Carpal Tunnel Syndrome

The carpal tunnel is a channel that exists between several legs and a strong ligament in the palm of the hand. Through the canal, an important nerve, the median nerve, and tendons pass to the muscles of the fingers. Carpal tunnel syndrome is caused by nerve constriction when the space has decreased.

Carpal tunnel syndrome is common, but rarely severe. The problems are most common in middle age.

Symptoms of Carpal Tunnel Syndrome

The most common symptom of carpal tunnel syndrome is numbness and tingling in the hands and fingers, especially at night. You can wake up because of the hassles and feel compelled to shake life in the hand, which feels completely sleepless.

The hassles can feel uncomfortable but are rarely serious. Sometimes they may be signs of other diseases, such as decreased thyroid hormone production.

Impaired feeling and stupidity

It is common for you to get a depressed feeling in your fingers. You can get numbness and tingling in the hand and the fingers to which the nerve goes. This, in turn, can cause you to become clumsy in your hand and easily drop things or have difficulty grasping small objects.

Above all, the thumb usually loses its usual strength. The muscles in the thumbs of the hand can thicken slightly. It can also hurt the hand and wrist. Sometimes the pain can radiate right up to the shoulder. The hand may also feel drier than usual.

When and where should I seek care?

The vast majority of people with carpal tunnel syndrome do not need to seek care because the problems usually go away by themselves with self-care.

Contact a health care provider if you have one or more of the following problems that do not go away within a couple of weeks or that get worse quickly:

  • numbness
  • clumsiness
  • decreased power.

What can I do for myself?

Take a short break if you start feeling tired in your hands or arms when using them actively. You can try if it relieves the trouble of resting or doing something else with your hands and arms for a while. This way you avoid overloading them.

Practice using the other hand

Some tasks that you usually do with one hand, you can do with some training just as well with the other hand.

Use wrist rest

It is good if you try to avoid having your wrists sharply bent while you sleep. For your help you can use a palm rest during the night. You can buy a wrist support at pharmacies or in health care stores.

Surveys

When you seek care, you have to perform various examinations at the doctor.

The function of the nerves and muscles is tested through various tests. Numbness and tingling that you have known at night can usually be induced by flexing the wrist for a maximum of a minute. The doctor can also pat or hit the inside of the hand with your fingertips. Often, such simple examinations are enough to get you the right diagnosis.

You may also have difficulty perceiving vibrations on your fingers. How sensitive you are to the touch of your fingertips can be tested with a paper clip or a soft brush.

Anyone who examines can judge by the strength of the thumb grip how affected your musculature has become. For example, if you have had the trouble for a long time, you can see if the muscles in the palm have become thinner. This is especially true of the muscles in the thumb side of the palm, that is, the thickening that is usually seen under the thumb.

Other investigations

Sometimes it is not entirely clear what the stings and numbness in the hand are due to. Then the doctor can write a referral so you can do more examinations.

Such a study is called electroneurography or ENG and measures how the nerve impulse spreads in the median nerve. The study may not show if you have carpal tunnel syndrome, but it can show how damaged the nerve is. ENG is done in a physiological laboratory, which is often found in a hospital.

You may also find out if some illnesses or deficiencies cause the trouble by passing blood tests. For example, it may be diabetes, that the thyroid gland is not working properly or that you are deficient in iron, vitamin B12 or folic acid.

The studies exclude other causes

Symptoms can also be due to other than carpal tunnel syndrome, such as neck pain or pressure on the median nerve in the forearm. To be able to get the right diagnosis and treatment, the doctor must be sure that the symptoms of carpal tunnel syndrome do not have these causes.

Treatment of Carpal Tunnel Syndrome

There are various ways to treat carpal tunnel syndrome. The treatment of carpal tunnel syndrome that suits you best is different from person to person. The most common treatment is that you may use a specially designed wrist rest. But sometimes you can get treatment from a physical therapist or occupational therapist.

You will receive a referral to an orthopedic surgeon or surgeon if the doctor determines that you need surgery.

Support rail for easier trouble

Sometimes it is enough with a wrist rest, which can either sit around the clock or just at night. The wrist rest, or the rail, holds the hand in a non-stressful position. The rail also prevents you from bending your wrist excessively. An occupational therapist can help try out and make such a track.

Gravida’s troubles disappear

If you have a problem during your pregnancy, the symptoms usually disappear some time after delivery. You can temporarily use a palm rest that makes it feel better.

When the bend tendons are inflamed

Treatment of carpal tunnel syndrome with anti-inflammatory tablets may help if there are certain signs that the flexor tendons are inflamed.

Cortisone sprays sometimes help

A syringe with cortisone in the carpal tunnel can reduce the inconvenience, but usually only temporarily. It is different from person to person what works best. Therefore, the doctor should recommend the treatment that is most suitable for you.

Other types of treatment of carpal tunnel syndrome

Carpal tunnel syndrome can also be treated by, for example, a physical therapist or a occupational therapist who can provide various types of treatment, such as ergonomic training.

You may also receive treatment from a chiropractor or a naprapath who often provides manual therapy. It aims to improve the space in the carpal tunnel to reduce the pressure in the nerve. There is no convincing evidence that manual therapy helps.

Operation

Some need to be operated. During the surgery, the surgeon makes a cut over the carpal tunnel and cuts off the ligament that covers it. It reduces the pressure on the nerve.

The cut ligament then heals itself in a slightly disjointed position by forming new tissue in between. This makes the ligament a little longer than it was from the beginning, which means that there is more space for the nerve under the ligament. The movement of the hand is not affected by the extension of the ligament.

The operation is fast

The surgery itself is done with open surgery or with the help of peephole surgery and takes about 15 minutes.

You are awake during the operation and are stunned before either directly in the blood or with local anesthesia. Local anesthesia means that you get anesthetic injected near the median nerve. It is done in the wrist and along the incision that will be made in the palm of the hand. To get anesthesia directly into the blood, you must first get a cannula in the back of your hand or in the arm fold of the arm to be operated on.

Tools during surgery

After anesthesia, the doctor wraps your hand and arm with a rubber band to squeeze out as much blood as possible. Sometimes you can keep your arm stretched for a while instead. You then get a so-called cuff on the arm that is pumped up.

If you get anesthesia directly in the blood, the arm is wrapped before you get anesthesia. The cuff will then receive double data. It should keep the blood from the arm and prevent the anesthetic from reaching the rest of the body. In this way, only the arm and the hand are stunned.

The pressure on the arm thus becomes so high that it prevents the blood from flowing back into the arm when the rubber band is removed. It is called surgery to empty the blood, which makes it much easier for the doctor to operate because the visibility is not obscured by bleeding.

Afterwards, it can hurt a little

Anesthesia that you received directly into the blood releases about ten minutes after the cuff is removed, while local anesthesia releases after a few hours. Then you may get a little hurt. Usually, it may be sufficient if you take lighter analgesic tablets containing acetacetamol during the first few days after surgery.

After the operation, you can get a bandage that will keep your wrist still. The dressing should remain between ten days and two weeks. It may take time before you feel good.

Avoid overload after surgery

When the dressing is removed, the stitches are also removed. You can then get a simpler dressing. It is important that you continue to be careful with your hand. You should avoid congestion, especially during the first weeks after surgery.

You may need to be on sick leave if, for example, you are in pain or feeling swollen. The wound itself is usually healed after about two weeks. 

Different long time before you become completely good

The symptoms of carpal tunnel syndrome that disappear first tend to be numbness, while drowsiness and powerlessness may remain for months after surgery. Especially if you have had problems long before you were operated on, it will usually take longer before you eventually become well. Sometimes you can get a permanent weakness in the muscles of the thumb.

The trouble may come back

Sometimes the problems can come back even though you have been operated on. This can happen, for example, if you have arthritis. Then the tissues swell up easily so that it becomes crowded in the carpal tunnel again. It can also happen if, after the operation, you return too quickly to a job where you overload your hand.

Smoking cessation reduces the risks

If you smoke, the winnings are many with  pausing for the operation . The wounds heal better and it reduces the risk of infections, moreover you recover faster after the operation. If possible, you should preferably take a break eight weeks before and after surgery. You can talk to your doctor if you need help and support.

What is it?

The carpal tunnel is a channel formed by the leg of the hand and a strong ligament. The legs lie shaped like a gutter, and the gutter is covered by the tight ligament. In this way, a tunnel-like channel is formed, the carpal tunnel. In this canal, an important nerve called the median nerve passes to the thumb, forefinger, middle finger, and part of the ring finger. There are also nine tendons for the muscles that flex the fingers. Carpal tunnel syndrome is caused by pressure on the median nerve in this duct.

Swelling pinches the nerve

As the nerve has limited space in the carpal tunnel, there is a risk that it will become trapped if space is reduced. The reduction in space in the carpal tunnel may be due to the following:

  • The tendons around the flexor tendons are swollen due to inflammation.
  • You have an inflammatory or rheumatic joint disease in the joints of the wrist, which causes the soft parts of the canal to swell.
  • Fluid has accumulated in the body due to pregnancy or other hormonal changes.
  • You have, or have had, a swelling in the duct in connection with injuries to the soft parts or fractures in the wrist.

Often it is not possible to find any explanation as to why there has been increased pressure on the nerve.

May be due to other diseases

Carpal tunnel syndrome is more common if you have diabetes. The symptoms are also more common if you have arthritis or reduced thyroid hormone production, hypothyroidism.

Vibrating tools can cause trouble

It is common for you to get carpal tunnel syndrome in the hand you use most often. That’s because the hassle has to do with having that hand loaded. For example, the left hand usually suffers from his left hand. But you can also have trouble with the other hand than the one you burden most, and sometimes both hands are affected.

Often the hassles come for no particular reason, but sometimes it may be because you have worked long workouts with vibrating tools or made repeated movements with your hand.

Common in pregnant women

In pregnant persons, carpal tunnel syndrome is relatively common, mainly from the sixth month of pregnancy onwards. The reason is the hormone changes you get during pregnancy. The imbalance in the hormones affects the body’s fluid balance and can cause more fluid to accumulate in the body’s tissues. This in turn can cause pressure on the nerve.

Influence and participate in your care

As a patient, you have under  the Patient Act  chance to affect your health.

You can  seek care at any medical center or open specialist clinic  you want throughout the country. Sometimes referral  to the open specialized care is required  .

You should understand the information

In order for you to be involved in your care and treatment, it is important that you  understand the information you receive  from the healthcare personnel. Ask questions if you don’t understand.

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