The Unravelling Of Carpal Tunnel Syndrome
22 November 2022
Pain in the hands can be caused by a variety of conditions, each with its own set of unique characteristics. The term ‘carpal tunnel syndrome’ refers to one of the conditions that frequently impacts the hands. Carpal tunnel syndrome affects many people around the world, and people who work in repetitive work environments, such as factory line workers or even office workers, are at risk of developing this hands-centric condition.
To unravel more about this condition, we’ve invited Dr. Teh Kok Kheng, Consultant Hand & Microsurgery Surgeon from Sunway Medical Centre to share his insights. It’s also worthy to note that Dr. Teh has made significant findings with regards to carpal tunnel syndrome and the recovery process which will also be discussed in this article.
What is carpal tunnel syndrome?
Carpal Tunnel Syndrome is the most common compressive neuropathy of the upper limb. It is a common cause of pain and numbness of the hand.
What causes carpal tunnel syndrome?
There is no real cause of carpal tunnel syndrome, but it can be associated with some chronic diseases like thyroid dysfunction, liver diseases and kidney disease. Most carpal tunnel syndrome is known as primary carpal tunnel syndrome that is not associated with any disease, but risk factors for carpal tunnel syndrome includes:
- Repetitive work like factory line workers.
- The elderly.
- Office workers.
What are the symptoms of carpal tunnel syndrome?
Typical carpal tunnel syndrome symptoms include pain and numbness of the hand, usually in the thumb, index, middle and half of the ring finger. Some patients may also have associated neck and shoulder pain that is due to referred pain. These associated symptoms are also commonly associated with neck pathology and sometimes heart diseases and therefore many patients may end up in the office of the cardiologist or spine surgeon at first.
Not all carpal tunnel patients describe their symptoms as pain and numbness; some report the symptoms to be like hand on fire or hand as cold as ice. The symptoms can also be worse during the night or early morning. In severe carpal tunnel syndrome cases, patients may report weakness of the hand and may have difficulties with pinching. Certain activities like driving, knitting, reading newspapers, using the mobile phone and computer may induce the symptoms of carpal tunnel syndrome.
Who is at risk of getting carpal tunnel syndrome?
A typical patient at risk of carpal tunnel syndrome is a woman in her 50s who is starting to experience peri-menopause. Other risk factors include: repetitive work like factory line workers, office workers with prolonged use of computers, carpenters and construction workers.
How is carpal tunnel syndrome diagnosed?
Diagnosis of carpal tunnel syndrome is made clinically. A good history taking and physical examination is all it takes for your good doctor to make the diagnosis. Other methods to screen for carpal tunnel syndrome include questionnaire and nerve conduction study.
What kind of treatments are available for people who struggle with carpal tunnel syndrome?
Treatment for carpal tunnel syndrome can be divided into either conservative or surgical treatment. Conservative treatments include splinting, nerve gliding exercise and steroid injection. Surgical treatment can be divided into open carpal tunnel release or endoscopic carpal tunnel release. The term endoscopic refers to the use of a small camera used during surgery. Endoscopic surgery is also known as keyhole surgery meaning the wound used in the surgery can be smaller when compared to open or conventional surgery. There are multiple methods that have been used for endoscopic carpal tunnel release but older techniques involve using a much larger endoscope (camera) that is inserted into the carpal tunnel that is already tight and diseased and therefore increasing the risk of injuring the median nerve that is the tunnel.
A new technique named Supraretinacular Endoscopic Carpal Tunnel Release (SRECTR) uses a smaller endoscope and is inserted above the carpal tunnel and therefore may reduce the risk of injuring the median nerve during surgery. On average a patient will find the pain and numbness symptoms improved as early as three days after operation, return to better function of the hand as compared to before surgery by one week and return of hand strength by three months after operation. The hand function and strength will continue to improve even up to six months after operation.
Can managing carpal tunnel syndrome at an early stage reduce the chances of surgery?
Early management of any disease is a good strategy. Whether or not early treatment of carpal tunnel release may prevent surgery unfortunately is not so clear. I am unaware of any publications to claim that but what we know is early treatment may prevent the symptoms from worsening and therefore prevent the nerve injury from progressing further. It is also important to ensure that the hand numbness is indeed caused by carpal tunnel syndrome and may not be something potentially sinister. Heart related problems and certain cancers might be associated with hand numbness that may mimic symptoms for carpal tunnel syndrome. Hence, it is essential to get your symptoms checked out by a qualified doctor.
Is carpal tunnel syndrome avoidable? If so, what are the steps one can take to prevent it?
Most carpal tunnel syndrome may not be prevented but one can also reduce the risk by having good posture and reducing repetitive activities like prolonged use of computers. If one is to use a computer for a prolonged period of time then a good ergonomic posture while using the computer may reduce the risk of developing carpal tunnel syndrome.
Can carpal tunnel syndrome recur?
After surgical release, most carpal tunnel syndrome will get better over time. Unfortunately, a small minority of patients may develop symptoms many years after surgical release. There is also a proportion of patients who may not have relief of their symptoms post operatively, this can be due to wrong diagnosis or the initial surgical release is inadequate.
What happens if carpal tunnel syndrome isn’t treated?
Prolonged untreated carpal tunnel syndrome may lead to loss of function of the hand. It can also cause sleep disturbances due to the night pain. Chronic sleep disturbances can lead to other medical problems like hypertension, diabetes and obesity.