Carpal tunnel syndrome • Symptoms & treatment

Pain, numbness, or tingling in the wrist – these symptoms may indicate carpal tunnel syndrome (KTS). The so-called carpal tunnel is a small space between the carpal ligament and the carpal bone. Important tendons and the median nerve run in this carpal canal. In the case of carpal tunnel syndrome, this canal narrows. The tendons, nerves and blood vessels are narrowed. Symptoms that in many cases are confused with other symptoms such as cervical spine syndrome for a long time can occur. However, those who recognize the disease in the joint early and treat it correctly enjoy good chances of recovery.

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What is carpal tunnel syndrome?

The median nerve, which runs in the carpal tunnel, controls some muscles in the hand. These include, for example, the muscles of the thumb, the index finger and parts of the middle finger. The symptoms are also noticeable here. The nerve is no longer adequately supplied with blood, nutrients and oxygen. In the long run, he can suffer permanent damage. For this reason, it is important to diagnose carpal tunnel syndrome early in order to initiate appropriate therapy.

KTS is the most common bottleneck syndrome, which affects nerves in the hand. It usually occurs between the ages of 40 and 70. In about half of the cases it is a one-sided problem, in the other cases it occurs on both sides on both hands. Women are affected about three times more often by the disease, sometimes in connection with pregnancy. The risk groups also include overweight people and people with physical work, especially through monotonous movements. It can also be observed that mostly the hand, which is more heavily burdened by hand, has greater complaints. Right-handed people are more likely to suffer from a KTS in the right hand. The reverse applies to left-handed people.

Causes of narrowing of the carpal canal

Both external and internal causes can be considered for carpal tunnel syndrome. It can be the result of injuries such as a broken bone in the spoke or the carpal bone. Mechanical causes include an anatomical predisposition, excessive stress or osteoarthritis in the wrist, which affects the carpal tunnel. The syndrome can also occur in combination with rheumatic diseases. Possible causes are also

• a herniated disc,
• whiplash,
• bleeding into the wrist,
• a benign or malignant tumor,
• a tumor-like or nodular thickening like a lipoma,
• a spinal injury or
• an acute tendonitis.

Finally, it can happen that metabolic disorders or changes cause the tendon sheaths to swell, which causes the bottleneck in the carpal canal. This is often the reason for carpal tunnel syndrome during pregnancy, which is one of the most common nerve compressions in pregnant women. In this case, the symptoms usually resolve themselves at the latest a few weeks to months after the birth. In most other cases, however, carpal tunnel syndrome is chronic. Edema and changes in the tendon sheaths or their chronic inflammation are the most common, but by no means the only causes of the carpal tunnel syndrome.

Symptoms: How can the early stage be recognized?

Regardless of the cause, the symptoms of carpal tunnel syndrome are always similar. In most cases, the first symptoms start at night. A diffuse feeling of swelling or numbness occurs here, which need not be limited to the affected areas in the hand. The hand or the whole arm feel "asleep". Many sufferers feel the need to get out of bed and shake their hands to stimulate blood circulation. This leads to increasing sleep disorders, whereby these nocturnal “attacks” are often the only symptom of carpal tunnel syndrome for a long period of time.

One problem is that the complaints are not yet taken seriously or misinterpreted by many people at this point. For example, they think they were wrong and that they cut their blood supply. Few sufferers see a doctor at this early stage, which causes the disease to progress and with it the symptoms.

With no treatment, the symptoms worsen

There are special forms such as carpal tunnel syndrome during pregnancy, which disappear on their own. In most cases, however, medical treatment is necessary. If this does not happen, the KTS and its symptoms progress over time. The first symptoms during the day, such as pain or restricted mobility, are becoming increasingly noticeable – for example when sewing or doing other work that requires sensitivity. Over time, the symptoms can become chronic. This includes:

• numbness
• paresthesia
• Stinging pain
• dysfunction
• paralysis

This mainly affects the middle and ring fingers, but often also the thumb and forefinger in the further course. In some cases, the pain also radiates onto the arm. If the median nerve is already damaged, persistent discomfort such as “electric shocks” or a permanent tingling sensation can arise. Failures such as numb fingers are still possible, which make tasks such as fine handicrafts increasingly difficult.

The course of the KTS is individual

Just like the most common causes, the course differs from case to case. It can therefore not be predicted whether, when and how quickly the median nerve will be damaged or which symptoms will occur at what time. Many sufferers have only minor complaints over several years, which increasingly occur after manual overload. So at rest, they have no pain or discomfort. That is why they often only see a doctor after a long time. In the worst case, permanent damage has already occurred.

Spontaneous improvements as well as spontaneous worsening or chronic illnesses with stable development were observed, i.e. the KTS does not get any worse. These differences in the course often make it difficult to diagnose carpal tunnel syndrome early.

What are the diagnostic options?

The diagnosis of carpal tunnel syndrome requires various tests in the affected joint. Especially in the early stages, it can be difficult to distinguish KTS from other symptoms such as cervical spine syndrome or tendonitis. The doctor has various options for examining the patient's wrist for a KTS. This includes:

• Anamnese: At the beginning, the person concerned describes his symptoms and gives the doctor all the information about the chronological course of his symptoms. Based on this anamnesis, the doctor makes a first guess that it could be a carpal tunnel syndrome.
• Motor examinations after sensations: He will then do motor tests to confirm his suspicions. Passively flexing the wrist usually causes numbness in the area of ​​the median nerve after about 40 to 60 seconds. Abnormal sensations also arise when the nerve is gently tapped on the wrist. The "bottle sign" is a good indicator, whereby the thumb strap does not adapt to the curve of the glass when holding a bottle.
• Investigations of possible sensitive failures: In addition to the motor skills, the sensitivity of the affected areas is also impaired in the KTS. It is therefore difficult for the sufferer to feel numbers written on the skin or light touches of cotton.
• Electromyographic and electrononeurographic examination: The previous examinations provide the doctor with initial information as to whether a KTS could be present and further diagnostic measures are appropriate. For this purpose, a band-shaped electrode is attached to the wrist, which measures the activity patterns of the muscle. The nerve conductivity and speed are also evaluated.

Additional neurographic examinations are also possible. The goal is a comprehensive diagnosis that not only clearly identifies carpal tunnel syndrome and differentiates it from other diagnoses, but also analyzes its severity and course. An individual therapy can then be planned.

Therapy: when should carpal tunnel syndrome be operated on?

In the early stages of the disease, the symptoms often go away by rubbing, shaking or moving the fingers. Cold water or changes in the position of the arm often have a soothing effect. In the case of acute KTS, for example during pregnancy or due to a temporary bleeding, the wrist immobilized with a splint is sufficient as therapy in many cases until the symptoms subside. Above all, this can alleviate nighttime sensations and thus prevent sleep problems. Carpal tunnel syndrome with a chronic course, however, requires more extensive therapy. There are two options here:

1. Conservative therapy: Usually, the first step is to alleviate the symptoms with conservative therapy and to stop the progress of the KTS. For this, a wrist splint is attached at night. Sometimes taking a corticoid preparation over a period of up to two weeks is also successful. It is also possible to infiltrate a corticoid crystal suspension into the carpal canal. Some doctors rely on local ultrasound examination or therapy. If there is an inflammation as a (co-) cause, the administration of anti-inflammatory drugs can also make sense. Targeted exercises for carpal mobilization also help many of those affected. Anti-inflammatory pain relievers can be taken at the same time.
2. Surgical treatment: If conservative therapy does not bring the desired success, surgery is the method of choice. The procedure can usually be performed on an outpatient basis and under local anesthesia. The pressure is removed from the median nerve during the operation. How exactly this happens depends largely on the cause. A distinction is made between open retinaculum division and endoscopic retinaculum division. In exceptional cases, surgical intervention is also recommended for pregnant women if the symptoms of deficiency are correspondingly large. In around 84 percent of the women affected, this is not necessary, since the complaints resolve on their own within one year after the birth.

Course and prevention of carpal tunnel syndrome

The course differs depending on which treatment the patient decides on: After a successful operation and medical follow-up treatment, the KTS heals completely in most cases. If the median nerve has already been damaged, however, sensations or impairments may remain. In the case of conservative treatment, the course must be checked regularly so that surgery can be initiated in good time if it worsens. However, even with conservative treatment, great success up to complete healing is possible. Spontaneous improvements or worsening of the clinical picture were also observed regardless of the therapy. This makes it difficult to reliably predict the course of the carpal tunnel syndrome.

Prevention is also only possible to a limited extent. After all, the disease can result from many different causes. It is helpful to avoid wrist overload, for example during physical activity. In addition, a doctor should be consulted early for the first symptoms, such as nighttime sensations. With timely therapy, the prognosis is good. The complaints are usually significantly reduced after the operation. The carpal tunnel syndrome should be completely healed after six months at the latest.

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