What is it about ?
Located on the inner side of the wrist, the carpal tunnel is a tunnel-shaped sheath that houses the nerves and tendons connecting the forearm to the hand. Sometimes the canal becomes too narrow and one of the main nerves in the hand, the median nerve, gets stuck in it. This compression can cause sensitivity problems (tingling, pain) or loss of strength in the hand and / or fingers. All of these symptoms are known as carpal tunnel syndrome (SCC).
Excess weight, rheumatoid arthritis, the diabetes, kidney disease, an underactive thyroid (hypothyroidism), a wrist fracture and pregnancy can trigger this syndrome. Carpal tunnel syndrome associated with pregnancy usually resolves spontaneously after childbirth.
Carpal tunnel syndrome can also be an occupational disease. Repetitive and forceful movements related to work, such as hammer blows, wringing mops (in surface technicians), vibrations and forced wrist positions are all risk factors for developing SCC.
How often and where do we find it?
In the general population, CTS affects about 90 in 1,000 women and 6 in 1,000 men. About one in 3 times the condition affects both hands.
Carpal tunnel syndrome is a condition that occurs more often in women than in men, especially in the 40-60 age group, but also often in the elderly.
How to recognize it?
Carpal tunnel syndrome is characterized by pain, tingling, and / or a feeling of numbness in the thumb, index, middle, and half of the ring finger.
At first, complaints increase in activity. After a while, they mostly occur at night. Often the symptoms can be relieved by shaking your hand. Sometimes the pain extends to the entire forearm. In contrast, tingling is usually limited to the palms of the hand and fingers, as well as the back of the fingertips.
At a more advanced stage, muscle weakness appears, mainly in the thumb. The thickness of the thumb muscle may decrease. Activities that require good coordination, such as tying a button, may be more complicated to perform. In severe and untreated cases, the abnormalities may become permanent.
How is the diagnosis made?
The doctor will ask you about your symptoms, examine you, and perform some tests to trigger the symptoms. Sometimes, your doctor will send you for an exam that measures the speed of the nerve impulse (electromyography or EMG) to confirm the diagnosis and determine if intervention is needed.
The severity of the abnormalities found determines the treatment you will have. The exam also helps pinpoint the spot where the nerve is stuck. It can happen that a nerve is compressed at the level of the vertebrae of the neck (cervical vertebrae) or the elbow.
What can you do ?
You can (temporarily) relieve complaints by making occasional hand movements, without putting too much strain on them. For example, you can flex and extend your wrists, clench your fists, stretch and spread your fingers, or shake your hands.
Symptoms usually go away when the trigger is removed, such as when you have given birth or your workload has decreased. Taking care of the professional factors responsible for physical overwork can be useful, for example by devising a technical solution and by reorganizing your tasks.
In mild to moderate cases, a splint may be worn at night to prevent flexing of the wrist during sleep. After 4 weeks, the complaints should have decreased significantly. If there is no improvement after 6 weeks, it is unnecessary to continue this treatment.
What can your doctor do?
Once in 4, the symptoms disappear without treatment in 1 year; once in 2, the symptoms change little and, once in 4, they increase1.
The general practitioner can give an injection of cortisone into the wrist. These injections can also be considered in the event of severe symptoms during pregnancy. If there is little or no improvement, you may receive a second injection after 2 or 3 weeks. If this injection does not produce more effect, continued treatment does not make sense.
Physiotherapy sessions may be offered to you because certain manual techniques have been shown to be effective and improve symptoms.
Surgery is indicated if the above treatments do not give any improvement, if the symptoms worsen, if the EMG is positive and, most importantly, if muscle weakness appears. The procedure involves cutting the carpal ligament under which the nerve is trapped. In advanced cases, the person may have to wait 1 year to recover their sensations and strength, or even never recover them.
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