|| United Medical Muscat Private Hospital

Carpal Tunnel Syndrome

by Dr. Abdullah Al-Harthy

The Almighty Allah gave us two remarkable instruments to help us in life: our hands! Our hands distinguish us from the rest of the animal world. They are capable of an amazing variety of functions. Our hands can be used to grip firmly like a vice, explore the world, bring food to our mouths, to care for our personal hygiene, or gracefully play the violin.

As our hands are used and overused throughout life, it is not surprising that they can become a source of pain. Carpal tunnel syndrome is only one of many causes of hand pain. The symptoms can be minor or severe, and sometimes disabling.

Carpal Tunnel Syndrome is one of the most common hand and wrist disorders. Occurs more frequently in women ages 30-60 years, but also can occur in men or in some children.

Although carpal tunnel syndrome may be aggravated by work, it is often seen in people whose jobs or hobbies require them to move their hands and wrists in repetitive motions. Computer operators, assembly line workers, supermarket checkout clerks, hairdressers and musicians.

It is sometimes associated with medical illness, such as patients with diabetes, rheumatoid arthritis, hypothyroidism, or those who had a fracture around the wrist. Carpal tunnels syndrome is also common in pregnant women, who often experience fluid retention and swelling in the hands and wrists during pregnancy. Carpal tunnel syndrome can occur also for no apparent reason.

Carpal tunnel syndrome is related to increased compression on the median nerve, which is one of three important nerves that supply sensation to the hand. The median nerve and multiple tendons of the fingers pass through a narrow tunnel in the palm side of the wrist known as the carpal tunnel. The wrist is composed of small bones, which make up the sides and the floor of the tunnel. Thick broad ligament called the transverse carpal ligament spans the sides forming the roof of the tunnel. { see picture 2 }

If any of the tendons swell, or if the tissues around the wrist become inflamed, the space inside the tunnel gets smaller and becomes crowded. Any activity that raises the pressure in the carpal tunnel affects the tendons and nerve. The median nerve gets squeezed and compressed and eventually sends painful signal to the brain.

Those sufferers with carpal tunnels syndrome experience initial symptoms of painful burning or tingling sensation in the fingertips especially of the thumb, index and middle fingers. The fingers feel numb as they are “ going to sleep”. The symptoms are usually worse at night, often awaken the sufferer from sleep and temporarily relieved when the affected hand is shaken or rubbed.

Those with longstanding symptoms develop weakness of their hands and eventually have difficulty opening jars, or picking or dropping small objects. If the symptoms are left untreated, the sufferers may lose practical use of their hands through significant muscle wasting, in particular those moving the thumb. Additionally there is a possibility of permanent median nerve damage, accompanied by loss of movements and sensation to the thumb and fingers. This damage can be prevented if the initial symptoms are given early medical attention.

If you have pain, numbness, and tingling in the fingertips of your hand with manual activity and you are awakened with these symptoms at night, you may have carpal tunnel syndrome and you need to see your doctor. Be sure to describe the location of your pain to your doctor. Also, mention the activities, which aggravate and relieve your pain. Your doctor will examine your hand and look for changes in muscle contour and sensibility. Your doctor may order blood tests and an X-ray or special electrical studies.

Although carpal tunnel syndrome can be painful, even disabling, there are many things, which can be done to relieve your pain. The treatment is designed to lessen the pressure on the median nerve. Generally starts with noninvasive i.e. non-surgical methods first. Anti-inflammatory drugs may help the symptoms recede, but this relief may only be temporary. Using a wrist splint or brace to restrict hand and wrist motions often reduces the pressure on the inflamed median nerve. Resting the hand and wrist, or avoiding irritating activity altogether may help. If the sufferer returns to the repetitive motions that originally triggered the symptoms, can expect the symptoms to return as well. If this fails a steroid injection into the carpal tunnel is the next option. Usually two thirds of the patients will respond to these initial measures. If this fails, or the symptoms are severe, and the muscles are affected surgery is recommended.

Remember, the problem of carpal tunnel syndrome is related to a compressed median nerve in a crowded tunnel. A hand surgeon can reduce the compression of the median

nerve by cutting into the roof of the carpal tunnel. Studies indicate that the volume of the carpal tunnel increases by 26%, enough to relieve most of the pressure on the nerve when the transverse carpal ligament is released. { see picture}. In most cases, surgery successfully alleviates the symptoms and prevents worsening of the condition. It is relatively a simple procedure usually done under local anesthesia on outpatient basis where no overnight stay is required.

Beneficial steps many can perform during our daily activities to prevent symptoms of carpal tunnel syndrome especially those working with computers. If you believe your problem is aggravated at your work, sometimes simple changes can make a difference. For people who sit at a desk or keyboard, the working surface should be adjusted so that the majority of work can be performed with the wrist in neutral position, not bent upwards or downwards. This can sometimes be accomplished by simple adjustment of the chair and the keyboard so that your wrists are comfortable. The wrists should be at or above, but not below your finger level. Consider a wrist- supporting foam pad to keep your wrists above your fingers. Inspect the type and height of your chair and its distance from a computer board if you use one. Your feet should be flat on the floor and your lower back well supported. Adjust your monitor so that its center is at or below eye level.

You can warm up your hands before work by massaging and stretching your fingers, bending your wrists and opening and closing your fists. This keeps the muscles and tendons in your hand warm and relaxed. Take frequent mini- breaks to keep the circulation going and give your hands a rest from the keyboard.

If you are overweight, lose weight. It is known that the more you are overweight the more likely you are to suffer from carpal tunnel syndrome. Do not use your hands as a hammer and avoid unnecessary trauma by using a real hammer. Wear protective gloves when working outdoor especially in cold weather.

Be kind to your hands! . Your hands are remarkable instruments, which can serve you well throughout life, but it is important that you take good care of them.

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