Carpal Tunnel Syndrome

DR LEOW HON KEONG, CONSULTANT ORTHOPAEDIC SURGEON

What is carpal tunnel syndrome?

Carpal tunnel syndrome is the most common case of nerve compression in the wrist that occurs when the median nerve (one of the major nerves in the hand) is squeezed or compressed.

The median nerve is a nerve that travels down the arm and forearm, passing through the carpal tunnel (a narrow passageway in the wrist) before reaching the hand. Problems arise when the carpal tunnel becomes narrowed or when the connective tissues inside the tunnel swell – therefore, putting pressure on the median nerve, leading to carpal tunnel syndrome. Patients experience pain, numbness, and tingling in the hand and arm.

Most common age group

It occurs most commonly in the elderly and those who are middle-aged. 80 per cent of carpal tunnel syndrome cases happen in those over 40 years old. It also affects more women than men.

Factors

Triggering factors include the overuse and repetitive stress on the wrist that can come about from doing housework or prolonged use of the mouse/keyboard. Handphone texting can also cause or worsen this condition.

Other factors include rheumatoid arthritis, hypothyroidism or fractures. Another interesting point to note is that women who are in the later stage of their pregnancy may experience an attack, which usually disappears after delivery.

Symptoms

Those who suffer from carpal tunnel syndrome will usually experience numbness in the hands – especially in the thumbs, index, middle, and ring fingers. The pain in the hands can be bad enough to awaken patients from their sleep at night. Patients may also report having weak and clumsy hands.

Treatment options

Firstly, doctors will run tests such as nerve conduction tests to confirm a patient’s condition. If it is confirmed to be carpal tunnel syndrome, the patient will need to stop or reduce activities that can cause overuse of the wrist such as using the keyboard and handphone. Changes will also need to be done to work stations and tables – such as the positioning of the mouse to ensure less pressure is put on the wrist.

Next, anti-inflammatory medications and Vitamin B will be prescribed to help relieve the pain and numbness. In addition, wrist splints may help and physiotherapy would be beneficial as patients will learn stretching exercises that can help with their condition.

Some patients may prefer steroid injections directly into the carpal tunnel as it can reduce swelling in the connective tissue and in turn, relieve pressure on the median nerve. If symptoms persist, a minor operation may be needed to decompress the carpal tunnel.

Other possible conditions that can result in wrist pain

Other conditions that may explain pain and numbness in the wrists besides carpal tunnel syndrome include cervical disc prolapse; De Quervain’s tenosynovitis; ulnar nerve compression; and diabetic neuropathy.