Our hands are one of the essential organs of our body. The design and development of our hands, allowing us to grip things much better than any animal, helped us climb up the ladder of evolution. According to Aristotle, "The hand is the tool of the tools." And carpal tunnel syndrome affects the very hands which we use every second of the day.
With changing lifestyles, our work habits are also changing. The increased acceptance of work from home concept and the hefty usage of computers increases our chances of suffering from the dreaded carpal tunnel syndrome or CTS. It is a severe and painful condition that often needs medical intervention. While the carpal tunnel release surgery, if done endoscopically, offers a quick recovery time of fewer than six weeks in most cases, in an open carpal tunnel surgery, the recovery time could take more than 12 weeks. Nevertheless, after a carpal tunnel release surgery, one can take several quick recovery steps to promote faster healing.
When carpal tunnel syndrome affect our hands, there is severe pain, tingling sensation in our fingers and numbness. The pain is more in the nights than during the day, and statistically, more women suffer from this than men. The medical condition caused by CTS is manageable by physical therapy sessions, medications and, in rare cases, carpal tunnel surgery.
What is carpal tunnel syndrome?
To understand this, we first must know what carpal tunnel is. Carpals are the eight bones in our wrist and connect the hand to the forearm. Carpal tunnel is a narrow tube-like structure from our wrist to the palm that allows the median nerve to pass through to the fingers from our shoulder. Apart from the median nerve, several tendons assisting the finger movement also pass through this tunnel. A mass of tissue called the transverse carpal ligament encases the carpal tunnel.
The median nerve is one of the five crucial nerves in the human body that start from the brachial plexus. It travels through the shoulder and the arm and reaches the fingers through the carpal tunnel. Also called the 'labourer's nerve,' the median nerve is the main nerve of the front forearm and helps control the hand's coarse movements. It supplies the palm of the hand and lateral three half digits, the thumb, forefinger, middle finger, and half of the ring finger. The median nerve does not pass through the little finger and hence CTS does not affect it.
In a person suffering from carpal tunnel syndrome, the tunnel becomes narrow because of the transverse carpal ligament tissues' inflammation. This inflammation compresses the median nerve causing pain, tingling sensation, and numbness of the fingers. Any movement of the wrist or the fingers' folding increases the nerve's compression, causing more pain. The entire wrist and the three and a half digits become numb and painful. Most daily activities become difficult, and the symptoms of pain worsen in the nights.
What are the symptoms of carpal tunnel syndrome?
Tingling, numbness, and pain are the three significant symptoms of CTS. These sensations and pain are mostly around the palm, thumb, index finger, middle finger, and half of the ring finger. Based on the symptoms, there are three groups of carpal tunnel symptoms:
Motor
Sensory
Vasomotor
Motor symptoms:
Motor is any physical activity of the body. The flexing of the fingers, making your hands into a fist, all are motor activities. Sometimes when the median nerve compresses the muscles around our palm, (called thenar eminence), becomes wasted, it leads to a condition called ape hand. In ape hand the movement of the thumb becomes difficult. It also causes loss of opposition of thumb, where one cannot touch other fingers with the thumb. Rolling the hand into a fist becomes difficult because of the median nerve's inflammation leading to compression.
Sensory symptom:
The dysfunction of the median nerve causes reduced sensation or hypoesthesia (loss of sensation) in the hand's fingers and palm. This often extends to the nail beds and the distal phalanges.
Vasomotor symptoms:
The median nerve compression leads to the dilation of the arteriolar and this dilation allows more blood flow into the area making it warmer. And the cut in the sympathetic supply leads to reduced sweating and results in dry and scaly skin.
The symptoms are often worse during the nights and increases after extended usage of the affected hand, and repetitive movement or even resting the hand for a prolonged time resulting in severe pain. Untreated carpal tunnel syndrome can lead to scaly skin and atrophy and pulping of the nails. There are other conditions, like neck or shoulder compression, which have similar symptoms like carpal tunnel syndrome. But CTS is easy to distinguish with the tingling sensation on the palm.
Who is affected by CTS?
Carpal Tunnel Syndrome affects both men and women of all ages. However, according to research, women suffer more from CTS than men. Significantly this is because women have a smaller carpal tunnel, and the chance of compression is higher. Pregnancy and menopause also cause more elevated risk for women.
Due to body degeneration, older adults are at higher risk, especially those above 65.
Patients with a history of rheumatoid arthritis pose an elevated risk of CTS. Generally, rheumatoid arthritis affects the small bones of the hand and can deform them, leading to narrowing the carpal tunnel and leading to the median nerve's compression.
Obese people and people with hypothyroidism are also risk factor for carpal tunnel syndrome.
What causes carpal tunnel syndrome?
The cause of CTS is the inflammation or nerve damage of the median nerve and the inflammation can be for one or a multitude of reasons. But research shows that family history and genetics play a significant role in cases of CTS. If any of your family members suffered from this syndrome, the chances are high that you will be affected.
Certain health conditions like diabetes, obesity, rheumatoid arthritis, pregnancy, and menopause are high-risk carpal tunnel syndrome factors.
The type of work we do is also a factor to be considered. The number of people on desk jobs is increasing and spending long hours using the mouse and keyboard is a particular risk. It is a proven fact that the decrease in work activities following the pandemic is likely to trigger a higher CTS incidence. Activity modification and using ergonomically designed desks can reduce the deep pressure felt at the base of the thumb because of chronic median nerve damage. Constant use of your hands sometimes can put much strain on the median nerve leading to pain and discomfort.
How to diagnose carpal tunnel syndrome?
Carpal tunnel syndrome is easy to diagnose because of the physical pain it presents. A quick physical examination involves gentle tapping on your wrist to see if it produces any tingling or numbness in the affected hand.
Other physical examinations involve tests like the Froments' Sign, where the patient holds a book between the thumb and the fingers. The Froments' sign tests the grip and strength of the affected hand. Because of the nerve compression, a person suffering from CTS will not be able to hold the book.
Phalen's manoeuvre is another test where the patient holds their wrist strongly opposite way in a forced flexion for about a minute.
The nerve conduction test is a standard diagnostic tool to understand the extent of nerve damage by measuring how fast signals travel through your nerves. In nerve conduction studies, small electrodes are placed on the hand and wrist. This produces a small current, stimulating the nerves and the report is used to assess the damage to the median nerve.
Underlying conditions like diabetes, hypothyroidism, rheumatoid arthritis, etc., usually increase your CTS risk and can be quickly determined by a blood test.
How to treat carpal tunnel syndrome symptoms?
Doctors treat carpal tunnel syndrome by releasing the pressure built up in the tunnel due to the median nerve's compression. Hence the terms carpal tunnel release or carpal tunnel decompression. Even with severe symptoms, the treatment can be a simple shaking of the wrist in the early stages to a complex carpal tunnel release surgery. Basically, most hospital treatment is an outpatient procedure, and there is a quick recovery in most cases.
Non-Surgical Treatments:
Most patients get well by non-surgical treatments like physical therapy, pain medication and rest. Since the focus of the treatment is to relieve the pressure, it is a good idea to avoid daily activities that increase the use of your hands and aggravate the compression. Office work involving a long time on the keyboard, mouse create significant problems in managing the median nerve's compression.
Physical Therapy treatments:
When the pain and discomfort increases a physical therapy treatments offers relief. Your physician can recommend you to a local hand therapist who will recommend physical therapy sessions, exercises, and procedures to allow a full range of motion for your wrist and fingers. Regular physiotherapy treatments help in improving the hand strength and achieving less pain for the patient.
A wrist brace or wrist splints are standard physical therapy devices used in the management of CTS symptoms. They are worn from the base of the hand to the palm and is made of high-grade cotton or breathable materials. The wrist braces or wrist splints provide pain relief and support stability and pressure on your wrist. Generally, they have a contoured right top and bottom that effectively stabilises the wrist while still allowing fingers to move freely. Your physical therapist or your health provider will guide you on the right product to choose.
Medication:
To manage the pain, your health provider may prescribe your medication to provide immediate and symptomatic relief. Corticosteroids are pretty commonly used to control inflammation and pain. In mild cases, your doctor may decide to use only oral drugs, and in severe cases, they may resort to steroid injection. This steroid is injected directly into your wrist, usually by an experienced doctor or nurse. It will provide immediate relief and is one of the most effective ways of managing carpal tunnel syndrome symptoms.
Home Remedies for relieving carpal tunnel syndrome symptoms:
In mild cases, you can manage CTS's common condition with treatment at home. However, if symptoms persist, seek immediate medical attention.
One of the most common ways of treating pain from CTS is to avoid repetitive movements. Cessation of even normal activities is necessary to manage the pain. Keep your wrist in a neutral position without extending it too far as to cause pain.
Avoid heavy lifting of things, and where required, use the shoulders to do the heavy lifting, thus reducing the stress on the wrist joints. Even light lifting of objects which is painful should be reduced. Ultimately, the idea is to reduce the pressure on the wrist joints.
Avoid handling power tools that vibrate like electric saws, jackhammer, etc. The vibrations from these types of machinery will aggravate the compression on the carpal ligaments.
Gentle massaging of the wrists, palms, and the back of the hands with massage oils will help improve the circulation of blood in the area and bring relief.
Keep cold packs on the affected hand to bring relief. Ice or cold gels wrapped in a plastic bag and tied to the base of the wrist will have a soothing relief.
If the dominant hand is affected, try using the other hand to do things comfortably.
Home remedies may not yield full mobility of the digits or complete recovery from pain and discomfort. But they are a supportive therapy and can help in managing most cases of CTS. In mild cases, home remedies should be the first course of action before consulting a health provider.
Surgical Procedure or Invasive Techniques:
Carpal tunnel surgery is generally the last option of a hand surgeon in treating CTS symptoms. Often surgical treatment is resorted to only if the patient is not responding to the conventional non-surgical procedures and threatens to become a chronic illness.
There are two types of carpal tunnel surgical procedures – open surgery and endoscopic carpal tunnel surgery. Both types of surgeries do not require general anaesthesia, and an experienced hand surgeon can perform it on an outpatient basis.
Open Surgery:
This type of hand surgery, also known as open carpal tunnel release surgery, is performed under local anaesthesia by making a small incision at the base of the palm of the hand. The incision helps the hand surgeon operate on the transverse carpal ligament and release the median nerve pressure. The small incision is then closed, and the scar tissue heals up in a few weeks. Consequently, the patient is discharged the same day, and a full recovery could take a few weeks. In some cases of CTS open surgeries, the pillar pain (pain around the palm area) remains for a longer time and requires analgesics to manage the pain.
Endoscopic carpal tunnel surgery:
This is also known as endoscopic carpal tunnel release surgery and performed under local anaesthesia. In this minimally invasive endoscopic procedure, the hand specialist makes two small incisions on your lower wrist and palm, and a camera is passed through. This incision is a much smaller incision than the one done for open surgery. The camera enables the hand surgeon to view the compressed transverse carpal ligament and operate on it. This type of endoscopic surgery does not leave any external scar tissues.
The common complication in both carpal tunnel release surgeries is the management of post-surgical infections. Often antibiotics control Post-surgical infections are controlled with the use of antibiotics. Infections are more prevalent in open surgery than endoscopic carpal tunnel surgery. In the open surgery, the wound area must be kept dry, and the bandage to be changed regularly till the wound is healed. In this type of surgery, the recovery time is longer than in endoscopic surgery. Whereas in endoscopic surgery, the wound is much more minor and heals faster.
Carpal Tunnel Release Surgery and achieving a quick recovery
Though the surgical procedure for CTS is under local anaesthesia, the recovery time can take longer. In an open surgery process, the recovery time can be about eight weeks on average. It could take up to twelve weeks for a full recovery. However, the time is lower for endoscopic surgery.
Managing the pain:
Pain management is one of the most critical aspects of a quick recovery after carpal tunnel release surgery. Immediately after the surgery, pain management has to be using analgesics or anti-inflammatory. Over the days, the pain becomes manageable without medication.
Physiotherapy:
To prevent fluid retention, regular physiotherapy under a certified therapist is a must. You should follow all the therapist's suggested activities regularly to reduce pain and improve mobility. You can resume work-related activities in a few days under guidance from your health advisor. Wearing of the wrist brace or wrist splints should continue for a few weeks, as it improves the support for the palm and the fingers.
Using the hand after carpal tunnel release surgery will reduce the swelling and stiffness. Getting back to a routine helps in building up the strength of the hand. You can start driving after the pain subsides and after achieving the full mobility of the fingers.
Understanding the leading causes of carpal tunnel syndrome as an occupational disease helps in prevention and quicker recovery. Repetitive hand motions are one of the top reasons, and any work-related activities which have such action should be avoided or managed with a wrist brace or splint. Similarly, any activity involving intense gripping, which produces mechanical stress on the palm, and vibration also lead to CTS. Consulting your occupational therapist will assist in quick recovery.
Smoking:
While smoking does not directly affect the recovery after carpal tunnel release surgery, it has an indirect effect. It is well known that tobacco smoke causes constriction or narrowing of the blood vessels. Consequently, there is reduced blood flow to the affected tissues and could delay the recovery time.
Health Factors affecting quick recovery after carpal tunnel release surgery
Obesity: Maintaining a body mass index of below 30 is considered ideal for preventing carpal tunnel syndrome. This also helps in the general health and management of other lifestyle diseases.
Diabetes: Managing the blood sugar levels with proper diet and medication, and exercise is essential for general health and CTS. The high blood sugar in diabetes damages the nerves and can also affect the median nerve, which causes carpal tunnel syndrome.
Management of other illnesses like rheumatoid arthritis, hypothyroidism, and other conditions that increase fluid retention in the body is essential in recovery.
Conclusion
Carpal tunnel syndrome affects an average of one out of ten people in their lifetime and is one of the most common nerve compression syndromes. With the sweeping changes in occupational hazards, it is likely to increase. Luckily it is a disease that can be managed and also diagnosed quickly. The surgical procedures are relatively standard and straightforward. Effective post-surgical management can help in quick recovery and prevention of this painful but common illness.