Carpal Tunnel Syndrome
What is Carpal Tunnel Syndrome (CTS)
Carpal Tunnel Syndrome (CTS) is a condition that affects the hand and arm, characterised by numbness, tingling, and other symptoms.
The carpal tunnel is a narrow passageway in the wrist, surrounded by bones and ligaments. The median nerve, which controls sensation and movement in the thumb and first three fingers, runs through this tunnel.
CTS occurs when the tunnel becomes narrowed or when tissues surrounding the flexor tendons swell, putting pressure on the median nerve. This pressure can lead to numbness and pain in the palm and fingers, particularly in the thumb, index, and middle fingers.
Signs and Symptoms
Symptoms of CTS usually develop gradually and vary in severity.
Numbness and Tingling
This is often the first sign, experienced in the thumb, index, middle, and ring fingers. It may feel like an electric shock and can occasionally extend to the forearm.
Pain and Burning
Pain may originate in the wrist and radiate up the arm. This pain can be particularly noticeable during activities that involve wrist motion.
Weakness
People with CTS may experience weakness in their hands and a tendency to drop objects. This is due to the numbness in the hand or weakness of the thumb’s pinching muscles, which are also controlled by the median nerve.
Night-time Symptoms
Symptoms like numbness, tingling, and pain are often more pronounced at night. This can be attributed to the relaxed position of the hands during sleep or fluid accumulation around the wrist and hand.
Sensation of Swelling
Individuals may feel a sense of swelling in the fingers, even though no visible swelling is apparent.
These symptoms can appear in one or both hands and can impact daily activities such as holding a phone, reading a book, or driving. In chronic or untreated cases, the muscles at the base of the thumb may visibly shrink (atrophy).
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Causes and Risk Factors
CTS arises from a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel.
- Workplace Factors: Repetitive use of vibrating hand tools or work that requires prolonged or repeated flexing of the wrist can create harmful pressure on the median nerve.
- Anatomical Factors: A wrist fracture, dislocation, or arthritis can deform the small bones in the wrist, altering the space within the carpal tunnel and exerting pressure on the median nerve.
- Gender: CTS is more common in women, possibly due to the carpal tunnel being smaller in women than men.
- Inflammatory Conditions: Conditions like rheumatoid arthritis can lead to inflammation in the wrist and put pressure on the median nerve.
- Obesity: Being overweight is a risk factor for CTS.
- Fluid Retention: Fluid retention can occur during pregnancy or menopause. It can increase pressure within the carpal tunnel, irritating the median nerve.
- Other Medical Conditions: Diabetes, thyroid dysfunction, and renal failure are associated with an increased risk of CTS.
- Genetic Predisposition: There might be a genetic link, as CTS is often found in families with a history of the condition.
Treatment Modalities
Pain Medication
This involves the use of medications such as Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), opioids, and other specialised medications designed for pain management. The type and dosage are tailored to the individual’s condition and medical history.
Myospan
Minimally invasive treatments aim to effectively relieve common pain conditions by targeting pain sources.
- Coreflex Injections: Typically contain a corticosteroid and are used for inflamed joints or tissues.
- Platelet-Rich Plasma (PRP) injections: Utilise own platelets to promote healing in damaged tissues.
- Intra-Articular Injections: Most commonly used to treat osteoarthritis in the hip or knee, but they can also be given in other joints, including shoulders, wrists, ankles, hands, and fingers.
For chronic pain conditions originating from spinal issues, Neurospan can be performed by our team of pain specialists from Singapore Paincare Center.
Prevention Strategies
It may not be possible to completely prevent CTS, especially because the condition is caused by everyday activities, underlying health conditions or anatomical factors. Certain strategies can help reduce the risk and alleviate symptoms.
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Workspace Ergonomics
Adjusting the workspace to ensure a proper wrist position can help. This includes using a keyboard and mouse that encourage a natural wrist position and ensuring that the work surface is at the correct height.
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Frequent Breaks
Taking short, frequent breaks from repetitive activities to stretch and bend the hands can help reduce the pressure on the median nerve.
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Hand and Wrist Exercises
Stretching and strengthening exercises for the hands and wrists can improve flexibility and reduce the risk of injury.
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Proper Hand Use
Avoiding bending the wrist up or down and maintaining a relaxed middle position is beneficial. Using the whole hand, not just the fingers, to hold objects can also help.
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Keeping the Hands Warm
Cold environments can lead to hand stiffness and pain. Keeping the hands warm may prevent stiffness and reduce the risk of developing CTS.
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Maintaining Healthy Habits
Overall physical fitness and maintaining a healthy weight can help prevent CTS. Conditions like diabetes and high blood pressure should be managed effectively.
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Wrist Splints
Wearing wrist splints at night can help keep the wrists in a neutral position, reducing pressure on the median nerve.
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Frequently Asked Questions
Does splinting help with Carpal Tunnel Syndrome?
Stabilising the wrist through immobilisation alleviates pressure on the nerves. Our Doctors might suggest combining splints with additional therapies to enhance effectiveness and facilitate recovery. The utilisation of these splints is typically advised for a duration of six to ten weeks.
Can Carpal Tunnel Syndrome go away on its own?
In some cases, especially if caused by a specific activity or pregnancy, symptoms may diminish over time. Persistent or severe cases require medical intervention.
Can exercises prevent or cure Carpal Tunnel Syndrome?
While exercises alone cannot cure CTS, they can help prevent it and alleviate symptoms when combined with other treatments.
Are there any long-term effects of Carpal Tunnel Syndrome?
If left untreated, CTS can lead to weakness and lack of coordination in the fingers and thumb, and in severe cases, muscle atrophy.
Can Carpal Tunnel Syndrome affect both hands?
Yes, it’s common for CTS to affect both hands, though the severity may vary between them.
Is Carpal Tunnel Syndrome related to any other health conditions?
Conditions like diabetes, rheumatoid arthritis, and thyroid disorders can increase the risk of developing CTS.
How can I tell if my wrist pain is due to Carpal Tunnel Syndrome?
A diagnosis should be made based on symptoms, medical history, and diagnostic tests.