Carpal Tunnel Syndrome and Its Treatment
CARPAL TUNNEL SYNDROME (WRIST NERVE COMPRESSION)
The structure called the carpal ligament forms a tunnel with the bones of the wrist beneath it, protecting the tendons and nerves responsible for finger movements, thus creating the wrist canal or carpal tunnel. This wrist canal is located at the level of the wrist and is covered by a thick band of tissue at the top. The median nerve, the thickest nerve in the hand, passes through this tunnel. This nerve primarily allows us to feel the thumb, index, middle, and ring fingers and enables some of their movements.
What is Carpal Tunnel Syndrome?
When the tunnel narrows in any way, the median nerve passing through it becomes compressed. This results in some dysfunction in the nerve, causing tingling, burning, and pain in the hand and wrist. This condition is called carpal tunnel syndrome.
What Causes Carpal Tunnel Syndrome?
The pressure on the nerve can occur in several ways. Swelling of the tendon sheaths that bend the fingers, joint fractures and dislocations, soft tissue trauma, vascular and muscular anomalies that narrow the canal volume, and postural reasons such as holding the wrist in a bent position for a long time can lead to the narrowing of the carpal tunnel and cause this syndrome. Carpal tunnel syndrome may develop in approximately 25-35% of pregnant women due to edema, but it often resolves spontaneously after childbirth.
Who Is at Risk for Carpal Tunnel Syndrome?
It is more common in individuals who perform repetitive hand and wrist movements in their work, especially those who perform tasks that stress the wrist in the same manner. Carpal tunnel syndrome is more frequently seen in groups such as housewives who do excessive handwork, employees in banking sectors with frequent typing or computer use, secretaries, and musicians. Additionally, conditions like diabetes, hypothyroidism, rheumatic diseases, obesity, gout, and kidney failure can increase the likelihood of developing this syndrome.
Fractures in the wrist, soft tissue tumors, joint cysts, fatty cysts, and anomalies in muscles and vessels can also lead to compressions in this tunnel. Carpal tunnel syndrome does not have a hereditary characteristic, but it is four times more common in women over 40 years old compared to men.
What Are the Symptoms of Carpal Tunnel Syndrome?
The condition usually starts with pain, which can sometimes radiate to the arm. Along with pain, there may be tingling, sometimes itching sensations, and a feeling of quick fatigue and weakness in the finger movements. The tingling sensations may be severe enough to wake the patient from sleep at night. Patients typically report that raising their arms and shaking their hands or massaging their wrists helps relieve the discomfort. Tingling is most commonly felt in the first three fingers.
If not diagnosed early and preventive measures are not taken, symptoms may worsen, leading to continuous tingling throughout the day. Over time, difficulties in grasping objects may arise, and in more advanced cases, muscle wasting in the palm may occur.
How is Carpal Tunnel Syndrome Diagnosed?
Early diagnosis and treatment are crucial to prevent permanent damage to the median nerve. If permanent damage occurs, the fingers may lose the ability to move.
The median nerve originates from the spinal cord. It can be compressed at any point between the spine and the fingers. The exact location of the problem can only be determined through electromyography (EMG) testing. EMG can identify whether the median nerve is compressed under the carpal ligament, where the compression occurs, and to what extent.
How is Carpal Tunnel Syndrome Treated?
Treatment for carpal tunnel syndrome can be either surgical or non-surgical, depending on the stage of the disease.
If there are no underlying conditions like diabetes or hypothyroidism, it is generally recommended to rest the affected hand and wrist for at least two weeks. Preventing or limiting activities that could worsen the symptoms, and immobilizing the wrist with a splint is important.
If swelling is observed in the wrist, cold therapy should be applied. While ultrasound therapy, laser treatments, B vitamins, and exercise therapies have been tried, there is no conclusive evidence supporting their effectiveness. Pain can be managed with NSAIDs (non-steroidal anti-inflammatory drugs). In cases of persistent pain, corticosteroid or local anesthetic injections may be administered for the wrist.
A wrist splint (resting splint), along with anti-inflammatory medications, should especially be worn at night. If symptoms persist for 6 months or longer, surgical methods should be considered.