Carpal tunnel syndrome: symptoms, causes, treatment

What is carpal tunnel syndrome?

Carpal tunnel syndrome is a neurological disorder affecting the hand and wrist. The carpal tunnel is a narrow channel between the wrist and the hand. Tendons of nine muscles of the digital flexor tendons and the median nerve pass through this channel internally.  The median nerve starts from the axillary area and passes through the entire arm reaching the palm of the hand and the fingers.  Enlarged tendons or other conditions that create swelling can narrow the tunnel causing a compression on the median nerve. The pressure on the nerve causes pain, numbness of the hand and wrist, weakness and tingling, and the so-called Carpal Tunnel Syndrome.

These symptoms affect the fingers of the hand (thumb, forefinger, middle finger, and part of the ring finger) and can occur overnight (involuntary movements of the wrist) or during tasks that involve the use of the wrist and hand.  In an advanced stage of the disease, pain can also affect the forearm and cause motor deficits.

What are the possible causes of carpal tunnel syndrome?

The main causes can be:

• Trauma and injuries: fractures and dislocation.
• Anatomical predisposition: a narrower carpal tunnel can increase the likelihood of developing this disorder.
• Family history: in some families the carpal tunnel syndrome is recurrent.
• Hormonal factors: women are more likely to develop this disorder, with a higher percentage during pregnancy or menopause.  Fluid retention in these periods, linked to an increased progesterone/estrogen ratio, can trigger the syndrome.
• General disorders: diabetes mellitus, rheumatoid arthritis, obesity, hypothyroidism, renal failure.
• Inflammation of the sheath covering the flexor tendons (tenosynovitis): these inflammations can be caused by an intensive use of the hand, typical of some repetitive working tasks (e.g. playing an instrument, using a computer, manual works).

Diagnosis

The first step is an objective and accurate examination of the wrist and hand, and a detailed clinical history of the patient. It may also be necessary to perform more in-depth tests such as electromyography and laboratory tests.

Treatment

Therapy depends on the severity and duration of the symptoms.  If the pain is mild and recent, conservative therapy can be attempted, including prescribing a period of rest for the wrist joint and using a brace, physical therapy and therapeutic exercises, and if need be local injections of corticosteroids (anti-inflammatory medications).

In most cases, however, surgery is necessary.  The surgery is performed under local anesthesia in an outpatient setting (no need for hospitalization) and is aimed at creating more space inside the carpal tunnel so that the median nerve can be decompressed. After surgery, the wrist must remain bandaged for a few days and then the patient must start a rehabilitation program, which is essential to recover the full functionality of the wrist.

Outpatient surgery, including carpal tunnel release surgery, is performed at UPMC Institute for Health Chianciano Terme.

For further information: +39 0578 61198