Article by Dr. Dhananjay I Bhat, Consultant – Neurosurgery, Aster RV Hospital
Is there any profession that doesn’t need you to move your hands? Hand movement is involved in almost every profession. Heavy wrist movements are common across professions, ranging from the corporate working professional to working home-makers to farmers, mechanics, etc. While doing these activities, one may experience a sudden discomfort in the wrist and hand, and dismiss it as a common ache. However, over a period of time this pain can transform into a disease that could potentially interfere with everyday activities. Known as Carpal Tunnel syndrome, a person afflicted by this could suffer from persistent and prolonged wrist and hand pain, such that he or she is unable to hold even a light newspaper in the hand.
Carpal tunnel syndrome is a condition that can cause pain, tickling, numbness and weakness in the hands. This happens when there is a pressure or compression within your wrist on the median nerve. When this occurs, pain or numbness is felt in the thumb, index finger, middle finger and half of the ring finger. The little finger is not affected. The reason behind this is that there is a tunnel in the wrist made up of bones and ligaments called carpal tunnel. Within this tunnel the median nerve travels from the forearm to the hand giving sensory and motor supply to the fingers and certain small muscles of the hand. Along with this, nerve muscle tendons also traverse this tunnel making it a cramped region. When the median nerve gets compressed in this tunnel, it causes Carpal Tunnel Syndrome. While this condition is usually uncommon before the age of 20, due to the Covid-19 pandemic, every single generation is constantly using their fingers and wrists more often while using gadgets. This increases the chance of developing Carpal Tunnel Syndrome. Women are also three times more likely to suffer from Carpal Tunnel syndrome than men, one of the reasons being the repeated movement of the wrist for kneading dough, opening jars, wringing clothes, gripping heavy objects etc. Other reasons include excess fluid accumulation in pregnancy, obesity, rheumatoid arthritis, acromegaly and diabetes
Nerve damage can even lead to pain spreading up to the forearms and into the shoulder, forcing a person to become significantly disabled. It can become very severe in the night and the patient may also wake up due to it. Often patients seek relief by keeping their hand down and continuously shaking it (flick sign). As the disease progresses there is difficulty in holding objects, writing and using a pincer grasp.
Can carpal tunnel syndrome go away on its own?
Once the pain becomes apparent, it is unlikely to heal on its own. It would be better to seek the advice of a medical professional, neurologist or neurosurgeon. If left untreated, it could lead to permanent nerve damage. A timely consultation will bring a huge relief. After discussing your symptoms and medical condition, the doctor will examine you. There are tests that your doctor might tell you to take up.
Ancillary tests like nerve conduction studies to confirm nerve compression at the wrist and its severity.
- To know the health of the muscle Electromyography is suggested
- MRI and Ultrasound of the wrist to look at the compression and amount of swelling of the median nerve. It also detects the presence of any lesion in the wrist.
How is it managed?
The initial line of management includes rest to the wrist, identification of the stress factors and avoiding it. Weight reduction, control of diabetes and rheumatoid arthritis, successful completion of pregnancy will all improve the condition. Wrist splints can be used to mechanically prohibit any unwitting wrist movement. Several medications in the form of tablets are given to alleviate pain. It is not uncommon to find relief with such maneuvers. Local injection of steroids to the affected wrist can be given to provide relief which is usually for a short term of a few months. Surgery is indicated if the pain is very severe not relenting to medications or if weakness of the fingers is appearing. It is essential to get operated at the earliest if weakness is appearing as if muscle wasting occurs it is irreversible. The surgery known as carpal tunnel release is done as a day care procedure under local anesthesia.
How can it be prevented or mitigated?
There are no specific strategies to prevent the Carpal tunnel syndrome but there are a few methods to avoid the condition. The initial line of management includes rest to the wrist, identifying the habits or factors causing stress in the hands and addressing these, reducing the weight, controlling diabetes and rheumatoid arthritis. Carpal tunnel syndrome observed in pregnant women generally improves following successful completion of pregnancy. Performing conditioning and stretching activities before and after performing hand strenuous tasks, taking regular breaks in between work will help prevent development or aggravation of carpal tunnel syndrome.