Carpal Tunnel Syndrome: Symptoms, Treatments and What You Need to Know

Carpal tunnel syndrome is a common condition that affects the hand. People with this condition may feel pain, numbness, and weakness in the hand and wrist,… Early detection and treatment are therefore very important to improve and restore function for patients.

What is carpal tunnel syndrome?

Carpal tunnel syndrome is a peripheral nerve disorder caused by abnormalities in the anatomy of the carpal tunnel. The median nerve in the carpal tunnel is compressed, causing inflammation and swelling, numbness in the fingertips, especially the index finger, middle finger, and half of the ring finger.

Although the cause of carpal tunnel syndrome is often unknown, some groups of people are at a higher risk, such as women in perimenopause, menopause, pregnant women, or those who use their wrists frequently for work…

Situation of the disease

Prevalence of the syndrome

In the United States

The prevalence of carpal tunnel syndrome (CTS) is 1-3 cases per 1000 people per year, with an incidence rate of approximately 50 cases per 1000 individuals in the general population. The prevalence rate may increase to 150 cases per 1000 individuals per year, with a higher prevalence rate of more than 500 cases per 1000 individuals in some high-risk groups.

Worldwide

There is a lack of studies on CTS prevalence worldwide. However, the incidence and prevalence rates in developed countries are similar to those in the United States (the incidence rate in the Netherlands is approximately 2.5 cases per 1000 people per year, and the prevalence rate in the UK is 70-160 cases per 1000 individuals).

Mortality

Carpal tunnel syndrome does not cause mortality, but it can lead to permanent median nerve damage and serious hand dysfunction if left untreated.

Ethnicity

White individuals have the highest risk of developing carpal tunnel syndrome. The syndrome is rare in some ethnic groups (e.g., non-white South Africans). In North America, white US Navy personnel are 2-3 times more likely to develop carpal tunnel syndrome than black personnel.

Gender

The incidence of carpal tunnel syndrome is three times higher in females than in males.

Age

The highest incidence of carpal tunnel syndrome occurs in individuals aged 45-60 years. Only 10% of patients with carpal tunnel syndrome are younger than 31 years old.

Causes and risk factors for carpal tunnel syndrome

Anatomical abnormalities Abnormal tendon folds.

• Congenital small carpal tunnel.
• Enlarged lymph nodes.
• Fatty tumors.
• The tight space where the flexor tendons pass through.
• Arterial blood clots.

Infections Lyme disease.

• Mycobacterial infection.
• Joint infection.

Inflammatory diseases Connective tissue disease

• Gout or pseudogout.
• Nonspecific tenosynovitis (the most common cause of carpal tunnel syndrome).
• Low-grade joint inflammation.

Metabolic disorders Acromegaly.

• Amyloidosis.
• Diabetes.
• Hypothyroidism.

Increased volume Heart failure.

• Edema.
• Obesity.
• Pregnancy.

Symptoms of carpal tunnel syndrome

Symptoms of carpal tunnel syndrome include pain, numbness, and tingling in the thumb, index, and middle fingers, which are controlled by the median nerve. However, there are also times when the entire hand feels numb. This symptom usually appears at night, and it can be relieved by raising the hand or shaking it like a thermometer. The feeling of pain and numbness is not limited to the fingers, it can also spread up to the wrist, forearm, or shoulder.

Initially, the numbness may go away on its own without any treatment. Later on, it will become longer and cause the patient to be numb all day. After some time, the numbness may suddenly disappear, but gripping objects becomes weaker, the hand trembles, and writing becomes difficult.

The above symptoms are typical of the condition when the median nerve is compressed in the carpal tunnel. Typical symptoms usually only occur in one hand, but they can also occur in both hands.

Treatment of carpal tunnel syndrome

Principles of treatment:

Treating the underlying causes and risk factors of the disease. For pregnant women with this syndrome, treatment is not necessary as symptoms will gradually improve after giving birth.

The carpal tunnel does not have elasticity, so there are two treatment options:

• Reducing pressure in the carpal tunnel: reducing inflammation and swelling.
• Releasing the ligament to expand the carpal tunnel.

Previously, conservative treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroid injections at the site was recommended. However, the results were limited and the recurrence rate was high, not to mention the side effects of prolonged use of drugs.

Currently, many studies have shown that carpal tunnel release surgery is the best treatment option because it is gentle, simple, has a very low recurrence rate, and does not have the side effects of anti-inflammatory drugs. However, in severe and prolonged cases that have caused muscle atrophy, surgery can only help prevent further damage.

Conservative treatment

Taking or injecting NSAIDs (nonsteroidal anti-inflammatory drugs) for pain relief is a common approach.

Corticosteroid injection into the wrist can provide good pain relief, but it should be avoided in pregnant or breastfeeding women (6 months old).

Wrist splinting.

Nerve tonic medications such as B vitamins or B6 derivatives.

Surgical treatment

Advantages

• The surgery is gentle, quick, and less painful.
• Local anesthesia or nerve block can be used for anesthesia.
• Patients can go home right after surgery.
• The surgical scar is small, about 3-4cm, or even shorter (about 0.5cm) if performed by arthroscopy.
• Immediate pain relief is possible right after surgery.
• Higher safety and much lower recurrence rate.

Disadvantages

• Higher cost compared to internal medicine treatment.
• May cause trauma to the patient’s body.
• Requires monitoring and care for the surgical incision.

May have surgical complications such as wound infection, bleeding, raised scar, damage to the motor branch of the nerve or symptoms will recur if the carpal tunnel is not fully released.