Carpal tunnel syndrome

What is carpal tunnel syndrome?

Carpal tunnel syndrome refers to a nerve impingement that usually occurs where the hand joins the forearm. At this point, the carpal bones on the palm of the hand form a carpal canal which the median nerve passes through. The median nerve is sometimes compressed in its carpal canal to such an extent that it causes the typical symptoms of carpal tunnel syndrome.

Most of us have experienced this at some point: Tingling hands, numb fingers. These signs are quite harmless in many cases. But if you experience these symptoms and pain in your hand more frequently, especially at night, it may be time to consult a doctor, as you could be suffering from carpal tunnel syndrome.

Carpal tunnel syndrome predominantly occurs in combination with other conditions like diabetes mellitus or rheumatoid arthritis, but it can also arise during pregnancy, as a result of a lot of fluid accumulating in the tissue.

What are the symptoms of carpal tunnel syndrome?

The symptoms typically only develop once pressure has been applied to the median nerve:

• Sensory disturbances: Tingling, numb hands or fingers

• Numbness

• Pain, that can occur in individual fingers or the entire hand or arm.

• The symptoms tend to be worse at night when sleeping, but they also intensify when flexing the hand, such as when holding a book, steering a wheel or talking on a smartphone (holding the phone).

Why is the pain actually worse at night?

During sleep, most people have their wrists slightly bent or their hands are usually squeezed by the body while they sleep, which increases the pressure and therefore the pain. This can be relieved symptomatically by briefly shaking your hands in the air or rubbing them together firmly.

How is carpal tunnel syndrome treated?

Carpal tunnel syndrome can be treated with surgical and non-surgical methods on a conservative principle. Any doctor will, however, start with conservative treatment methods and only resort to the scalpel if all the previous treatment attempts have failed. Exceptions requiring surgical intervention are severe injuries, inflammation or bleeding that cause the pressure in the wrist to rise unnaturally.

Non-surgical method

If carpal tunnel syndrome only results in mild pain, it can be managed well with a padded wrist splint. This splint is usually worn at night and prevents the wrist from bending involuntarily and causing pain. The splint is removed during the day and patients are instructed to avoid mechanical overloading of the wrist in order to minimize pain.

Injections or tablets of cortisone can also help to ease the pain. Some doctors also believe that the administration of non-steroidal anti-inflammatory drugs (NSAIDs) is beneficial. However, it is not yet clear if these drugs have any positive effect on the carpal tunnel syndrome itself apart from relieving the pain.

Surgical method

If surgery is required for carpal tunnel syndrome, there are two options currently available to surgeons:

1. The classic, open procedure, which can be performed under local or general anesthesia.
2. Minimally invasive, endoscopic surgery, requiring only two small incisions in the skin and performed via two small tubes. Since only two very small scars are created here, there is a much lower risk of any scar tissue limiting the movement of the forearm.

The surgeon basically cuts open the carpal tunnel in both cases, which is bounded at its top by a connective tissue sheet. The pressure drops rapidly as a result and the pain and restrictions subside. At the same time, the surgeon can remove certain soft tissue changes or tumors or repair the thickened tendon sheath. Stitches are usually removed after about two weeks and after this, patients should be able to resume normal activities.

Immediately after the operation, patients begin rehabilitation with hand exercises. However, the hand can only be stressed again slowly and heavy activities requiring the hand can only be resumed after four to six weeks.

There is unfortunately very little that patients can do about carpal tunnel syndrome themselves. If only mild symptoms are present, the affected hand should always be rested, although this should always be combined with causal therapy by a doctor, as an untreated carpal tunnel will always worsen.

What are the causes of carpal tunnel syndrome?

The carpal tunnel is normally formed by a plate of connective tissue, the flexor retinaculum. Like a bony roof, it stretches over the hollow on the palm of the hand. The tendons of the finger flexor muscles and the median nerve pass within this plate. This is where carpal tunnel syndrome occurs if the median nerve is squeezed or if the surrounding connective tissue swells and compresses the nerve, resulting in a peripheral nerve conduction disorder. Often it is not even known what causes the connective tissue to swell, in which case doctors usually speak of idiopathic carpal tunnel syndrome. There are, however, diseases that can often lead to this syndrome:

• Rheumatoid arthritis
• Osteoarthritis
• Gout or other metabolic diseases such as myxedema

Nevertheless, in some cases the causes are obvious. A distinction can then be made between two further causes:

• Firstly, local mechanical irritation of the hand
• Secondly, systemic or hormonal changes (e.g. pregnancy)

How is carpal tunnel syndrome diagnosed?

The symptoms described by the patient are usually pointing to carpal tunnel syndrome. However, the diagnosis is confirmed by clinical diagnostics. By means of an electromyogram (EMG) and a device that measures the nerve conduction velocity (NLG), a neurologist can check to what extent the affected hand varies from the healthy hand. If there is a suspicion of a bony change, the doctor will also take an X-ray. Furthermore, the doctor will also perform a number of clinical tests like the bottle test, Hoffmann-Tinel test or Phalen test.

Assuming that the carpal tunnel syndrome stems from a change in the soft tissue, an MRI or ultrasound scan will be carried out in all cases.

What is the course of carpal tunnel syndrome?

If left untreated, carpal tunnel syndrome will always worsen over time and never improve spontaneously. The pain can radiate from the forearm to the shoulder. Over time, the mobility and musculature of the fingers also diminish. There is a very good prognosis for treated carpal tunnel. After surgery, the pain is usually very mild and the paraesthesia often decreases. Generally speaking, the earlier treatment is initiated, the better the chances of recovery.

Carpal tunnel syndrome can also arise during pregnancy. As more fluid builds up in the tissue during this time, it can also increase the pressure in the carpal tunnel and cause discomfort. In most cases, however, the symptoms disappear after the birth.

Which doctors and clinics specialize in carpal tunnel syndrome?

If you're in need of a doctor, you expect the best medical care possible. So of course patients are curious to find out what clinic to go to. As there is no objective way to answer this question and a legitimate doctor would never claim to be the best, patients must rely on a doctor's experience. Let us help you find an expert for your condition. All listed doctors and clinics have been reviewed by us for their outstanding specialization in the field of carpal tunnel syndrome and are looking forward to your inquiry or wish for treatment.