Get to know Carpal tunnel syndrome, a common disease for excessive hand use, and its treatments

Carpal tunnel syndrome is a disease that occurs when the nerve in the wrist is continuously compressed for a long time. The disease is commonly found in patients who use their wrists in improper postures or excessively use their hands and wrists for too long.
The symptoms of carpal tunnel syndrome include pain in a wrist and its fingers, especially the thumb, index finger, and middle finger, sharp pain like a needle prick in a palm. If hand weakness and difficulty to grasp an item occur, consult a doctor.
Two periods of time when symptoms of carpal tunnel syndrome worsen are nighttime, as well as wake-up time, and while doing activities using either hand for a long time such as driving, using a mobile phone.
To diagnose the symptoms, medical specialists will utilize appropriate assessment methods for each patient, including physical examination and electrodiagnosis
Treating carpal tunnel syndrome at kdms Hospital in Bangkok, Thailand, our team of medical specialists in bones, joints, and muscles will holistically take care of our patients since their first touch to the day they return to normal.

Are you a person who uses your wrists regularly as a routine? Are you an office worker who uses a mouse and a keyboard all day long? Or are you an athlete who uses your wrist to play the sport? If your wrists repeat or stay in a posture like bending or flipping for a long time, you may have experienced wrist pain, hand numbness, or even weakness.

These symptoms are the warning signs of carpal tunnel syndrome, a chronic disease which exacerbates over a period of time and spends much more time to recover. If you leave it untreated, your thumb muscles might be weakened and your hand might be too weak to grasp items. However, if the treatment is undergone on the spot, it will be easy and quick to recover from the symptoms.

Table of Contents

What causes carpal tunnel syndrome?

Carpal tunnel syndrome is a disease that occurs when the nerve in the wrist is continuously compressed for a long time. The disease is commonly found in patients who use their wrists in improper postures or excessively use their hands and wrists for too long. For example, those who do housework, drive, use a mobile phone or computer and other devices for a long time may be at risk of this disease.

Symptoms of carpal tunnel syndrome

Carpal tunnel syndrome is caused by excessive use of hands and wrists, causing tendons that pass through the carpal tunnel to swell and push the nearby nerve into a thick band of fibrous tissue. This forces the nerve to send the warning signs to the body before developing into severe carpal tunnel syndrome by causing one or more of these symptoms:

Pain in a hand, a wrist and its fingers, especially the thumb, index finger, and middle finger
Sharp pain like a needle prick in a palm
Hand numbness or tingling
Burning sensation in a hand
Pain in a hand that feels like an electric shock
Hand weakness and difficulty in grasping an item, even failure to hold an item or clench a hand tightly

In an early stage, these symptoms may occasionally come with numbness. It usually occurs at night and at the break of dawn. When the symptoms become more serious, they can take place more frequently or at all time. Therefore, people with the symptoms mentioned above should not ignore or leave them for too long because the symptoms will exacerbate and interfere the daily life. Even the symptoms are mild or little, it is urgent to see a doctor before they get worsened.

Which symptoms are the warning signs to consult a doctor?

Those who are prone to carpal tunnel syndrome will show the symptoms of pain in a wrist and its fingers, sharp pain like a needle prick in a palm, and hand weakness. If these symptoms affect the use of wrists in a daily life, for instance, difficulty to grasp an item, failure to hold an item, inability to drive long, or pain in the wrist while using a computer keyboard, pause these activities and rest the injured hand for 1-2 weeks. It is urgent to consult a doctor if these conditions are not relieved after a period of break.

At what time do the symptoms of carpal tunnel syndrome occur?

Normally, symptoms of carpal tunnel syndrome are intermittent; however, there are 3 periods of time when they relapse or worsen:

Nighttime
Wake-up time
While doing activities which use either hand for a long time such as driving, writing, using a mobile phone or computer devices, house making.

Diagnosis of carpal tunnel syndrome

To diagnose the symptoms of carpal tunnel syndrome, medical specialists will utilize appropriate assessment methods regarding each patient’s condition, ranging from history taking and physical examination to additional electrodiagnosis.

1. Physical Examination

Physical examination is a fundamental method of diagnosis for carpal tunnel syndrome. A doctor will start with history taking and symptoms pattern examination, followed by provocative tests on wrists and hands as described below:

Knocking over the nerve at the wrist to test for abnormalities
Flexing the affected wrist to observe numbness and pain
Testing sensitivity at the tip of the affected fingers and hand
Examining strength of the muscles at the base of the thumb

2. Additional electrodiagnosis

For some patients whose diagnosis results from physical examination are uncertain, the doctor will recommend an additional examination with electrodiagnosis.

This method is used to detect the malfunction of hand nerves by measuring the electrical activity of the nerves in response to stimulation. Electrodiagnosis also assists in both identifying carpal tunnel syndrome and sorting out other diseases which cause hand numbness as well, for example, cervical herniated disc.

Carpal tunnel syndrome treatments

There are 2 methods of carpal tunnel syndrome treatments – non-surgical and surgical treatments. In most cases, a doctor will prescribe non-surgical ones as primary care. If the symptoms do not improve after all, a choice of surgery will be introduced.

1. Non-surgical carpal tunnel syndrome treatments

Non-surgical treatments are applied to patients with early or mild carpal tunnel syndrome. They will be given instructions to observe their symptoms along with the treatments. There are various methods of non-surgical treatments as shown below:

Keeping the wrist in a brace, mostly for patients in an early stage
Anti-inflammatory medication, to reduce pain in a short term
Steroid injections, a stronger pain-relief anti-inflammatory medication
Physiotherapy, or exercises in many different postures

2.Surgical carpal tunnel syndrome treatments

Patients whose symptoms do not improve after non-surgical treatments will be recommended carpal tunnel surgery. That’s because the symptoms of carpal tunnel syndrome can become chronic if the patient persists with the same treatments such as worsened hand numbness, atrophied muscles at the base of the thumb, or difficulty to grasp an item. Some may be disturbed with these symptoms during their sleep and daily life, which is a warning sign to undergo surgery.

Carpal tunnel surgery involves cutting a thick band of fibrous tissue that is constricting the nerve at the hand. There are 2 ways to perform surgical treatments for carpal tunnel syndrome:

1. Open carpal tunnel release

This surgery technique involves making an incision of 3-4 centimeters in the palm to cut its fibrous tissue and free the nerve from compression.

2. Endoscopic carpal tunnel release

This technique equips an endoscopic technology in a surgery, enabling surgeons to undergo the treatment by inserting a small device with camera into the wrist and performing a surgery through that device.

Endoscopic surgery makes a smaller incision on the patient’s wrist compared to an open surgery. With a 1-centimeter-long opening, the patient can take care of the incision more easily and use the hand in light activities almost right after the surgery. A smaller wound also makes it easy for the patient to recover and get back to everyday activities more quickly.

In summary

Carpal tunnel syndrome is caused by behaviors that include using wrists in improper postures or using hands and wrists excessively for too long, leading to continuous compression at the nerve in the wrist that eventually results in a thicker band of fibrous tissue. The symptoms of carpal tunnel syndrome include pain in a wrist and hand numbness. In severe cases, hand weakness and difficulty to grasp or hold an item are able to take place. To recover from carpal tunnel syndrome, the patient should practice using the hand more appropriately, reduce pain with medication, keep the wrist in a brace, and do physiotherapy. Patients whose symptoms do not improve after non-surgical treatments will be recommended carpal tunnel surgery for better results.

Q&A

Steroid injections are a treatment to reduce pain and inflammation that causes swelling of nerves and tendons. They are a standard method for carpal tunnel syndrome treatment that has a good effect in patients whose symptoms are mild or fresh. Doctors usually prescribe steroid injections no more than 1-2 times per a patient.

Patients whose symptoms do not improve much after steroid injections will be recommended carpal tunnel surgery. For those who are worried about the dangers of steroid injections, this substance does not affect the body as a whole as it only cures the symptoms at the targeted area.

Carpal tunnel surgery is a method to treat hand numbness and pain from nerve compression. After the surgery, the patient will start feeling a relief of pain, followed by hand numbness alleviation a while after. The length of time to recover from the numbness depends on various factors. Despite the fact that it may take weeks, or even months, for some patients to get better, carpal tunnel surgery ensures that patients with any stages of carpal tunnel syndrome will return to normal after surgery, and their wrist will be able to work as usual.

An article by Asst. Prof. Chinnakart Boonyasirikool, M.D., Experienced Hand, Wrist and Arm Surgeon

Consult symptoms before scheduling an appointment.