Median nerve compression (Carpal Tunnel Syndrome): Symptoms, Causes, Diagnosis & Treatment

Carpal tunnel syndrome (CTS), also known as median nerve compression is a medical condition due to compression of the median nerve as it travels through the wrist at the carpal tunnel.

The common symptom pain, may extend up the arm which can lead to weak grip strength and after a long period of time the muscles at the base of the thumb may waste away. Thus, being physically active can decrease the risk of developing CTS.

More than 10 million cases are reported in India, per year. CTS usually begins in adulthood, and women are more commonly affected compared to men.

How does Carpal Tunnel Syndrome affect your body?

Carpal tunnel syndrome is the consequence of a compressed median nerve. This means that something puts pressure on the nerve that runs down the palm side of the wrist. The median nerve is connected to the first three fingers on each hand, so when compressed, nerve signals to those fingers are damaged resulting in a tingling sensation or numbness that can eventually cause the muscles in the wrists and hands to weaken. If untreated, the nerve and muscle damage may be permanent.

What are the causes of Carpal Tunnel Syndrome?

  • While most cases of CTS are of unknown cause, some can be associated with any condition that causes pressure on the median nerve at the wrist.
  • CTS can be caused by conditions including obesity, hypothyroidism, arthritis, diabetes, prediabetes (impaired glucose tolerance), and trauma.
  • Genetics can also play a role in causing CTS.Using birth control pills does not affect the risk.
  • Intrinsic factors that exert pressure within the tunnel, and extrinsic factors which include benign tumors such as lipomas, ganglion, and vascular malformation can cause CTS.
  • Severe CTS often is a symptom of transthyretin amyloidosis-associated polyneuropathy.
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What are the risk factors of Carpal Tunnel Syndrome?

  • Intrinsic factors-Wrist fracture, arthritis, fracture or dislocation that deforms the small bones in the wrist, can alter the space within the carpal tunnel and put pressure on the median nerve. Also people with smaller carpal tunnel may be more likely to have CTS.
  • Sex– CTS is generally more common in women than men. This might be because the carpal tunnel area is relatively smaller in women than in men.
  • Nerve-damaging conditions-Chronic illness such as diabetes, increase the risk of nerve damage, including damage to median nerve.
  • Inflammatory conditions– Conditions involving inflammatory such as rheumatoid arthritis, can affect the lining around the tendons in the wrist and put pressure on median nerve.
  • Obesity– Obesity puts a significant risk factor for carpal tunnel syndrome.
  • Alterations in the balance of body fluids– Fluid retention may increase the pressure within carpal tunnel, irritating the median nerve. This is usually common during pregnancy and menopause.
  • Workplace factors-Working with vibrating tools or on an assembly line that requires prolonged or repetitive flexing of the wrist may create harmful pressure on the median nerve or worsen existing nerve damage.
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What are the symptoms of Carpal Tunnel Syndrome?

Common CTS symptoms include:

  • Tingling or numbness– Tingling and numbness usually in the thumb and index, middle or ring fingers are affected, but not little finger. A sensation like an electric shock in these fingers can also be experienced. These symptoms often occur while holding a steering wheel, phone or newspaper and may also wake you from sleep.
  • Weakness-Weakness in hand and a tendency to drop objects due to the numbness in hand or weakness of the thumb’s pinching muscles, which are also controlled by the median nerve.
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How is Carpal Tunnel Syndrome diagnosed?

  • History of symptoms– Reviewing symptomslike numbness in finger(s) may indicate a problem other than carpal tunnel syndrome.
  • Physical examination– Physical examination includes testing for the feeling in fingers and the strength of the muscles in the hand.Bending the wrist, tapping on the nerve or simply pressing on the nerve can also trigger symptoms in many people.
  • X-ray– X-ray of the affected wrist can be done to exclude other causes of wrist pain, such as arthritis or a fracture.
  • Electromyogram-Electromyogram measures the tiny electrical discharges produced in muscles to identify muscle damage. During this test, a thin-needle electrode is inserted into specific muscles to evaluate the electrical activity when muscles contract and rest.
  • Nerve conduction study– In a variation of electromyography, two electrodes are taped to the skinand 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 rule out other conditions and diagnose CTS.
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How to prevent & control Carpal Tunnel Syndrome?

  • Reduce force and relax your grip. For instance, if your work involves a cash register or keyboard, hit the keys softly.
  • Take frequent breaks and gently stretch and bend hands and wrists periodically.
  • Avoid bending your wrist all the way up or down and keep your keyboard at elbow height or slightly lower.
  • Improve your posture as this can affect your wrists, fingers and hands.
  • Make sure to use a computer mouse which is comfortable and doesn’t strain your wrist.
  • Keep your hands warm because hand pain and stiffness more likely is developedin a cold environment.

Treatment of Carpal Tunnel Syndrome- Allopathic Treatment

Wrist splinting– A splint to hold wrist still while sleeping can help relieve nighttime symptoms of tingling and numbness.

Medications used are:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)Ibuprofen (Advil, Motrin IB) may help relieve pain from carpal tunnel syndrome in the short term.
  • Corticosteroids-Corticosteroid such as cortisone is injected in the carpal tunnel to relieve pain. This also decrease inflammation and swelling, which relieves pressure on the median nerve.

Surgery involves:

  • Endoscopic surgery– In this surgery, a telescope-like device with a tiny camera is attached to endoscope to see inside the carpal tunnel. Then the surgeon cuts the ligament through one or two small incisions in hand or wrist. This surgery may result in less pain than does open surgery in the first few days or weeks after surgery.
  • Open surgery-In this surgery an incision is made in the palm of hand over the carpal tunnel and ligament is cut through to free the nerve.

Treatment of Carpal Tunnel Syndrome- Homeopathic Treatment

  • Causticum– This is helpful when there is excessive loss of muscle strength in the hands.
  • Ruta– Ruta works well when over straining or inflammation of the wrist tendons leads to CTS.
  • Hypericum– This is indicated for CTS resulting from trauma.
  • Plumbum Met– This is prescribed when the finger muscles have started to atrophy or degenerate. A marked weakness in hands and fingers appears and the person is unable to lift anything with his hand due to weakness.
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Carpal Tunnel Syndrome- Lifestyle Tips

  • Take more frequent breaks to rest your hand and avoid activities that worsen symptoms.
  • Apply cold packs to reduce swelling.
  • Take a pain reliever, such as, ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve).
  • Wear a wrist splint at night, especially during pregnancy.
  • Avoid sleeping on your hands and use a pillow.

What are recommended exercise for person with Carpal Tunnel Syndrome?

  • Bend exercise includes bending your wrist, forward at a right angle and hold for 5 seconds. Straighten your wrist and gently bend it backwards and hold for another 5 seconds. Repeat this 10 times in 3 sets.
  • Hand squeeze exercise involves squeezing a rubber ball and hold for 5 seconds. Repeat it 10 times in 3 sets.
  • Finger bend exercise involves holding finger out straight and gently bend the middle joints of your fingers down toward your upper palm and hold for 5 seconds. Again 3 sets; 10 repetitions.

Carpal Tunnel Syndrome & pregnancy- Things to know

  • Carpal tunnel syndrome affects about one in three pregnant women.
  • The symptoms of CTS include numbness and needles in fingers and hands; usually first thing in the morning.
  • According to experts, CTS during pregnancy is due to hormone-related swelling.
  • CTS generally improves within a week or two after delivery. It may also take months.
  • Breastfeeding may be painful with CTS. Use pillows and blankets to prop, support, or brace the head of the baby when needed.
  • Simple measures like splinting and taking pain- reliving medication are standard therapies and usually bring relief.

Common complications related to Carpal Tunnel Syndrome

  • Weakening of the muscles; base of the thumb.
  • Dexterity of affected fingers.
  • Atrophy

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