The initial symptoms of carpal tunnel syndrome are hand numbness, tingling, and burning. Initially the symptoms occur intermittently and worst at nighttime while the patient is sleeping. The tingling often wakes up the patient, and they have to shake their hands to get rid of it. As the disease progresses the frequency and the intensity of the tingling and burning increases, eventually the symptoms become constant and severe. As the carpal tunnel syndrome gets worst the patient can develop symptoms of weakness and paralysis of the fingers and the hands.
Causes of Carpal Tunnel Syndrome
Tingling is usually a sign of nerve injury. Nerves generally have two major functions. There are sensory nerves which sense information in the skin, and there are motor nerves that are used to move the muscles. Several symptoms occur when there is nerve injury, there could be numbness, tingling, or burning and there could also be associated weakness and paralysis of the muscles. One of the nerves that supply the hand is called the Median nerve. This nerve travels across the wrist to supply the fingers. With repetitive bending and straightening of the wrist this nerve gets injured; Injury of the Median nerve at the wrist causes carpal tunnel syndrome. It tends to occur in people that use the computer frequently, use the cash register, or are involved in activities that involve repetitive motion at the wrist. There is greater frequency of carpal tunnel syndrome among post-menopausal women.
Diagnosis
The diagnosis of carpal tunnel syndrome is made using a nerve test called EMG/Nerve conduction study. Since there are multiple other causes of hand tingling, nerve testing is crucial to know if the Median nerve is injured at the wrist, which would confirm the diagnosis of carpal tunnel syndrome, or is there another cause. It also gives us crucial information about how severe the injury is, which determines the type of treatment. Another very helpful diagnostic procedure is musculoskeletal ultrasound. It further helps us to identify the cause, location and size of damaged nerve. Rapid diagnosis of carpal tunnel syndrome is important since if the problem is ignored the injury could continue and the symptoms could progress and become permanent.
Treatment
Once the diagnosis of carpal tunnel syndrome is made we will determine the best possible treatment for the patient trying to prevent further nerve damage and trying to reverse the process. The different treatment options include bracing, injections, special physical therapy release and exercise methods, extracorporeal shockwave therapy. The treatment of carpal tunnel syndrome that is chosen depends on the severity of nerve damage shown on the nerve conduction study and diagnostic ultrasound, making this test very crucial. The earlier in the disease process that we see the patient the better chances of recovery. The later in the course the patient comes to our attention the chances of recovery are less, the patient could develop permanent paralysis, and surgical procedures might be required even though they could have been avoided early in the disease course. Patients with carpal tunnel syndrome could have full recovery with minimal intervention if they seek medical attention and treatment early.
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Dr. Mikhail Bernshteyn
Dr. Christina Pekar
Dr. Michelle Agyakwah
Mariam Kodsy
