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Carpal Tunnel Syndrome can also have other causes.
Carpal Tunnel Syndrome can occur at any age, though it most commonly appears after the age of fifty. It affects several percent of the population, with women being three times more likely to develop CTS than men. With appropriate treatment, patients can regain full health.
Causes of Carpal Tunnel Syndrome
The wrist is made up of many joints, which allow us to perform various movements. Anatomically, the carpal tunnel resembles a tunnel bordered on three sides by bones and on one side by the transverse carpal ligament. Within this tunnel runs the median nerve and the flexor tendons of the fingers. These structures are tightly packed together, so due to inflammatory changes, swelling, thickening, and hypertrophy of the transverse ligament, ischemia and compression of the median nerve occur within the carpal tunnel. Causes of Carpal Tunnel Syndrome can include rheumatoid arthritis, or it can be classified as an occupational disease, for example, construction work, assembly line work in factories, or typing extensively as a secretary. CTS also occurs with frequent and prolonged use of a computer mouse, strenuous cycling, or playing a musical instrument. Sometimes, nerve compression is caused by trauma, such as a wrist fracture, or by swelling of structures within the carpal tunnel during pregnancy.
Symptoms of Carpal Tunnel Syndrome
The symptoms of Carpal Tunnel Syndrome can be divided into three stages, each involving numbness and pain in the fingers, often ignored and attributed to incorrect sleeping positions. Patients may have difficulty performing precise movements with the affected hand. Sometimes, CTS symptoms are described as an inability to clench the hand into a fist, as the hand feels weak. Initial suspicion of Carpal Tunnel Syndrome arises if pain and numbness in the fingers, such as the index finger, wake the patient during sleep. Carpal Tunnel Syndrome does not affect the little finger. Initially, symptoms may occur rarely, but over time, they appear multiple times during the night, with pain radiating to the forearm and shoulder.
Carpal Tunnel Syndrome Symptoms:
- Tingling in the thumb, index finger, middle finger, and half of the ring finger.
- Muscle atrophy in the thenar eminence.
- Weak grip strength.
- Lack of precision and limited movement.
- Difficulty clenching the hand into a fist.
- Dropping objects held in the hand.
In the second stage of Carpal Tunnel Syndrome, symptoms intensify. Pain and numbness occur more frequently, including during the day. This can be associated with increased exertion, such as driving a car or cycling. This stage may also involve decreased manual dexterity for precise tasks like pinching or buttoning clothes. If untreated, CTS progresses to the third stage, where previously mentioned symptoms worsen, and muscle atrophy may appear in the thenar eminence. Degenerative changes of the median nerve deepen. In chronic, untreated cases, irreversible nerve damage may occur.
When diagnosing Carpal Tunnel Syndrome, it is also essential to identify activities that may have caused the condition. This allows for preventive measures in daily life. For example, if CTS is related to computer work, it is advisable to use ergonomic wrist supports when using a mouse.
How to Diagnose Carpal Tunnel Syndrome
The basis for diagnosis, says Dr. Krzysztof Drozd from Rehasport, is a patient interview. Carpal Tunnel Syndrome has characteristic symptoms: numbness and paresthesia (tingling) in the fingers innervated by the median nerve, which worsen at night. Patients often wake up in the morning feeling their hand is numb. Clinical examination is the next step. The hallmark symptoms include sensory disturbances in the median nerve territory, which includes the thumb, index finger, middle finger, and the radial side of the ring finger. In advanced stages, CTS causes muscle atrophy in the thenar eminence, leading to thinning of the area and sometimes pain radiating to the shoulder.
Specialized tests such as Tinel's and Phalen's tests are also used. Additional confirmatory tests include nerve conduction studies (NCS) and ultrasound imaging. No other examinations are necessary.
In some cases, a phenomenon called Double Crush Syndrome can occur, where nerve damage happens at two levels. For the median nerve, this involves both the wrist and higher up at the cervical spine. In such cases, diagnostics should include cervical spine assessments through X-ray and MRI.
Treatment of Carpal Tunnel Syndrome
In early and mild cases of CTS, treatment may involve wearing a wrist splint and administering a local corticosteroid injection into the carpal tunnel to reduce inflammation. In the treatment process, adds Dr. Krzysztof Drozd, physical therapy and physiotherapy can also provide relief, although often only temporarily. In most cases, surgery is the only effective treatment.
Surgical Treatment: The procedure for Carpal Tunnel Syndrome is typically performed as an open surgery, where the skin, subcutaneous tissue, palmar aponeurosis, and the flexor retinaculum are incised. The essence of the surgery is to increase the volume of the carpal tunnel, relieving pressure on the median nerve. The decompression procedure is usually performed on an outpatient basis, under local or regional anesthesia, and does not require special preparation.
Exceptions for Surgery:
- Pregnancy: Surgery is delayed until after delivery, as symptoms often resolve spontaneously.
- Hypothyroidism: Proper thyroid treatment may resolve CTS symptoms.
Postoperative Pain Duration
Pain after Carpal Tunnel Surgery may last a few days. During this time, standard pain medications are administered for about 3-5 days, depending on the patient's pain tolerance. Symptoms that led to the surgery, such as pain and numbness, often subside quickly. Patients commonly report significant improvement and resolution of nighttime symptoms the very first night after surgery.
Side Effects of Carpal Tunnel Surgery
In the early postoperative period, patients may experience pain for a few days. Some patients report hypersensitivity of the surgical scar, which can be managed with massages using baby oil or scar creams. This process is known as desensitization. Temporary weakness in hand grip strength may occur but typically resolves within a few days as muscle strength returns. If performed correctly, Carpal Tunnel Surgery should not cause significant complications.
Postoperative Restrictions
During the healing process, the operated hand should be rested and not held too low. The hand should be kept elevated on a sling at heart level to prevent swelling. Patients are advised to avoid physical work and heavy lifting for up to six weeks post-surgery. After this period, normal daily activities can be resumed.
Recovery and Rehabilitation After Carpal Tunnel Surgery
Carpal Tunnel Surgery can only be fully effective with proper rehabilitation. In the early period (6-8 weeks) post-surgery, the hand must be rested and not overstrained. Skin healing takes about two weeks, after which rehabilitation begins, focusing on wrist movement exercises and neural mobilization.
Rehabilitation for Carpal Tunnel Syndrome
The importance of physiotherapy in Carpal Tunnel Syndrome, says Kacper Abramowski, a physiotherapist at Rehasport, is undeniable both in conservative treatment and postoperatively. Physiotherapy should start as soon as possible after surgery. Its main goals are to reduce pain and improve hand function, as these significantly affect the patient's quality of life. An experienced physiotherapist will assess joint mobility, muscle strength, release scar adhesions, and take a holistic approach to the entire upper limb and proper body posture.
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