The carpal tunnel syndrome (CTS) is a condition where the median nerve is compressed in the carpal tunnel. The carpal tunnel is a narrow and rigid passage of bones and ligament, located at the base of the hand. When the median nerve becomes pinched or impinged, it will cause pain, tingling, weakness and numbness in the part of the hand that receives signals from it (mostly hand and fingers, but it might radiate into the forearm). The reason why a median nerve becomes compressed is the swelling of the tendons or the nerve in the wrist.
History of Carpal Tunnel Syndrome
The incidents of carpal tunnel syndrome appeared in the surgical literature during the mid 19th century, with the first compression of the median nerve being mentioned in 1854 by Sir James Paget. The term “carpal tunnel syndrome” was first used in the year 1939 and its incidence started being more commonplace after World War II. The pathology was identified by Dr. George S. Phalen after working with patients in the 1950s and 1960s.
The symptoms start gradually, and include the following:
- Frequent tingling, burning or itching numbness of the palm and the fingers (especially thumb, index and middle finger)
- Symptoms often appear during the night first, and may affect one or both hands
- Decreased grip strength
- Difficulty to form a fist or grasp small objects
- Muscle dystrophy in severe and/or untreated cases
Causes of carpal tunnel syndrome
There is no single cause that triggers carpal tunnel syndrome; it is most often triggered by a combination of factors that increase the pressure on the tendons of the carpal tunnel and the median nerve. The most common causes include:
- A congenital disposition – individuals who have a smaller carpal tunnel are more susceptible to the condition.
- Trauma and injury to the wrist that cause swelling, such as a sprain or a fracture
- Work stress – repeated use of vibrating hand tools
- Fluid retention – during pregnancy or menopause
- Development of a cyst/tumour in the canal
- Rheumatoid arthritis
Carpal tunnel syndrome might resolve on its own without utilizing any treatment, but most of times, this isn’t the case. Treatment should begin as early as possible, under a constant doctor’s supervision. Initial treatment involves resting and avoiding activities that worsen the symptoms. Further damage is avoided by immobilization, and inflammation is treated with cold packs,
Various drugs can ease the pain and swelling. Nonsteroidal anti-inflammatory drugs (NSAIDs) are often used as pain relievers, and diuretics can reduce swelling. Corticosteroid injections are administered directly to the wrist and provide immediate (but temporary) relief to individuals who display mild or intermittent symptoms. Exercise and stretching has beneficial effects, but it should be done under the supervision of a physical therapist. Acupuncture and chiropractic care have been beneficial in some cases, but their effectiveness varies from person to person.
Should the symptoms last for more than six months, a surgery may be the only choice left. To reduce the pressure on the median nerve, a band of tissue around the wrist is severed. The surgery is done under local anaesthesia. The symptoms often disappear immediately after surgery, but full recovery might take months.