Carpal Tunnel Syndrome

The carpal tunnel is located at the wrist joint and is formed on three sides by the carpal bones, with the fourth side made up of a non-extensible ligament. Through it pass 9 flexor tendons for the fingers and the median nerve, structures responsible for finger movement and the sensation in the palmar skin and fingers 1-4.

Carpal tunnel syndrome is caused by compression of the median nerve at the wrist joint, leading to a series of symptoms that significantly affect hand function.

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WHAT ARE THE SYMPTOMS OF CARPAL TUNNEL SYNDROME?

  • paresthesia (sensation of numbness, tingling)
  • reduced sensitivity
  • constant burning sensation
  • skin becomes dry, without sweating
  • pain at the wrist joint, which may radiate to the forearm and hand
  • hand weakness (reduced muscle strength and dexterity), affecting
  • professional or daily activities
  • difficulty moving the hand is more pronounced in the morning
  • cold or hot sensations in the hand
  • loss of hand function
  • nighttime pain in the wrist and hand

CAUSES OF CARPAL TUNNEL SYNDROME

  • repetitive hand movements due to profession: typing on a computer,
  • instrumentalists (pianists), manual workers with repetitive movements, use of
  • electric machines producing vibrations, sports (tennis, golf)
  • pregnancy: can trigger the syndrome, usually disappearing after childbirth
  • hypothyroidism
  • diabetes
  • osteoarthritis
  • trauma
  • genetic factors
  • obesity
  • oral contraceptives
  • synovial cyst, lipoma

WHO CAN SUFFER FROM CARPAL TUNNEL SYNDROME?

People most at risk of median nerve compression are:

  • especially women over 40 years old (risk is 3 times higher than in men)
  • pregnant women
  • people with various rheumatic conditions
  • manual workers, pianists, or people who work extensively at the computer

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HOW IS THE DIAGNOSIS MADE

Carpal tunnel syndrome is diagnosed through clinical and electrophysiological tests.

  • The Phalen test is the simplest clinical method to diagnose median nerve compression in the carpal tunnel: holding the hand in maximum flexion for 1 minute causes the symptoms to appear or worsen.
  • The Tinel test is performed by tapping the median nerve along its course at the wrist; it is positive if tingling occurs in its innervation area.
  • Electrophysiological tests accurately determine median nerve compression by measuring nerve conduction and detecting where nerve impulses are blocked.
    In clinically difficult cases, EMG (electromyography) is recommended.

TREATMENT

The most effective therapeutic method is undoubtedly surgery. The operation is performed on an outpatient basis under local anesthesia or nerve block and involves releasing the median nerve by cutting the “roof” of the carpal tunnel, the transverse carpal ligament. The incision is small (4-5 cm), and closure is done with separate stitches.

Postoperatively, the wrist will be immobilized with a splint for 12-14 days, after which the stitches are removed. Gradual resumption of activities is recommended, avoiding intense physical effort. Immediate postoperative relief usually occurs, with a sensation of release and ease.

Recovery of sensitivity is slower, as nerve regeneration depends on age, duration of compression, associated diseases (diabetes negatively affects recovery), etc.

Alternative treatment methods:

  • splint immobilization
  • corticosteroid injections
  • physiotherapy
  • oral or local non-steroidal anti-inflammatory drugs

Unfortunately, alternative methods only temporarily alleviate symptoms.