Carpal Tunnel Syndrome Treatment

Carpal tunnel is a narrow canal in the wrist that allows the median nerve and tendons in connecting the hand and forearm. The median nerve gives sensation provides sensation to the thumb and fingers of the hand, except the little finger. 

Median nerve compression may lead to symptoms like pain, numbness, and tingling sensation in the hand and arm. Carpal tunnel syndrome usually becomes worse with time and, therefore, early diagnosis and treatment are necessary.

Causes: The various causes of carpal tunnel syndrome are:

1. Repetitive movements of the hand, such as using the keyboard or typing
2. Degenerative conditions, such as arthritis, rheumatoid arthritis, and osteoarthritis
3. Activities in which the extension and flexion of the hand and wrist are needed for a prolonged time
4. Repetitive grasping hand movements, such as doing certain sports or physical activities
5. Hormonal changes
6. Pregnancy
7. Type 2 diabetes
8. Thyroid disorders
9. Family history
10. Injury or trauma in cases like dislocation, sprain, swelling, fracture, and wrist inflammation 

Risk factors: The following factors may increase the risk of developing carpal tunnel syndrome:

• More common in women
• Nerve-damaging disorders, like diabetes
• Wrist fracture
• Wrist dislocation 
• Arthritis
• Use of anastrozole (medicine for breast cancer)
• Obesity
• Pregnancy
• Menopause
• Kidney failure
• Thyroid disorders
• Working on the laptop or vibrating tools for prolonged periods 

Prevention:
Carpal tunnel syndrome can be prevented by minimizing the stress on the hands and wrists using the following methods:

• Take frequent, short breaks while using vibrating equipment
• Avoid bending the wrist all the way up or down
• Use a big pen having an oversized and soft grip adapter, and free-flowing ink for prolonged handwriting
• Hit the keys softly if you need to use the keyboard for a prolonged time
• Use a computer mouse that is flexible and easy to use
• Improve your body posture
• Keep the hands warm

Symptoms

Symptoms: Carpal tunnel syndrome may have the following symptoms:

• Numbness in the wrists and hands
• Pain in the wrists and hands
• Weakness of the hand
• Burning and tingling sensation in the fingers and thumb
• A feeling of finger swelling, even though there is no swelling 

Diagnosis

1. Physical examination: The sensations on the fingers and thumb, along with the strength of the hand muscles are checked by the doctor. The doctor will inquire about the symptoms that the patient may be having, and the family history and medical history of the patient are noted.
2. Tinel’s test: The doctor will tap the median nerve at the wrist region to check for any numbness or tingling sensation in the fingers.
3. Wrist flexion or Phalen test: The patient is asked to press the back of the hands against each other so that the wrist is bent. If a numbing sensation or tingling occurs within one minute, it could indicate damage to the median nerve.
4. Nerve conduction study: The doctor will place electrodes on the hand and wrist. Small electric shocks will be applied. This test will help in measuring how quickly the nerves will transmit the impulses to the muscles.
5. Electromyography: A fine needle will be inserted into the muscle. The electrical activity seen on a screen will reveal if there is any median nerve damage, and if present, how severe is the damage.
6. Imaging tests: X-rays can help in checking for the presence of fractures and arthritis and ultrasound scans can help in checking the structure of the median nerve.

Treatment

Depending on the severity of the symptoms present, carpal tunnel syndrome may be treated in the following different ways:

1. Non-surgical treatment:

This approach is used in mild cases of carpal tunnel syndrome. The different ways of performing non-surgical treatment include:

• A wrist splint can be given to the patient to wear at night.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may help in pain relief.
• Corticosteroid injections help in relieving pain and swelling associated with the condition.
• Workplace environment modifications can be made, such as:

1. Movement of the computer keyboard
2. Changing the hand or wrist position frequently 
3. Raising or lowering the chair
4. Using heat treatments, exercises, and splints 

2. Surgical treatment:

It is performed in severe cases of carpal tunnel syndrome or when the non-surgical methods of treatment have failed. 

It is generally performed under local anesthesia (numbing the treatment area) or intravenous anesthetic (injecting the anesthesia directly into the vein). 

Surgical treatment can be performed using any of the following techniques:

1. Open surgery:
The surgeon first makes an incision or cut in the palm of the hand over the carpal tunnel.
The ligament is then cut through to free the nerve.
The ligament will gradually grow back together following the surgery, but the pressure on the median nerve will be relieved and the carpal tunnel will have more space.
Internal healing takes several months, but the skin on top will heal in a few weeks.

2. Endoscopic surgery: 
This method involves the use of a telescope-like device having a camera on one end, called an endoscope.
The surgeon will make one or two small incisions in the wrist area or hand.
An endoscope is inserted through one of the incisions to view the carpal tunnel from inside while performing the procedure.
Other small surgical instruments are inserted through the other incision to cut through the ligament.
This is a minimally-invasive type of surgery, which is less painful, has fewer complications, and has quicker recovery compared to open surgery.

Risks

If carpal tunnel syndrome is left untreated it may lead to the following complications:

• Weakness
• Lack of coordination 
• Permanent nerve damage
• Surgery performed for treating carpal tunnel syndrome may have the following complications:
• Infection
• Bleeding
• Delayed wound healing
• Nerve injury or aggravation
• Blood vessel injury
• Scar formation
• Incomplete ligament release

After Procedure

1. The patient is usually discharged on the same day after the surgery.
2. It is normal to have some soreness after surgery around the incision for a few days.
3. Heavy lifting or gripping strongly with the operated hand should be avoided.
4. The operated hand should be rested till recovery is completed.
5. The symptoms of numbing and tingling sensation will go away after the surgery and the strength in the hand and wrist will return to normal.
6. If the surgery has been performed on the patient’s dormant hand and the patient does not perform repeated hand or wrist actions at work, the patient can mostly return to work 7 to 10 days after the surgery.
7. The recovery period following an open surgery will be a few weeks, whereas, the recovery period following an endoscopic surgery is comparatively shorter.
8. Regular follow-up appointments with the doctor are necessary.

Home remedies:

The following home remedies may help in providing relief from carpal tunnel syndrome:

• Rest the affected wrist and hand for at least two weeks
• Wear a wrist splint or brace 
• Do gentle finger, wrist, and hand stretching exercises
• Use anti-vibration products along with vibrating tools
• Massage the palms, wrists, and backs of the hands
• Wear gloves when working to protect the wrist and the hands
• Heat application to the wrist helps in relieving pain
• Ice pack application may help in reducing the swelling
• Add extra material to the utensil handles and tools to get a more comfortable grip
• Use over-the-counter pain-relieving medications like ibuprofen and naproxen

Cost of Carpal Tunnel Syndrome treatment in India- 

The cost of carpal tunnel syndrome treatment in Mumbai is between INR 45,000 to INR 70,000.
The cost of carpal tunnel syndrome treatment in Delhi is between INR 40,000 to INR 65,000.
The cost of carpal tunnel syndrome treatment in Bangalore is between INR 40,000 to INR 65,000.
The cost of carpal tunnel syndrome treatment in Chennai is between INR 38,000 to INR 60,000.