Carpal Tunnel Syndrome: The Painful Constriction In The Wrist Joint

It all starts harmlessly. Under stress, there is a tingling sensation in the thumb, index finger and middle finger. The fingers become numb, after a short shakeout, everything is fine again. You may think that you have pinched a nerve.

It could also be tendinitis in the wrist. However, if the symptoms become chronic, carpal tunnel syndrome is usually responsible for the discomfort. Here you can find out which treatment methods are available and what causes carpal tunnel syndrome.

Carpal Tunnel Syndrome At A Glance

Carpal tunnel syndrome occurs when a nerve is pinched in the carpal tunnel. This nerve is responsible for several areas of your hand and if it is permanently pinched, symptoms arise. These include, for example, pain, sensations such as tingling and, in the later stages, paralysis.

Initially, the symptoms are reminiscent of an acute tendonitis, but this disappears after a while. Permanent constriction in the carpal tunnel can cause the symptoms of chronic tendonitis of the hand to develop.

The carpal tunnel is located in the wrist. The median nerve, the middle arm nerve, runs through its center. It begins in the shoulder, runs down the upper arm, and finally enters the hand. It is responsible for muscle movement and the sense of touch in the hand.

If the carpal tunnel is narrowed, the nerve becomes pinched and thus permanently irritated. The discomfort is sporadic at first but manifests itself quickly. You should therefore see a doctor in good time because in the early stages therapy is often possible by splinting the wrist.

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The Causes Of Carpal Tunnel Syndrome

There are various causes that make the development of carpal tunnel syndrome likely. Women are basically more often affected, as they have a narrower carpal tunnel by nature. However, other causes are also possible.

  • Inherited, anatomical narrowing of the carpal tunnel.
  • Incorrect stress on the wrist.
  • Injuries are also a trigger, such as a fractured radius.
  • Tendonitis when accompanied by swelling.
  • Permanent tendovaginitis of the hand.
  • Rheumatic diseases.
  • A chronic weakness of the kidneys requiring dialysis.
  • Water retention that presses externally on the ligaments and stresses the nerve.

Carpal Tunnel Syndrome And Its Symptoms

Most sufferers do not think of carpal tunnel syndrome when they first experience symptoms. Tendonitis is also often not taken seriously, although it can be the trigger of the narrowing in the carpal tunnel.

Sports are used to try to combat the symptoms, but exercise has no chance against a constriction.

Symptoms In The Early Phase

There are classic symptoms that indicate carpal tunnel syndrome. At the beginning of the disease, it is mainly the falling asleep of the hands and fingers at night, which is noticeable for the affected person. It is often sufficient at this stage to shake out the hands briefly and then continues sleeping.

This is not painful at the beginning, the hand only needs a short movement and the tingling disturbing sensations are gone.

In the later stages, however, severe pain in the wrist is possible, extending into the fingers and shoulders. It may take several minutes for the pain to improve briefly when the hand is repositioned.

Sensory disturbances are also among the early symptoms. In the early stages, the palms of the hands tingle most, but later the symptoms spread to the fingers. Characteristically, only the thumb, index, and middle fingers are affected. The little finger and large parts of the ring finger are supplied by the radial nerve, another arm nerve.

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Pain as in tendonitis hardly occurs at the beginning of the disease. Pain can only occur with permanent incorrect strain, such as frequent computer games.

Only later do the painful episodes also occur outside of stress. As a result of the permanent incorrect strain, chronic tendonitis of the hand can also occur.

Symptoms In The Late Stage

If the pressure on the carpal tunnel persists, the nerve becomes permanently pinched and more and more damaged. The tingling sensations in the fingers diminish over time, and paralysis appears instead.

The thumb muscle, which is supplied by the median nerve, gradually regresses. In a pronounced carpal tunnel syndrome, significant atrophy of the ball of the thumb develops over time.

At this point at the latest, the thumb function becomes limited. The finger can no longer be spread, nor is it possible to grip a bottle. When these symptoms occur, severe damage to the nerve has already occurred. In the worst case, the numbness in the fingers can remain permanently.

Making A Diagnosis Of Carpal Tunnel Syndrome

Once the symptoms have become too severe, most patients voluntarily seek medical attention. They often go to their family doctor with the suspicion of tendonitis in the wrist but are then referred to a neurologist. The first step is to take a medical history. Hereditary known cases are queried, and typical strains are also asked about.

There are three simple tests the doctor can use to differentiate symptoms from tendonitis.

  • Thumb function test.
  • Sensitivity test.
  • Palpation test.
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In the thumb function test, the patient is asked to clasp a bottle with his or her fingers. Carpal tunnel syndrome is indicated, among other things, by the fact that the thumb can no longer be splayed. With tendonitis, this is painful but still possible.

The sensitivity test shows the doctor whether the surface sensitivity of the hand is still present. A feather or cotton ball is used to stroke the palm of the hand. If the patient cannot feel the touch, the sensitivity is already disturbed.

In the tactile test, the patient’s task is to pick up paper clips or other small objects with the fingertips. Due to carpal tunnel syndrome, numbness occurs, making these tasks difficult or impossible.

Detect Carpal Tunnel Syndrome With Provocation Tests

In addition to the medical history and initial tests, there is also the option of performing two provocation tests. If these tests are positive, the suspicion of carpal tunnel syndrome is confirmed.

  • Hoffman-Tinel test.
  • Phalen test.

In the Hoffman-Tinel test, the physician taps the skin located over the carpal tunnel. A shock-like pain makes the doctor suspect more strongly that carpel tunnel syndrome is present.

In Phalen’s Test, both hands are placed with the back of the hand against each other. Flexing the wrist increases the pain associated with carpal tunnel syndrome. However, Phalen’s test is also positive in the case of tendonitis.

Now It Gets Serious: The Diagnosis By A Neurologist

Only a neurologist can make a definitive distinction between tendon sheath inflammation and carpal tunnel syndrome. For this purpose, an electroneurography, or ENG for short, is performed.

Electrodes are attached to the skin, which finally address the nerve with electrical impulses. In this way, the nerve conduction velocity can be measured. For the patient, the examination is painless.

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In some cases, a needle ENG is also necessary. This involves inserting fine needles near the median nerve, which are then used to measure nerve conduction velocity. This treatment is also almost painless, only somewhat uncomfortable for the patient.

Surgery Or Conservative Therapy For Carpal Tunnel Syndrome?

Once carpal tunnel syndrome has been proven beyond doubt, the question of therapy arises. Is surgery really necessary or does the treatment still work manually? There are indicators that surgery is necessary.

  • No success with conservative therapy.
  • Severe, nocturnal pain.
  • Chronic numbness in the affected finger.
  • Decreased nerve conduction velocity.

Procedure Of Surgery For Carpal Tunnel Syndrome

Although the term surgery is initially frightening to most patients, carpal tunnel is quite easy to operate on. In most cases, general anesthesia is not necessary, and the procedure is performed on an outpatient basis.

The treating surgeon first cuts the carpal ligament. In addition, the tissue responsible for the constriction of the nerve is removed from the tendon compartment. As a result, the nerve is no longer constricted and the tendons can recover.

In many cases, the surgery is performed endoscopically, leaving hardly any visible scar. If open surgery is necessary, the incision is made in the palm. Due to the structure of the hand, the scar is hardly visible later.

After the operation, the patient is still put on a splint for stabilization for two weeks. The pain disappears immediately after the operation, only the sensory disturbances can last longer. If treated very late, sensory disturbances may even remain forever.

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