Have you seen someone doing this to alleviate a hand pain?
This is a typical sign of carpal tunnel syndrome.
The person will feel a heavy pain, some tingling in the fingers,
mostly the thumb, index and middle fingers. There may also be numbness and weakness of the hand.
There are some activities that predispose a person to have carpal tunnel syndrome,
like anything that bends the wrist too much or anything that occupies space inside of the wrist.
Today I’ll tell you what cause carpal tunnel syndrome,
how a person can find if they have this condition, how to manage the symptoms and avoid surgery.
So, let’s talk about carpal tunnel syndrome today
There is a nerve called median nerve that passes inside the wrist. The wrist
contains this thick band like a very strong bracelet to protect the structures inside it.
The median nerve is responsible for controlling the muscles of the thumb and this part of the
palm of the hand. The skin sensations in this area are transmitted to the brain via the median nerve.
So, any injury to the median nerve here will lead to loss of sensation
in this area, and weakness of the muscles in the thumb and palm.
The sensation loss is usually noticed before the weakness.
This is because the fibers that carry sensation information are thinner and easier to get bruised.
The nerve fibers that control the muscles are thicker and more protected by myelin,
but eventually, if there is no treatment, even the thicker fibers will get damaged.
One of the signs that the muscles are getting weaker is atrophy of the thenar eminence,
this area of the hand. And the person will notice weakness to do movements like an
O. This is usually very strong, but when the have advanced median nerve damage,
they will not be able to hold the O very strong. Carpal tunnel syndrome is common in people with
manual labour who do repetitive bending of the wrist. This is in fact one of the tests
that we do to find out if the person has carpal tunnel syndrome or not.
We ask the person to hold this position for 2 minutes,
and if they start feeling numbness and tingling in the fingers,
especially the thumb, index and middle finger, this is likely carpal tunnel syndrome.
There are some conditions that put a person at higher risk of carpal tunnel syndrome,
like diabetes, thyroid disease, rheumatoid arthritis and pregnancy.
When we suspect of carpal tunnel syndrome, we usually order
a test called nerve conduction study, and sometimes we need to do an electromyography,
or EMG too. This is important to assess the severity and need for surgical intervention.
Also, it is important to distinguish if the pain and weakness
is not coming from the neck or cervical spine. The NCS and EMG exam will be able to show if the
problem is at the wrist level, the elbow, the axillae, the neck or the cervical spine.
I have another video explaining what is nerve conduction study
and electromyography that you can watch and learn more about this test.
In mild to moderate cases, when there is only reduced speed of nerve conduction
at the wrist level, the only thing that is recommended is to avoid bending the wrist.
This is especially important at night, because we might not pay attention and
spend various hours with our wrist like this. Usually if the person wears the night splint
for 12 weeks, there is a lot of improvement in the symptoms. There are many splints that are
readily available in pharmacies and you don’t need to buy anything too fancy or expensive.
There are no exercises that can make carpal tunnel syndrome better. But
it is important to pay attention to the position, posture and ergonomics,
especially for people who spend a lot of time on the computer or doing manual work.
It is also important to avoid myofascial pain of the forearm, shoulder and neck,
because if they have trigger points, they may radiate
pain down to the arm and add more pain to the already painful hand.
In some patients, we also do an injection of steroids in the area to reduce swelling and
inflammation around the nerve. This might provide some relieve for a couple of weeks to months.
But the problem may return, and the person will need another injection.
If the nerve conduction study shows that there is a severe disease, this means that there is damage
to the myelin around the nerve affecting the speed of electrical transmission in the nerve.
But severe disease also means that there is reduction of the amount of axons that
are transmitting information, then referral to surgery is indicated as soon as possible.
This is important to prevent more loss of axons, which may lead to more weakness of the hand.
Surgery in most cases is only a small cut in the hand under anesthesia and they will open
up the thick bracelet and give more space for the median nerve to breathe. It is usually a
day surgery and the person does not even need to spend a night in the hospital.
They go home on the same day of the surgery.
The recovery after surgery may take months,
the person will need to use a daily splint and will have to avoid activity with the hand.
It is important to do physiotherapy to maintain a good range of motion
and strength of the hand, fingers, elbow and shoulder during the rehabilitation period.
Please, don’t forget that this video is for educational purpose only.
If you have a condition that needs medical advice, please talk to your doctor.
And if there is an emergency, go to the nearest emergency department.
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Thank you for watching. Good bye.