Are the symptoms curable?
Carpal tunnel syndrome is a compressive neuropathy of the median nerve. Appropriate treatment (clinical or surgical) by a specialist physician usually yields good results.
The most important thing is to make an accurate diagnosis, as many other diseases affecting the upper limb can cause similar symptoms. The Electroneuromyography exam can show Carpal Tunnel Syndrome as a report, even in cases where this disease is not present. As a result, the primary diagnosis is made by a skilled physician through clinical examination[1]Bland JD. Treatment of carpal tunnel syndrome. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine. 2007 Aug;36(2):167-71..
What Should You Expect From the Disease?
The severity of carpal tunnel syndrome varies greatly. Most people have a mild form, where the symptoms are transient and do not interfere with daily activities.
In contrast, few may have a disease that interferes with more common activities such as washing dishes, using the phone, and driving and necessitates specific treatments, but with a good response.
What is Carpal Tunnel Syndrome?
This syndrome is caused by compression of the median nerve, which runs through the Carpal Tunnel in the wrist. Increased thickness in the structures passing through the tunnel causes compression.
The disease is common in people performing manual work with repetitive movements. Still, it is also associated with hormonal changes, such as menopause and pregnancy, which explains the higher frequency in women aged 35 to 60[2]Wilson JK, Sevier TL. A review of treatment for carpal tunnel syndrome. Disability and rehabilitation. 2003 Jan 1;25(3):113-9..
Other associated diseases are Diabetes Mellitus, rheumatoid arthritis, and thyroid diseases.
Signs and Symptoms
The most frequent symptoms are pain, shock, numbness, tingling, and loss of hand dexterity.
The pain is worse at night, especially after excessive hand use during the day, and can be severe enough to cause the patient to wake up. The pain may spread to the arm or even the shoulder. Activities that promote wrist flexion for an extended period can aggravate the pain.
The palm is affected by decreased finger sensitivity, which manifests as numbness or tingling, while the hand’s little finger and back are unaffected. Tying shoes, buttoning a shirt, and picking up objects may be difficult if you have hand weakness. In 60% of cases, both hands are likely to be involved.
Causes of carpal tunnel syndrome
1. Tendinitis of any of the nine tendons: Tendinitis of the wrist flexor muscles tendons causes carpal tunnel syndrome symptoms.
2. Any arthritis in the wrist joint: The wrist joints can develop arthritis, an inflammatory condition that causes stiffness and swelling.
3. Wrist fracture: A fracture in the wrist can compress the nerves and soft tissues in the carpal tunnel, causing symptoms.
4. Diabetes: Hyperglycemia, or high blood sugar associated with diabetes, can damage nerves and cause carpal tunnel syndrome symptoms.
5. Everyday activities that require the strength of the wrist, both in extension and in flexion, such as typing, ironing, and holding on to the bus bar: Repetitive use of the wrist tendons and muscles can overload the tissues and compress the nerves in the carpal tunnel, causing symptoms.
6. Swelling of the hands, as is the case in pregnancy, renal disease, and thyroid disease: Hand swelling caused by pregnancy, renal disease, or thyroid disease can increase pressure in the carpal tunnel and compress the nerves, causing carpal tunnel syndrome symptoms.
Risk factors
• Menopause (due to hormonal changes): Menopause is a time in a woman’s life when significant hormonal changes occur. These hormonal changes can contribute to the development of carpal tunnel.
• Pregnancy (fluid retention in the tendons): During pregnancy, the body retains more fluid, which can lead to inflammation of the tendons and increased pressure in the carpal tunnel.
• Polycystic Ovaries / Endometriosis: Women with polycystic ovaries or endometriosis may be predisposed to carpal tunnel syndrome due to hormonal imbalances associated with these conditions.
• Poor posture: Poor posture, especially when using a computer or cell phone, can increase pressure in the carpal tunnel.
• Osteoarthritis: Osteoarthritis can cause inflammation and stiffness in the tendons, thus increasing pressure in the carpal tunnel.
• Rheumatoid Arthritis: Rheumatoid arthritis can lead to inflammation of the tendons and joints, thus increasing the pressure in the carpal tunnel.
• Hypothyroidism: Hypothyroidism can reduce tendons’ elasticity, contributing to carpal tunnel syndrome development.
• Post Wrist Fracture: People who have suffered a wrist fracture may develop carpal tunnel due to swelling and inflammation of the joints and tendons.
• Repetitive movements/computer or cell phone use: Prolonged computer or cell phone use and repetitive movements can lead to increased pressure in the carpal tunnel.
• Age (after age 40): Although anyone can develop carpal tunnel, the chances increase after age 40.
• Gender (more common in women): Carpal tunnel is more common in women than men.
“The median nerve and some hand tendons travel from the wrist to the hand through a narrow and inflexible channel. This nerve controls the sensitivity of the thumb, index and middle fingers, and a portion of the ring finger. It also controls the small muscles at the base of the thumb. Symptoms are produced by situations that cause nerve compressions, such as decreased flexibility of the carpal tunnel and tendons inflammation.”
It is necessary to perform tests such as electromyography and ultrasound to identify the cause and degree of impairment. Mild cases usually respond to anti-inflammatories, immobilization with a splint, and eventually local injection of medications guided by ultrasound. Advanced cases typically do not respond to this treatment and present a risk of motor loss, that is, hand weakness as a definitive sequel, in addition to chronic and difficult-to-control pain.
Is Carpal Tunnel Syndrome Curable?
When the patient receives proper treatment at the onset of the clinical picture, before atrophy or hypotrophy of the thenar musculature, excellent results occur in 80% of cases and good results occur in 10% of cases.
The results are a little worse if the patient presents the disease in an advanced stage. However, the procedure prevents the disease from causing further damage to the compressed Median Nerve. Among the expected complications of the surgical procedure, we have infection of the surgical wound and inadequate release of the Median Nerve, which results in the persistence of the symptoms[3]O’Connor D, Marshall SC, Massy‐Westropp N, Pitt V. Non‐surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database of systematic reviews. 2003(1)..
Thus, the need for a professional experienced in this type of surgery increases the success rates of the procedure.
Treatment
The treatment varies according to the degree of involvement. We use splints to immobilize the wrist and prevent its flexion, especially at night, associated with hand therapy to control pain, muscle stretching, postural correction, and muscle strengthening[4]Graham B, Watters III WC, Turkelson CM, Haralson III RH, Wies MJ. The treatment of carpal tunnel syndrome. J Bone Joint Surg Am. 2010;92:218-9..
In selected cases, infiltration may be attempted to decrease pressure on the nerve. Surgery is necessary to save the nerve in resistant cases or severe compression. This surgery consists of “opening” the tunnel’s roof and freeing the compressed nerve.
When should you see an orthopedist?
If symptoms persist for a few days, you should see an orthopedist to be examined and possibly have some tests to confirm the diagnosis and indicate treatment. The earlier the diagnosis and treatment start, the less likely surgery will be needed.
Conservative treatment can range from anti-inflammatories and immobilization to corticosteroid injections. Most people respond to conservative treatment, with surgical treatment reserved for cases that don’t respond to clinical treatment[5]Ostergaard PJ, Meyer MA, Earp BE. Non-operative treatment of carpal tunnel syndrome. Current reviews in musculoskeletal medicine. 2020 Apr;13(2):141-7..
Is it possible to treat Carpal Tunnel Syndrome without surgery?
In the early stages of the disease, conservative treatment is used to avoid surgery. This happens when the patient has mild pain that only occurs during certain activities, such as driving or talking on the phone, and there is no loss of sensation in the fingertips or muscle atrophy.
Conservative treatment includes pre-molded removable splints that keep the wrist slightly extended, as well as anti-inflammatory medications.
In the absence of improvement, corticosteroid infiltration can be attempted.
Conservative treatment should be attempted in pregnant patients for as long as possible, as symptoms usually resolve spontaneously after delivery. They should not be given anti-inflammatories.
Surgery with local anesthesia is indicated if the patient can no longer sleep or perform daily activities.
Can the surgery be performed on both hands at the same time?
No, as the patient will need relative rest on the operated hand in the initial period, mainly without being able to wet the surgery site. If the procedure is performed on both sides, the patient will have difficulty performing her activities, becoming dependent on others.
It is indicated to perform the surgery on the side with the worst pain; at least 30 days later, do it on the other side.
What happens if carpal tunnel syndrome is not treated?
If left untreated, carpal tunnel syndrome can cause nerve and muscle atrophy in the hand and loss of strength in gripping objects.
MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.
References
| ↑1 | Bland JD. Treatment of carpal tunnel syndrome. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine. 2007 Aug;36(2):167-71. |
|---|---|
| ↑2 | Wilson JK, Sevier TL. A review of treatment for carpal tunnel syndrome. Disability and rehabilitation. 2003 Jan 1;25(3):113-9. |
| ↑3 | O’Connor D, Marshall SC, Massy‐Westropp N, Pitt V. Non‐surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database of systematic reviews. 2003(1). |
| ↑4 | Graham B, Watters III WC, Turkelson CM, Haralson III RH, Wies MJ. The treatment of carpal tunnel syndrome. J Bone Joint Surg Am. 2010;92:218-9. |
| ↑5 | Ostergaard PJ, Meyer MA, Earp BE. Non-operative treatment of carpal tunnel syndrome. Current reviews in musculoskeletal medicine. 2020 Apr;13(2):141-7. |