Getting a grip on carpal tunnel syndrome

Posted on 6 September 2012

Dr Tom Barrett is an orthopaedic surgeon at Mediclinic George. ‘I think orthopaedics is the most rewarding branch of medicine,’ he says. ‘Specialising in the mechanics of the body, orthopaedic surgeons are often able to follow the route of common sense to correct problems: if it’s broken, we fix it; if it’s skew, we straighten it; if it’s under pressure, we release the pressure.’

My thumb and index finger on my right hand often feel numb. Lately I’ve also often felt a sharp pain shooting up my arm. What could it be?
It sounds like the signs of carpal tunnel syndrome. Carpal tunnel syndrome often presents in people who experience repetitive strain in their hands or wrists, as could be caused, for example, by working with vibrating machinery for long periods, sewing or even aggressive piano playing. Carpal tunnel syndrome occurs only in adults and is more common among women than among men.

What exactly is carpal tunnel syndrome and what causes it?
Carpal tunnel syndrome is pressure, irritation or crowding on the median nerve as it passes through a bony tunnel in your wrist. The median nerve supplies sensation and some strength to the hand, and shares the tunnel with tendons that flex the fingers and thumb. Risk factors for developing carpal tunnel syndrome include:
• abnormalities of the anatomy, for example if you’ve broken bones in your wrist before.
• swelling in the tunnel, for example inflammation of the tendons, as occurs with rheumatoid arthritis, or abnormal fluid-handling by the body, as often occurs during pregnancy.
• conditions that lead to nerve damage, such as diabetes or alcoholism.
• environmental factors that lead to irritation of the nerve, for example repetitive wrist movement as in piano playing or working with vibrating machinery for long periods.

How is carpal tunnel syndrome diagnosed?
The doctor will consider your symptom history, perform a physical examination and, if necessary, do further tests. Patients often complain of numbness in the palm of the hand, excluding the little finger. These symptoms often occur at night, and patients commonly report that shaking the hand out relieves the sensation. During a physical examination, a shooting pain is often experienced if the doctor taps over the carpal tunnel. The patient can also simulate the symptoms of numbness by pushing the wrist into severe flexion. Other physical signs include weakness or even wasting of the thumb muscles. Additional tests may include a nerve-conduction study to assess whether there is damage to the nerve at the level of the wrist, and possibly also a neck X-ray.

Does being diagnosed with carpal tunnel syndrome mean that I will lose functionality in my hand?
Leaving a severe carpal tunnel syndrome untreated may lead to permanent nerve damage, which could result in loss of hand function. But if the condition is treated correctly before long-standing nerve damage has in, you can expect nerve function to recover fully in time. The longer the nerve is under pressure and the more pressure on the nerve, the more likely permanent nerve damage will be.

What does treatment involve?
The condition can be treated with either medication or surgery. The nonsurgical option involves medication to reduce inflammation in the tunnel, for example anti-inflammatories or a short course of oral cortisone. Your orthopaedic surgeon may also suggest injecting cortisone into the carpal tunnel. Surgery is for those cases that don’t respond to the non-operative treatment, or if the orthopaedic surgeon considers the nerve damage to be severe enough already to not delay surgery. Surgery involves opening the roof of the carpal tunnel to release the nerve.

What can I do to prevent carpal tunnel syndrome from developing or an existing condition from worsening?
The most sensible advice is to avoid activities that cause repetitive strain in your hand and wrist. It’s also helpful to take regular breaks to stretch your hand and wrist if you have to perform activities that cause pain. Wearing a wrist brace at night – and sometimes during the day if the symptoms persist – may be useful.

If you’d like to know more about this condition, post your questions here. 

Published in Orthopaedics

In the interest of our patients, in accordance with SA law and our commitment to expertise, Mediclinic cannot subscribe to the practice of online diagnosis. Please consult a medical professional for specific medical advice. If you have any major concerns, please see your doctor for an assessment. If you have any cause for concern, your GP will be able to direct you to the appropriate specialists.

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