Carpal tunnel, what is it?
Carpal tunnel syndrome is a condition characterised by symptoms that appear around the hand area and it is caused by pressure on the median nerve. In the wrist, the median nerve and the flexor tendons of the fingers pass through a “tunnel”, called the carpal tunnel.
This tunnel is very narrow and as a consequence, every condition that reduces this space, an inflammation for example, causes a pressure on the median nerve. This can disturb the nerve impulses and cause different symptoms to appear. Some movements of the fingers and especially the thumb, can become particularly difficult, or even impossible.
Causes of carpal tunnel syndrome
Without explanation, women are three times more affected by carpal tunnel syndrome than men. But the origins of the latter are diverse. Studies have discovered hormonal or metabolic factors (pregnancy, menopause, diabetes etc.), constitutional or acquired anomalies, as well as some illnesses (arthritis, gout etc.).
Some movements or postures can also help this syndrome to develop. The risk is especially higher among people in a work environment, in jobs exposed to continuous movements of the wrist, the forearm, movements that require a significant force on the hand, restrictive postures for the hand, as well as those who handle tools that vibrate.
Symptoms and pains of carpal tunnel syndrome
Carpal tunnel syndrome is characterised by different syndromes which all stem from a pressure of the median nerve. It can affect both hands at the same time, but it is not systematic and sometimes only one hand is affected. These symptoms can include:
- numbness of the hands and fingers
- tingling sensations in the hand(s) (paraesthesia)
- a pain in the wrist and the palm which radiates towards the fingers or the forearm
- difficulties to grip or hold objects
These problems occur especially during the night or during an activity. They often disappear by shaking the hand or letting it hang. Nevertheless, the signs can also appear during the day, whilst carrying out certain movements or maintaining a position for a prolonged period of time.
Symptoms can also depend on the degree of the development of carpal tunnel syndrome. In women, pains can occur before menstruation, during the last months of pregnancy and a little after childbirth.
Treatment and operation: how to care for carpal tunnel syndrome
As soon as symptoms causing carpal tunnel syndrome start to appear, it is important to quickly consult a doctor who could confirm the diagnosis. This is because the earlier the problem is started to be dealt with, the more the treatment will help.
Treatment for carpal tunnel syndrome begins with the removal of factors which can cause it (see causes above). This can be sufficient to make symptoms regress. Whilst carpal tunnel syndrome doesn’t show signs of seriousness, it is cared for with medical treatment.
This treatment involves:
- wearing a detachable brace which allows to wrist to stay in a neutral position during the night, generally for a duration of 3 months. This helps to ease nocturnal symptoms.
- an infiltration of corticosteroids in the carpal tunnel. However, this measure does not offer immediate relief and the latter may be temporary depending on the severity of the syndrome.
- taking medication such as painkillers or non-steroidal anti-inflammatory drugs which allow pain to be relieved.
In case of medical treatment failing or if the syndrome is too serious, surgical intervention can be proposed. It is however only rarely urgent and essentially consists of severing one of the ligaments situated around the carpal which is the group of bones situated around the wrist. This can reduce the pressure of the median nerve.
This operation is the most often carried out as an outpatient surgery (entry and exit of the patient on a single day) and under locoregional anaesthetic, in other words, only the arm is put under anaesthetic. The procedure usually helps to gradually remove tingling and other sensations. The pains then regress in a few weeks.