbness, and pain during work or daily hand use (such as talking on the phone, reading the newspaper, using a keyboard or mouse, or knitting or crocheting). Symptoms often first appear at night while sleeping. The person is awakened from sleep, and the symptoms subside after shaking or rubbing their hand. In severe cases, nighttime awakenings increase in frequency, and the pain and numbness take longer to resolve, or the numbness becomes permanent. As the degree and duration of the compression increases, muscle weakness and wasting begin in the hand. The person may report feeling unable to grip objects due to numbness, loss of sensation, and loss of strength, and that they often slip and fall.
How is it diagnosed?
Carpal tunnel syndrome can be diagnosed by listening to and examining the patient. An EMG examination should be performed to make a definitive diagnosis, determine the level of compression, assess it, and document the problem. Direct X-rays, ultrasounds, MRIs, and laboratory tests may be necessary to differentially diagnose similar problems, identify accompanying conditions, and investigate predisposing factors. It is most commonly confused with conditions such as spinal calcification in the neck region and a cervical disc herniation, and should definitely be considered in the differential diagnosis.
How is carpal tunnel syndrome treated?
The most important factors determining treatment and method are the duration of the problem, the severity of symptoms, the EMG findings and degree, the presence of muscle atrophy, and the cause of the compression.
Preoperative treatment includes the use of a wrist brace to keep the hand in a neutral position during daily use, work, and sports, the application of anti-edema and anti-inflammatory medications or soothing agents, training in hand positioning, and physical therapy. While controversial, intracanal cortisone injections may be considered. Certain medications and vitamins that aid nerve sheath healing may be administered. If all these non-surgical methods fail, the decision to proceed with surgery is made based on a combined evaluation of the patient's symptoms, examination, and EMG findings.
How is surgery performed for carpal tunnel treatment?
The patient is evaluated holistically. The type of anesthesia used is local or block anesthesia unless otherwise indicated. The surgery takes approximately 5-15 minutes. The patient is discharged the same day. Postoperative pain is minimal, or if present, it is easily controlled with painkillers. Hand use resumes within a few days after surgery.
The most important factor determining the success of the surgery is the duration and degree of compression. Numbness and pain usually subside within the first night, and the patient feels significant relief. Prolonged or severe compression can take some time to resolve the numbness.