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Carpal tunnel syndrome

Carpal tunnel syndrome is a frequent and often neglected condition that causes irreversible damage if not treated promptly. It occurs in adulthood more commonly in people aged 50 and up. It is estimated that nearly one in 20 adults in Canada has it. It affects both men and women, but its frequency is 4 times higher in women.

It occurs when the median nerve that passes through the wrist is compressed in its channel, the carpal tunnel. Compression affects the sensory and motor function of the hand, which can cause numbness, pain, and the inability to perform certain movements. In the majority of cases, the disease is bilateral, meaning it affects both hands.

What causes carpal tunnel syndrome?

Several causes can be at the root of the problem, including repeated bending movements, hormonal imbalances, a structural or bone anomaly, or certain chronic illnesses.

Diabetes, smoking, pregnancy, osteoarthritis, hyperthyroidism, excess weight, menopause and radius fracture are among the most common risk factors.

What are the symptoms?

The main symptoms of carpal tunnel syndrome, in order of appearance, are:

  • Pain or burning sensation in the hand, fingers or forearm. 
  • Numbness and tingling in the hand, especially in the thumb, index and middle fingers.
  • Symptoms get worse at night.  Night awakenings. Need to shake hands.
  • Worsening of symptoms with manual activity or driving.
  • Swollen feeling in the fingers and hand.
  • Weakness, clumsiness and loss of dexterity.

Answer all the questions and you will receive our free guide, Self Help book for Carpal Tunnel syndrome: the essential guide to a quick recovery.

1. Does your work or personal occupation cause you to perform repetitive manual actions? ( Question 1 / 15 )

2. Do you suffer from numbness or frequent tingling sensations in the palm of your hand or in your fingers (especially thumb, forefinger and middle finger)? ( Question 2 / 15 )
3. Do you feel tingling and numbness especially in your thumb, forefinger, middle finger and fourth finger rather than your little finger? ( Question 3 / 15 )
4. Do you feel numbness or tingling in your fingers when you read a newspaper, drive a car or talk on the phone? ( Question 4 / 15
5. Do you feel numbness in your hand or hands when you raise them above your head? ( Question 5 / 15 )
6. Do you often feel a burning sensation in the palm of your hand or at your fingers? ( Question 6 / 15 )
7. Do you need to shake your hand or hands to try to relieve numbness? ( Question 7 / 15 )
8. Do your fingers seem swollen or clumsy, even if the swelling is not obvious? ( Question 8 / 15 )
9. Do the symptoms seem greater at night or on waking? ( Question 9 / 15 )
10. Have you ever awakened at night feeling the need to shake your hand to alleviate the symptoms? ( Question 10 / 15 )
11. Does splinting at night alleviate symptoms? ( Question 11 / 15 )
12. Do you feel weakness in your hand or wrist? ( Question 12 / 15 )
13. Have you noticed any discomfort or awkwardness when holding objects in your hand or trying to perform certain motions? ( Question 13 / 15 )
14. Do you have difficulty buttoning your clothes or handling small objects? ( Question 14 / 15 )
15. Do you have symptoms in both hands? ( Question 15 / 15 )

Numbness and tingling in the palm of the hand or in the fingers are usually the first signs of the disorder. These symptoms occur especially at night, or early in the morning, and often cause insomnia or nocturnal awakenings. Itching or burning pain is sometimes felt. Patients often have to shake the affected hand to remove numbness.

During the day, symptoms can be triggered by activities such as driving, prolonged phone use, or reading the newspaper.

With time and the progression of the problem, there is a loss of sensitivity, at first transient and then permanent, in the fingers of the hand. Affected patients lose touch and the sensation of touch, in the thumb, forefinger, middle finger and half of the fourth finger. Subsequently, when the condition becomes more severe, atrophy can be observed, which is a weakening of the muscles from the base of the thumb to the palm of the hand. A loss of manual dexterity and a decrease in the strength of the thumb-index pinch follows. It becomes difficult to manipulate small items such as coins or buttoning clothes. Clumsiness appears to the point of dropping pens and having trouble writing.

How to diagnose it?

The diagnosis is based mainly on clinical examination and symptom description. Various challenge tests, including the Tinel sign, Durkan compression test, limb elevation test and Phalen manoeuvre, can also be used to assess symptoms and measure the severity of the syndrome. The Scratch Collapse Test is very useful for confirming nerve damage. Electromyography (EMG) and nerve conduction tests are complementary tests sometimes recommended to provide differential diagnosis and to measure the severity of nerve damage. They also make it possible to accurately confirm the site of nerve compression.

All patients presenting with hand numbness in the area corresponding to the median nerve (major index thumb) should be examined not only for carpal tunnel syndrome, but also for compression of this nerve in the elbow, under the lacertus fibrosus. The scratch collapse test is a very little known but very useful physical examination manoeuvre for the diagnosis of nerve compression such as CTS or lacertus fibrosus syndrome.

Indeed, between 33 and 50% of patients with median nerve compression in the carpal tunnel also have a similar compression even higher, at the elbow and forearm. If this compression is not identified and treated, many symptoms may persist after carpal tunnel surgery. Ignorance of this pathology is a common cause of the failure of carpal tunnel surgery.

Non-surgical treatment

Beyond maintaining a healthy lifestyle and controlling chronic diseases, several measures can help to relieve symptoms.  Conservative management includes stretching and nerve movement exercises, night splinting, prevention of incorrect or non-ergonomic postures, and reduction or elimination of repetitive movements.

Wearing a night orthosis can be recommended for four to six weeks. If, at the end of this period, symptoms are still present or if signs reappear when the orthosis is abandoned, surgery is required. Orthotics are not a permanent solution to the problem and can, on the contrary, adversely affect the treatment protocol. 

Cortisone injections, preferably performed under ultrasound monitory, are sometimes performed for the purpose of temporarily relieving the pressure inside the carpal tunnel. They can also be used as therapeutic tests when the diagnosis is uncertain. These injections may mask the symptoms of compression. They should not be repeated to avoid the development of irreversible neurological damage.

Carpal Tunnel

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Relieve your pain quickly

Relieve your pain quickly

Download your free information kit

Information kit

How to ease your carpal tunnel syndrome symptoms? How to recognize trigger finger? What should you bring the day of your surgery?  

By Jean Paul Brutus MD 

Get your free guide now

Practical medical guides

Dr. Brutus offers a series of publications on a variety of health topics. Written in a clear and simple language, in collaboration with experts of various fields, these books are offered free of charge in downloadable version.

By Jean Paul Brutus MD and Nathalie Brisebois

Download your free information kit

Information kit

How to ease your carpal tunnel syndrome symptoms? How to recognize trigger finger? What should you bring the day of your surgery?

By Jean Paul Brutus MD 

Get your free guide now

Practical medical guides

Dr. Brutus offers a series of publications on a variety of health topics. Written in a clear and simple language, in collaboration with experts of various fields, these books are offered free of charge in downloadable version.

By Jean Paul Brutus MD and Nathalie Brisebois

Surgery

Two types of surgery are available when first-line treatment is not enough to improve symptoms.

The conventional or “open” decompression method involves making a 3-4 cm incision in the palm of the hand to cut the transverse carpal ligament and reduce pressure on the median nerve. This is the most common method in the Canadian public health system. Unfortunately, this method is invasive and unnecessarily sacrifices many structures interposed between the skin and the ligament that is the target of the surgery, which leads to a convalescence of several months.

Dr. Brutus favors a newer, less invasive alternative method called endoscopic decompression. This technique makes it possible to selectively cut the ligament using miniaturized instruments introduced by a mini-incision made in the forearm. The procedure is done in minutes under local anesthetic and usually does not require stitches. Unlike the conventional method, the skin and muscles of the hand are not damaged. The pain is minimal and the relief of symptoms is fast. This method also makes it possible to treat both hands in one session, which considerably shortens the convalescence period.

Endoscopic release offers significant comfort and productivity benefits. Because of its less invasive nature, it provides rapid symptom relief, improved motor recovery and a much faster return to normal activities.

 

Recuperation

Endoscopic release provides rapid relief from numbness and tingling. The duration for complete recovery and resumption of activities varies from a few days to a few weeks, depending on the patient. Recovery does not require rehabilitation.

Comparison between the two surgical methods

The average duration of work stoppage is 14 days for patients treated by the endoscopic method, compared to 32 days for patients operated on “openly.” The average time to resume driving is 3 days after endoscopic decompression, compared to 28 days with the conventional procedure.  In addition, scar pain is considerably reduced by the endoscopic technique, which limits the inconvenience associated with taking narcotic painkillers.

In general, the satisfaction rate among patients who have undergone endoscopic decompression is much higher. According to a study conducted in patients who had experienced both methods, 95% of them preferred the endoscopic method.

2- Learn more about carpal tunnel exercices and treatments

3- Learn more about carpal tunnel surgery

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It will be our pleasure to give you an appointment for a consultation and treatment in the next few days.




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