Carpal Tunnel Syndrome: Causes, Manifestations and Treatment

Carpal tunnel syndrome is referred to as CTS or wrist tunnel syndrome. It is the most common compression syndrome. This means that it arises from compression of the nerve. More precisely, the median nerve, ie the central nerve that runs through the tunnel.

It affects women more often, about three times more than men. Generally aged about 40-50 years. It affects the dominant hand more frequently, but even bilateral occurrence is not exceptional. Various publications report the number of cases in 100-350 out of 100,000 people.

Small space and big problems

If there is compression or chronic pressure, or prolonged overpressure of the wrist, there is oppression of this nerve, pain in the wrist area and other problems. Nerve oppression can also occur in the event of an injury, swelling or inflammation of the tendons or ligaments in this area.

Carpal tunnel syndrome is one of the most common occupational diseases.

Sometimes there are also difficulties in pregnant women. This is due to water retention in the body and swelling of the soft tissues. This compression syndrome is very unpleasant and is accompanied not only by pain, but also stiffness of the wrist and problems in the nerves and muscles of not only the wrist but also the palm.

This results in a dysfunction of the hand.

What is the carpal tunnel?

The carpal tunnel is a narrow passage that connects the forearms with the palm. It consists of wrist bones (called carpal bones, or ossa carpi) and the flexor retinaculum of the hand (also called retinaculum flexorum). One massive median nerve, the median nerve and 9 flexor tendons run through there. The nerve innervates the first three fingers and one half of the fourth finger.

Innervation of this nerve ensures movement, i.e. gross and fine motor activities and sensitivity of the fingers. Tendons, or finger flexors, are responsible for tehir mobility.

Problems in the carpal tunnel area result in a number of difficulties, ranging from pain, movement issues to sensitivity in that area.

The anatomical arrangement in the carpal tunnel area is a risk factor for problems. Difficulties arise due to the narrowing of an already small space. We then react sensitively to changes in the nerve or its surroundings.

Difficulties can occur acutely, such as in an accident, or recur, but are often chronic. As a result of the pressure, various problems arise. The increase in internal pressure can be caused by several causes, such as:

• changes in the bones
• excess of various materials in the area (fat, fluids)
• incorrect posture or position
• repeated wrist movements

Carpal tunnel syndrome is a frequent work-related complication that often results in work disability. Stereotypical wrist movements also occur during activities that are not related to work.

Risky occupations and other activities include, for example:

• long-term computer work (keyboard and mouse) as a frequent modern problem
• long-term work with a screwdriver, pliers and the like (electricians, painters and other workers)
• vibration drill, pneumatic hammer, jackhammer, chainsaw
• milkers (in the past)
• work at conveyor belts and assembly lines
• when sewing, cleaning
• cooks
• gardeners
• playing musical instruments such as the piano, stringed instruments, or the violin
• athletes, especially bodybuilders and cyclists
• walking on bars

Thus, the most common cause of the syndrome is chronic stress and long-term physical overload of the wrist with work or other monotonous activity, in addition, inappropriate ergonomics (position) of the hands at work, such as computers and sports.

However, sometimes this pressure damage can also occur in the event of injury, tendonitis and ligaments in this area. Compression of the wrist canal is also a consequence of some diseases.

Hormonal changes in the body are a risk factor, too.

Some risk factors influencing the development of carpal tunnel syndrome:

• injury, fracture, bump, sprain
• swelling and excessive fluid in the area (kidney disease, pregnancy)
• hormonal changes
  • thyroid dysfunction
  • pregnancy, especially the 3rd trimester
  • hormonal contraceptives
  • menopause
  • acromegaly
• degenerative changes in ligaments, tendons, bones
• rheumatic disease
  • arthrtitis
  • lupus erythematosus
• inflammation in the area (bone, tendon)
• diabetes and neuropathy (nerve damage)
• gout
• being overweight and obese
• alcoholism
• eating disorders
• tumour, cyst, ganglioma, lipoma
• congenital narrowing of the carpal tunnel

Carpal tunnel syndrome is most pronounced on the dominant hand, and thus on the one who is more stressed. However, this is not always the case as it can affect both hands. Difficulties are localized in the carpal tunnel area, but the hands can also radiate to the higher parts of the limb.

The pain can shoot into the shoulder and arm. Difficulties are aggravated by a certain position (holding a book, the position of the hands while driving), but also by exertion. The onset of symptoms during rest and at night is common and characteristic, resulting in poor or intermittent sleep.

Learn more about insomnia in this article.

An example is if the affected person wakes up at night and the pain disappears after warming up. They are not able to button up, grab the needle, the knife. Hanging clothes and dropping objects can also cause some incovenience. The disability thus affects the fine as well as gross motor activities.

Characteristic signs and symptoms of carpal tunnel syndrome:

• paresthesia, i.e. a tingling sensation in the hand, thumb, forefinger, middle finger and one half of the ring finger
  • twitching, tingling in the fingers and wrists
  • pain, burning sensation
  • pain can shoot into the shoulder, into the arm
• impaired function, limited mobility, ie fine and gross motor skills
  • inability to button up
  • dropping objects
  • inability to rotate the hand around the wrist
  • inability to clench the fingers
• stiffness
• loss of muscle strength, weakness, muscle weakness
• increased hand fatigue
• swelling or just a sensation of swelling without actually swelling
• lack of sensitivity, numb hands
• change in the colour and temperature of the skin of the palm and nails

Subjective, i.e. perceived by an individual, issues develop as follows:

1. the initial phase is morning numbness in the fingers
2. the second phase is paresthesia, i.e. tingling in the fingers during the night
3. the third phase is when paraesthesias are also present during the day, especially in the position of the hands above the head
4. the fourth phase is characterised by impaired mobility of small joints

Table: Degrees of classification of carpal tunnel symptoms (CTS)

Carpal tunnel syndrome is diagnosed based on typical symptoms and medical history. Physical exams and palpation checks are performed. Sensitivity and mobility of the wrist and fingers are observed.

Provocative tests also help to determine the diagnosis.

The provocative test involves targeted hand movements to narrow the space in the carpal tunnel and thus provoke the signs and symptoms. They also use a hammer or bending, wiping the hand on the wrist, or raising the hand for 60 seconds.

EMG, or electromyography, is used to confirm the diagnosis. The EMG monitors electrical activity at the neuromuscular level, thus confirming nerve compression. Nerve blockage is a method in which a local anesthetic is injected into an area. If the difficulties subside, the diagnosis is confirmed.

X-ray, USG, CT and MRI scans are used for differential diagnosis. In case of immunological problems, a blood sample is taken. It is similar in the case of chronic problems. Alternatively, a revision surgery of this wrist strait may be performed.

The purpose of differential diagnosis is to differentiate, i.e. to distinguish the cause of the problem, since other diseases can cause similar signs and symptoms, such as neurological diseases, diseases of the tendons, joints, and problems with the cervical spine. Even, several difficulties may occur with CTS.

TIP: Learn more about the cervical vertebrae.

The carpal tunnel is a strait through which a nerve and 9 tendons pass. Together, they have the task of controlling and performing movement and, of course, an important sensory property of the hand and fingers. There is little room for abnormalities in the area.

Each deviation then causes a problem. It occurs acute, accidental or chronic. Long-term load, inappropriate hand position at work or monotonous activity, or sports is the cause of CTS.

Although the causes may vary, the manifestations are usually similar. Symptoms such as tingling during the night, general tingling in the hands and fingers are usually the first to appear. Daily paresthesias after exertion or inappropriate hand position come next. The hand hurts, the wrists and fingers are stiff.

Sleep disorder is also associated. This arises from the occurrence of pain and paresthesias during sleep, especially in the upper hand. Warming up the hand and wrist helps. The reason is mainly the wrong position.

The ability to move and the dexterity of the fingers decreases. There is also a loss of strength and muscle mass. Swelling of the wrist is associated. Sometimes a feeling of swelling may be present, even without its apparent and confirmed occurrence.

The hand, fingers, and the skin change colour, it may fade and the fingers feel colder. It is difficult to hold objects with the fingers, objects are dropped from the hands and there are sensitivity disorders in the affected area of innervation.

There is a risk of remission of difficulties, which usually means severe damage to nerve fibers in the late stages of CTS.