This condition most commonly affects the hands and is caused by high pressure accumulating in the carpal tunnel, which then compresses the median nerve. This nerve is responsible for controlling thumb movement and is also the nerve associated with sensation in the palm of the hand, the index finger, middle finger, and lower half of the ring finger.
 

Causes

Carpal tunnel syndrome is caused by overuse or frequent and prolonged bending at the wrist while working. This explains why this condition is common among office workers, as well as others who work from home on computers or mobile phones, those who garden, those who frequently lift heavy objects, and obese individuals. Carpal tunnel syndrome is more prevalent among women than men and diabetics are at increased risk.

Symptoms

Patients may experience numbness in their affected hand; it starts in the index and middle finger and subsequently spreads to the whole hand. The condition can come on gradually in its initial stage, only causing numbness while using the hands, but then that numbness can become constant once the condition progresses to stage 2, which is characterized by numbness that is worse when first waking up or during the night. Should the numbness lead to aches and pains, the patient may find it difficult to sleep, while the thumb in particular may deteriorate in strength and be subject to muscle atrophy.
 

Diagnosis

When consulting a doctor, patients will first have their medical history analyzed alongside a physical examination and diagnostic processes aimed at ruling out other potential causes, such as cervical radiculopathy, entrapment neuropathy, and cubital tunnel syndrome. Differential diagnosis requires an experienced specialist to accurately diagnose and treat the condition. This may involve performing a nerve conduction study when their condition flares up to confirm the diagnosis.
 

Treatment
 

1. Non-surgical treatments include medication, resting the hand, hand exercises aimed at strengthening the muscles and tendons in that area, or a wrist splint (most regularly used in the condition’s initial stage).
2. Physiotherapy can ease the condition in some cases.

Surgery is an option when conventional treatment was not successful, or in cases where the symptoms are worsening to the extent that their hand is constantly numb, and experience aches and pains throughout the night. Surgery is indicated if the symptoms last for more than 3 months without respite, if there is visible muscle atrophy in the thumb, or that a nerve conduction study has confirmed the diagnosis. Fortunately, such surgeries are minimally invasive and do not require a stay in hospital. Surgeons begin by making an incision of around 1cm in length, through which they cut and release thickened carpal tunnel ligament to widen the carpal tunnel and reduce pressure on the nerves. Doing this, can restore function to the nerves and ease any symptoms the patient may be experiencing.


Authors: Dr. Surachai Rattanasaereekiat is an orthopedic surgeon at Orthopaedic Center Bumrungrad. Dr. Surachai is currently a hand and trauma Specialist at Bumrungrad, specializing in upper extremity and trauma fracture surgery.