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Carpal Tunnel Syndrome Treatment In Singapore

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Dr Jacqueline Tan

MBBS (SG) | MRCS (Edin) | MMed (Surgery) | FAMS (Hand Surgery)

Carpal Tunnel Syndrome occurs when the median nerve, which runs from the forearm into the palm of the hand, is compressed at the wrist. The carpal tunnel is a narrow passageway in the wrist made up of wrist bones and a ligament. It contains nine tendons, the median nerve, and the synovial sheath (a tissue lining the tendons). The median nerve provides sensation to the fingers and controls the small muscles at the base of the thumb.

This condition leads to pain, tingling, numbness, and weakness in the hand and wrist, making tasks like typing, gripping, and lifting increasingly difficult.

Symptoms of Carpal Tunnel Syndrome

Symptoms of Carpal Tunnel Syndrome tend to develop gradually, worsening over time if untreated. Common symptoms include:

  • Tingling or Numbness: Most commonly felt in the thumb, index, middle, and part of the ring fingers, which begins intermittently but later becomes persistent. This sensation often spares the pinky finger and may occur during wrist-bending activities, such as holding a phone or driving.
  • Hand Weakness: Grip strength diminishes, making it challenging to perform everyday tasks such as holding a coffee mug or turning a doorknob. Some patients may drop objects due to numbness or nerve compression.
  • Pain or Discomfort: Discomfort may be localised in the wrist and hand or radiate to the forearm and shoulder, especially after repetitive use.
  • Numbness During Rest or Sleep: A tingling or numb feeling often worsens at night or during periods of inactivity, such as while sleeping. Symptoms can wake patients from sleep and interfere with their rest.

Causes and Risk Factors

Several factors increase the likelihood of developing Carpal Tunnel Syndrome by increasing strain on the median nerve. These include:

Repetitive Movements and Wrist Positioning

Frequent hand and wrist motions, such as typing, sewing, or using vibrating tools, strain the median nerve. Prolonged wrist flexion or extension during tasks or sleep can further narrow the carpal tunnel and irritate the nerve.

Health Conditions and Fluid Retention

Chronic illnesses, such as diabetes, hypothyroidism, and rheumatoid arthritis, can cause swelling and inflammation in the wrist, increasing nerve sensitivity. Fluid retention during pregnancy or menopause also narrows the carpal tunnel, making women particularly susceptible.

Injuries and Structural Issues

Wrist fractures, dislocations, or deformities caused by arthritis alter the carpal tunnel’s shape and reduce its capacity, putting pressure on the median nerve. Inflammation of the synovial sheath, ganglion cysts, or other structural abnormalities can also contribute to nerve compression.

Anatomical Factors

Individuals with smaller carpal tunnels, often due to genetics or natural variations, are at higher risk of nerve compression. This could explain why women, with smaller wrists, are more likely to develop Carpal Tunnel Syndrome than men.

Age and Occupational Factors

Carpal Tunnel Syndrome is most common in individuals aged 30 to 60, likely due to cumulative strain over time. Occupations involving repetitive hand and wrist motions, such as assembly line work, musical performance, or prolonged computer use, significantly increase the likelihood of developing symptoms.

Obesity and Lifestyle Factors

Excess body weight can increase pressure on the wrist structures, while a sedentary lifestyle may reduce muscle flexibility and strength, exacerbating strain on the wrist.

Diagnosis of Carpal Tunnel Syndrome

Physical Examination

A physical examination involves assessing symptoms through specific tests to evaluate nerve function. The doctor may apply pressure or perform certain movements to check for tingling, numbness, or pain in the fingers. They will also assess muscle strength in the thumb and sensation in the fingers to identify signs of nerve compression.

Nerve Conduction Studies

This test measures the speed of electrical signals as they travel along the median nerve. A slowed signal suggests compression within the carpal tunnel and helps quantify the severity of the condition.

Electromyography

Electromyography evaluates muscle response to electrical signals, identifying nerve damage or dysfunction. This test is particularly useful for ruling out other conditions that mimic Carpal Tunnel Syndrome, such as cervical nerve issues.

Imaging Studies

Ultrasound can visualise swelling or abnormalities in the carpal tunnel, while MRI provides detailed images of soft tissues. These tools are often used to detect swelling, fluid retention, or cysts contributing to Carpal Tunnel Syndrome.

Treatment Options

Treating Carpal Tunnel Syndrome depends on the severity of symptoms and how much they affect daily activities. Most cases begin with non-surgical methods, while surgery may be considered for persistent or severe symptoms.

Non-Surgical Treatment

Rest and Activity Modification

Limiting repetitive tasks and avoiding activities that worsen symptoms can reduce strain on the wrist and allow the nerve to recover. Regular short breaks during tasks are effective for managing symptoms.

Wrist Splints

Wearing a brace, particularly at night, stabilises the wrist in a neutral position, minimising pressure on the median nerve and alleviating symptoms, especially nighttime discomfort. Splints can also be worn during repetitive daytime tasks.

Medications

Over-the-counter non-steroidal anti-inflammatory drugs, such as ibuprofen or naproxen, help manage inflammation and provide short-term pain relief in mild to moderate cases.

Physical Therapy

Tailored stretching and strengthening exercises improve wrist flexibility and hand function. Therapists may also use nerve gliding techniques to enhance median nerve mobility and reduce compression.

Corticosteroid Injections

These injections deliver strong anti-inflammatory medication directly to the carpal tunnel. They provide temporary relief but may not address the underlying causes of Carpal Tunnel Syndrome.

Surgical Treatment

Open Release Surgery

This traditional method involves making a small incision in the palm to access and cut the transverse carpal ligament. By releasing the ligament, pressure on the median nerve is alleviated. Recovery may take several weeks, with physical therapy aiding in restoring wrist strength and functionality.

Endoscopic Surgery

Endoscopic carpal tunnel release is a minimally invasive procedure where a small camera and tools are inserted through small incisions. The ligament is cut with less disruption to surrounding tissues, resulting in quicker recovery and less post-operative discomfort. This technique is suitable for less complicated cases.

Carpal Tunnel Syndrome

Common cause of hand numbness

Carpal tunnel syndrome occurs when the median nerve becomes pinched and compressed due to inflammation of the tissue lining the tendons, fluid retention or the presence of a ganglion cyst. It is mostly observed in women and could be attributed to having a smaller carpal tunnel area as compared to men. Some of the most obvious signs include a tingling sensation and numbing in the hands that are most often felt during the night. If you suspect you are suffering from carpal tunnel syndrome, it is advisable that you visit a hand surgeon to seek treatment early to prevent your condition from worsening.

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Prevention and Management

Preventing Carpal Tunnel Syndrome involves reducing strain on the wrist through proactive measures and addressing underlying risks. Adjusting work environments, such as using ergonomic keyboards and wrist rests, can help minimise stress on the wrist. Incorporating daily wrist stretches and strengthening exercises can improve flexibility and reduce the likelihood of nerve compression. For individuals with chronic health conditions like diabetes or arthritis, effective management of these conditions is necessary to prevent Carpal Tunnel Syndrome from developing or worsening.

Frequently Asked Questions

What happens if Carpal Tunnel Syndrome is left untreated?

Untreated Carpal Tunnel Syndrome can lead to permanent nerve damage, causing chronic pain, weakness, and loss of sensation in the fingers and thumb. Over time, it may also result in muscle atrophy at the base of the thumb, affecting hand function.

Do symptoms fluctuate, or are they constant?

Carpal Tunnel Syndrome symptoms often fluctuate in the early stages, with tingling, numbness, or pain coming and going. Over time, these symptoms become more consistent and may interfere with daily activities.

How long does it take for non-surgical treatments to show improvement?

Mild to moderate cases often improve within a few weeks to a few months with consistent non-surgical treatments such as splints and physical therapy. Severe cases may take longer or require additional interventions.

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Dr Jacqueline Tan

MBBS (SG)

MRCS (Edin)

MMed (Surgery)

FAMS (Hand Surgery)

Dr. Jacqueline Tan is a hand surgeon in Singapore with over 18 years of experience in managing hand, wrist, and nerve conditions. Formerly the Head of Department of Hand and Reconstructive Microsurgery at Singapore General Hospital, she has continued to contribute significantly to her profession.

  • Director of Micro-Reconstruction Service and the Director of Peripheral Nerve and Paralytic Upper Limb Service
  • Upon the completion of her training as a hand surgeon in Singapore, Dr Tan was awarded the prestigious Health Manpower Development Plan scholarship by the Ministry of Health (MOH).
  • Completed a one-year advanced fellowship in Taiwan under the tutelage of internationally-acclaimed Hand and Orthopedic Microsurgeon – Professor Yuan-Kun Tu
  • Dr Tan’s field of expertise is in early and late brachial plexus reconstruction, peripheral nerve disorders, reconstructive microsurgery of the extremities and wrist disorders.

Widely Published
In hand surgery

Active In
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    Mt Elizabeth Novena Hospital

    38 Irrawaddy Road #07-42
    Singapore 329563

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    +65 9230 9554