Understanding Carpal Tunnel Syndrome

Created 07 May 2018
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CTS is caused by pressure on the median nerve, which runs through the length of the arm to the hand, while travelling through the wrist passage called the carpal tunnel.

 

Dr. Alain Fauvy. — Photo courtesy of Hanoi French Hospital  

By Dr Alain Fauvy*

Carpal Tunnel Syndrome (CTS) is caused by pressure on the median nerve, which runs through the length of the arm to the hand, while travelling through the wrist passage called the carpal tunnel.

The median nerve controls the movements and sensations of your thumb and other fingers, except the pinky. If the median nerve is compressed, you may feel numbness, tingling, pain or weakness in your hand and the first four fingers.

Symptoms of CTS generally start showing at night, as most people sleep with their wrists bent, increasing the pressure on the median nerve. As the condition worsens, you may experience the same symptoms during the day too, usually associated with actions that make your wrist bend up or down for some time, like typing on your computer or driving your car or any other repetitive motion.

Diagnosis

Your doctor may do several tests to diagnose CTS and rule out other causes for your symptoms. The tests commonly include:

  • Physical examination to test the feeling in your fingers and the strength of your hand muscles. Bending the wrist, tapping on the nerve or simply pressing on the nerve may trigger symptoms.
  • X-ray.
  • Nerve conduction study (NCS) and Electromyogram (EMG). An NCS measures the speed of a nerve impulse to travel along a nerve and how your muscles respond to the signal. If the nerve is trapped, damaged or sick, these signals will be slow and your muscular response will be less. During a needle EMG, the electrical activity of your muscles is measured at rest and after muscle contraction, which is directly recorded by inserting a small needle electrode into your muscle(s). This is sometimes necessary in addition to NCS to confirm the diagnosis of CTS and rule out other conditions.

Treatment

CTS starts off slowly but worsens progressively. It is important to start treatment as early as possible to minimise the risk of permanent nerve damage and to maximise outcome and ensure speedy recovery. Many options are currently available.

 

If you have moderate symptoms for less than six months or when awaiting surgery, non-surgical treatment may help to relieve your symptoms. Such options include:

  • Wrist splinting to stabilise your wrist during sleep, which may improve night-time symptoms and are a good solution during pregnancy.
  • Non-steroidal anti-inflammatory drugs may help to relieve pain but cannot improve the cause. They should only be used for a short term.
  • Corticosteroid injections into the carpal tunnel may decrease inflammation and swelling and, consequently, pressure on the median nerve and pain. This treatment usually only has short-term effects.

If your symptoms are severe, have lasted for more than six months or do not respond to other treatment, surgical treatment may be the best option. Surgical treatment of CTS is considered the gold standard yielding excellent immediate and long-term results. Two different techniques are available, endoscopy and open surgery. In both the procedures, your surgeon cuts the ligament around the carpal tunnel to reduce the pressure on the median nerve. The ligament will heal back together but with more space for the nerve.

  • Open surgery involves a large cut or incision on the palm of your hand over the carpal tunnel through the ligament to free the nerve. Your surgeon may also remove the synovial tissue if you have an inflammation of your flexor tendons, known as tendinitis, which is often associated with CTS.
  • In endoscopic surgery, your surgeon makes two small openings in your wrist and hand and inserts a telescope-like device with a tiny camera attached to it (endoscope) to see inside the carpal tunnel and to guide him in cutting the ligament. Because the openings are smaller in this technique, you may heal faster and experience less pain.

In either technique, only a short stay at the hospital is required. Based on the severity of your condition, your surgeon will recommend the type of surgery and anesthesia most suitable for you. Your doctor will also explain the risks and benefits associated with the recommended procedure. Complications are rare, but it’s good to ask your doctor for detailed explanations about the risks, which may include nerve damage, wound infection and a painful scar. Sometimes the ligament is too hard to cut during an endoscopic procedure and a conversion to open surgery may be needed. You may experience relief from symptoms the same day of your procedure, but complete healing can take up to several months. — Hanoi French Hospital

* Dr Alain Fauvy works together with Cao Manh Lieu at the Department of Orthopedic Surgery and Traumatology at Hanoi French Hospital (HFH). He has many years of medical expertise in the treatment of conditions and injuries of the bones, joints and muscles.

If you have any questions or want to book an appointment with our doctors, please contact us at 84-24.3577.1100, or visit www.hfh.com.vn, or email us at This e-mail address is being protected from spambots. You need JavaScript enabled to view it . Address: 1, Phương Mai, Đống Đa, Hà Nội

 

Source: VNN

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