Carpal Tunnel Syndrome
Carpal Tunnel Syndrome
We speak of carpal tunnel syndrome if a peripheral nerve is compressed by the surrounding muscles, tendons, or bony canals. There can be several reasons for the development of carpal tunnel syndromes:
- Injury, fracture, or inflammation can trigger the compression of peripheral nerves.
- Scarring and bone spurs can also narrow the diameter of the canal.
- Various diseases can also cause it: diabetes, hypothyroidism, rheumatoid polyarthritis, gout.
- Overuse or regular, monotonous use of the affected limb.
We distinguish several forms of carpal tunnel syndromes. Their common characteristic is well-defined symptoms. The primary complaint of carpal tunnel syndromes is pain, which mainly occurs at night. Initially, we only feel an unpleasant numbness in the limb, which first appears at night, then gradually intensifies during the day. The unpleasant, disturbing numbness is caused by the compression of the peripheral nerves that innervate the affected body part. These nerves often run in canals enclosed by tendons, muscles, or bones. These canals are called tunnels, and if the nerves running within them are compressed, we speak of carpal tunnel syndrome.
After a longer period, we experience sensory loss, sharp pain, and a persistent burning sensation. If carpal tunnel syndrome is not diagnosed in time, it leads to muscle weakness, causing the limb muscles to atrophy.
Some types of carpal tunnel syndromes
Carpal tunnel syndrome
We speak of Carpal (Wrist) carpal tunnel syndrome when the nerve innervating the forearm flexor muscles and several small hand muscles is compressed at the wrist level by the surrounding muscles, tendons, and bony canals. This condition can arise as an occupational hazard from overuse of the wrist or forearm, or from regular, monotonous use of the fingers (excessive, prolonged use of a computer keyboard and mouse) following excessive physical strain on the hand and wrist (when lifting heavy weights), during which tingling, numbness, then sensory disturbance (paresthesia), sensory impairment, and tactile insensitivity occur at the ends of the thumb, index, and middle fingers. The wrist is usually sensitive to pressure, and the pain increases when it is moved, especially when bent backward, often radiating into the forearm. In the initial stage of the disease, good results can be expected from conservative treatment. If the patient’s complaints do not subside despite conservative treatment, then surgery is the final solution, after which – if muscle atrophy was not pronounced – muscle strength soon returns.
Cubital tunnel syndrome
Cubital tunnel syndrome most often develops in athletes and those performing heavy physical labor. Most often, an injury to the elbow or an joint problem is responsible for the cause of the syndrome. Peripheral nerves can also be compressed due to leaning on elbows, extensive writing, or excessive mobile phone use. Numbness primarily occurs in the ring and little fingers, and in the palm, especially at night. The unpleasant numbness is accompanied by a burning pain that can radiate into the forearm. The affected hand is often clumsier, and fine motor movements and bending the little finger become difficult. If the disease is not diagnosed in time, the intrinsic muscles of the hand can also atrophy.
Guyon’s canal syndrome
If one branch of the ulnar nerve in the forearm becomes compressed, we speak of Guyon’s canal syndrome. Its main symptoms are numbness in the ring and little fingers, which can radiate into the forearm. The muscles of the fingers may also weaken, and muscle atrophy can develop.
Causes may include:
- Strenuous physical work
- Ulnar fracture
- Prolonged pressure on the hypothenar eminence (e.g., crutch use, cycling)
Treatment of carpal tunnel syndrome
If other diseases (diabetes, hypothyroidism, rheumatoid polyarthritis, gout) cause the symptoms, the primary disease must be treated and eliminated. The affected area can be treated with Kinesio Tape, which reduces inflammation and pain. The tape can remain on for several days, and because it is flexible, it does not hinder the patient’s movement. Inflammation can be reduced with non-steroidal anti-inflammatory drugs and ointments. Physiotherapy and therapeutic exercises can significantly improve the condition of the painful limb. One of the most effective therapeutic exercise techniques is Peripheral nerve mobilization. The essence of the method is to release pinched, adhered peripheral nerves from compression. The treatment reduces pain and sensory disturbances in the affected area, then restores the limb’s function. If conservative treatments do not help, surgical intervention is necessary. During surgery, the nerve is released from compression within the framework of day surgery.
Examination: Hand surgeon, orthopedic specialist, or rheumatologist.
Therapy: hand surgeon, orthopedic specialist, rheumatologist, physiotherapist
Our hand specialists
Dr. János Bartha
Chief Orthopedic-Traumatologist, Robotic Surgeon
Dr. György Kocsis PhD
Orthopedic-Traumatologist, Chief Hand Surgeon, University Assistant Professor, Wrist, Elbow, and Shoulder Surgeon, Upper Extremity Specialist