Carpal Tunnel Syndrome
The carpal tunnel is a small space composed of wrist bones bound by a ligament, filled with nine tendons, the median nerve and synovial sheath located at the base of the hand. The median nerve is the nerve that provides feeling to parts of our fingers and controls the small muscles at the base of our thumb while the synovial sheath is a tissue lining our tendons.
Carpal tunnel syndrome is a common condition that results in numbness, tingling and pain in the hand and forearm. It occurs when one of the major nerves to the hand—the median nerve—is squeezed or compressed as it travels through the wrist, due to inflammation of the synovial sheath, fluid retention, or the presence of a ganglion cyst. The pressure on the median nerve reduces blood supply, causing some of the nerve fibres to degenerate and cutting out the sensation to the hand and fingers.
In many patients, carpal tunnel syndrome may worsen over time. If left untreated, it can lead to permanent dysfunction of the hand, including loss of sensation in the fingers and weakness. If pressure on the median nerve continues, it can lead to nerve damage. To prevent permanent damage to your hands, it is important to diagnose and treat carpal tunnel syndrome promptly.
Carpal tunnel syndrome is caused by the increase in pressure within the tunnel, resulting in pressure on the median nerve. Many times, there is no single cause of carpal tunnel syndrome, but some of the common causes are wrist fractures, swelling of the lining of the tendon, and even arthritis.
A number of factors have been associated with carpal tunnel syndrome, however not all of them directly contribute to carpal tunnel syndrome. Instead, some of these factors may increase the risk of irritation or damage to the median nerve.
Carpal tunnel syndrome in Singapore is mostly observed in women, and this could be attributed to the carpal tunnel area being relatively smaller than in males. In addition, fluid retention may increase the pressure within the carpal tunnel, irritating the median nerve. Women are more susceptible to carpal tunnel syndrome since they experience fluid retention during pregnancy and menopause.
Patients who suffer from fractures, dislocation or arthritis of the wrist may have deformities in the small bones within the wrist. These alter the space within the carpal tunnel and put pressure on the median nerve. Some other factors include medication, pre-existing medical conditions and obesity.
Signs and symptoms
- Patients suffering from carpal tunnel syndrome in Singapore typically present with tingling and numbness in most, if not all, of the fingers except for the pinky. This sensation is often felt during the night and may wake you up from your sleep. However, it can also be felt during the day when you are doing activities that require the bending of wrists, such as holding a phone, writing and even driving. Some patients may experience weakness in their hands and drop objects. This could be attributed to the numbness in the hand or pinching of the median nerve.
- It is recommended to see a doctor when these symptoms start affecting your normal activities and sleep pattern.
Aside from asking questions and about your medical history, doctors will usually perform tests to check the sensation of the fingers and the strength of the muscles in your hand. Some doctors may also send you for nerve conduction tests to diagnose your condition and rule out other possible causes.
It is recommended to seek treatment for your carpal tunnel syndrome as early as possible to prevent the condition from worsening. Conservative treatment options include wrist splinting, prescribing non-steroidal anti-inflammatory drugs (NSAIDs) and steroid injections.
A wrist splint is often advised to be worn at night to relieve symptoms of tingling and numbness. However, it can also be worn during the day especially if you are repeatedly bending your wrist.
NSAIDs are usually effective in relieving the pain experienced by patients suffering from carpal tunnel syndrome, although this is only a short-term treatment option. Doctors will also opt to administer steroid injections to decrease inflammation and swelling at the site, thus relieving pressure on the median nerve. In most cases, patients are able to get relief from modifying their activities to reduce pressure within the carpal tunnel. Surgery is only recommended if the conservative methods prove to be unsuccessful in relieving the symptoms.
The goal of surgery is to relieve the pressure by cutting the ligament that is pressing on the median nerve. There are two different techniques in performing the surgery for carpal tunnel syndrome:
Known as a less invasive procedure, the surgeon makes a small incision over the volar aspect of the wrist to insert a telescope-like device with a tiny camera (endoscope) to see the inside of your carpal tunnel. The surgeon then proceeds to cut the ligament that is pressing on the median nerve with an endoscopic blade. Endoscopic surgery tends to result in less pain as compared to open surgery.
Unlike endoscopic surgery, in open surgery, the surgeon makes an incision over the proximal aspect of the palm of your hand over the carpal tunnel and cuts the ligament under direct vision to alleviate the pressure on the nerve.
Every case is different, hence it is best to consult a hand surgeon to determine the treatment method that is most suitable for you. Reach out to us today if you are suffering from carpal tunnel syndrome and let us help you.